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179 March Ferry Rd Lot 30 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section o,. 1?-0l P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5789-76-5851.30 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#30 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2788 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths Dishwasher Garbage Disposal Washing Machine: Basement w/Plumbing:❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People(/ #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply C O Design Wastewater Flow(GPD) Site: New❑ Repair❑ System Specifications: Tank Size IMD GAL. Pump Tank GAL. Trench WidthT Rock Depth Linear Ft`176)0 Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6 K BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: X,Tr Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900025 Tax PIN/EH M 5789-78-5851.30 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#30 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2788 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA ONSTRUCTION IS V ID�OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: lezel Date: DCHD 05/99(Revised) ► APPLICATION FOR SITE EVAI1JATi0N/IMPROVl3AEN1 PERMR&ATC IE ow IE ' Davie County Health Department D _ Envilronmenfit/Hea/0 Seefon P.O. Box 848/210 Hospital Street [)EJ; 71999 Mockeville, HC 27026 (336)751-8760 #**Z1�t7RTAHT*** THIS APPLicnION cmmm BB no== UNLR88 AIZ = RRQOIRRD XIMPMIITIOH IS PROVIDRD. Rater to the INrORHILTION BULLRTIN for instructions. 1. Masa to be Billed /C/l 14�y,Cff_�2beN �n�S�" contact Person D1C1e/7AfV0,�07J Wiling Address c;A:5 (it/f,)G.14AV W L/✓ i acus phos. q9A— 7 57 9 City/stab/sza A Oc1Cs V/t.L-e, N. C• Q 70.t.ESwm9 Business "Zona 76. 7-'7:E 1. Meme on Persiit/M it Different.than 7►bove Failing Addrems City/stab/sip !. Application For: Site =valuation 0 Improvement Permit/ATC 0 Both e. systen to service: House 0 Mobile Home 0 Business 0 Industry 0 Other a. If Residence: # People # Bedrooms IMPSr-La/ 3 # Bathrooms Dishwasher ) O"Zbage Disposal \V"bing DPaobina 0 Sas'easn�t/pltmm%4nQ 0asu Sant/No plumbing 6. tf Business/taduatr:/otberi specify `type # woopla # sinks # coasodes # showers # Urinals # water Coolers It I=SZRVICS: # Seats Ratimated Water Usage (gallons per der) 7. Type of Water supply: (County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the faeility this system Is Intended to serve? 0 Yes �No If yes,what type? ***IMPORTANT***CLIENTS MflST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESVBM 77'ED by the client with THIS APPLICATION. Property Dimensions: AM&>e e21-a A 4 ex lB WRITE DIRECTIONS(from MocksAle)to PROPERTY: Tax Office PIN: # S7 SS ! 76—s��1�y) � C/O 7-D 2'01" Property Address: Road Name &AeelC 4 - GEFT (/-1 M L6 7-D City/Zip #Mto)j U%"-m- If in a Subdivision provide information,as follows: /riA� G q • Name: ) A2G14 W Ob O.5 P�4A2EL/ 98 Section: Block: LAM1 0 Date Property Flagged: This is to certify that the Information provided is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation,if the site plans or intended we change,or If the Information submitted in this application is falsified or changed. 1,also,understand that l am responsible for all charges Incurred frons this applicallom I,hereby,give consent to the Authorized Representative of the Davie County Health Department. to enter upon above described property located in Davie County and awned by to conduct all testing procedures as necessary to determine the site-nitsbillft. DATE /-2 -) y 9 9 SIGNATURE 9P�JZZ'l." d.--- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge �► Date(s): Cil nt Notification Date: EAS: Account No. O`20 Revised DCHD(07/99) Invoice No. /a�'( • iN -�6 t WC 140' J 4Z - L 43 t 451 - 4 110' ` _J Iz� 10 J EGD J - v n X 05 CA 4 �` DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900025 Tax PIN/EH#: 5789-76-5851.30 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#30 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: JI y10 Water Supply: On-Site Well Community Public 1/ _ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position ,L Slope% L HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence i Structure Mineralogy / HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONGTERM ACCEPTANCE RATE i SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: l OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD 05/99(Revised)