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198 Primrose Rd 11 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT ' \� Account #: 989900025 Tax PIN/EH#: G9090D011 Billed To: Dick Anderson Construction Subdivision:Info, Marchwoods Lot#11 Reference Name: LocationiAddress: 198 primrose-27006 Proposed Facility: Residence Properly Size: 0.922 ATO T9§7uance of this Operation Permit shall indicate the system described on the ATC 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. System Type: S.T.Manufacturer OR Tank DatTank Sizej, q Pump Tank Size J System Installed By: E.H.Specialist Date: o? GPS Coordinate: r 3 151 DCHD 11/06(Revised) 4�8 j� Tax Map: 4 Address: 130 0, (, co �� Installer: .� EHS: . ps Date: 3-13-�a rnOperation Permit Inspection Checklist I z O t`i L'ocation and Separation Distances TT1. Distance from septic tank/pump tank to foundaf on/basement ' 11 feet 2. Distance from system to well if applicable /A feet 3. Any other setback(.1950)requirements /Ird cr-pS 3 Supply tine G�• 1. Material supply line is constructed of� (', diameterinches 2. Length of supply line(2'min.) ' 3. Amount of fall in supply line(1/8"per foot min) N 4. Distance from ST/PT to the nitrification field/dist.device) feet 2qCP Septic Tank/Pump Tank 1. Visually inspect top of tanks(s),interior&exterior walls,baffle wd bottom -30•(9' 2. Any honeycombing or exposed rebar present? Circle: YES or O 3. Visually inspect sanitary tee,lids,and air vent for proper installation and sealant -1- Z Grp 4. Tank Serial Numbers:STB 7W PTW A 5. ST Win 6"finished grade?Circle: YES or NO 6. Date of manufacture:Si ( 271�J PT 7. Liquid capacity of tanks ST PT 8. Effluent filter type e u lS 9. Pipe penetration seaf pres t?CirYES or NO 10. Riser(s)present?Circle: YES ok_V Riser Type 11. Pump Tank riser 6"above finished grade?Circle: YES or NO 12. Riser approved?Circle: YES or NO Nitrification Field 1. Septic Tank outlet elevation 2. Trench Depth Readings(inches) 3 3. Number of Trenches Distance between trenches D.e... 4. Trench Width 5. Aggregate material type - and size 3 4 5 6 57 (Circle) 6. Aggregate Depth(inches) 7. Nitrification lines installed on contour?Circle: YE2tified NO 8. Innovative system type Insta for installation?Cir NO 9. 2'earthen dam between ST or d-box)and beginning of nitrification line?Circl :YES o O 10. Stepdowns NIA a. 'undisturbed earthen dam(s) Circle: YES or NO b. Proper rise over stepdowns?Circle: YES or NO c. Solid pipe used? Solid,Corrugated or other? d. Elevation of each stepdown e. Are all stepdowns lower than the ST outlet elevations? Circle: YES or NO Distribution Devices 1. Type Is the device watertight? Is it level? 2. Distance from Dist.device to trenches feet 3. Record elevations:Inlets Outlets 1;ILL r d DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mock§ville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900025 Tax PINIEH#: G9090D011 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#11 Reference Name: LocalionfAddress: 198 primrose-27006 Proposed Facility: Residence Property Size: 0.922 Site Type: ❑New ❑Repair ❑Expansion ATC Number. 5857 **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms #Bathrooms #People_Z Basement❑Basement plumbing❑ Non-Residential Specifications: Facility Type - #People #Seats Square Footage(or Dimensions of Facility) Lot Size _qZQG Type of Water Supply: &ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater'Flow(GPD) Tank Siz4mo GAL.Pump T GAL. Trench Width 36i r Max.Trench Depth;y Rock Depth Linear Ft. ( o2c Site Modifications/Conditions/Other:_ Ud h Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. C;V7) ti r /7�J { - Environmental Health Specialist Date: ( DCHD 11/06(Revised) Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account M 989900025 Tax PIN/EH#: G9090D011 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot# 11 Address: 225 Wing Haven Lane Location/Address: 198 primrose-27006 City: Mocksville Property Size: 0.922 Reference Name: Propos&R0i §gfvwvment Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: RNew ❑Repair ❑Expansion Permit Valid for: 195 Years ❑No Expiration Residential Specifications: #Bedrooms 3 #Bathrooms 5- #People 2 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):36rO Type of Water Supply: XCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial Repair 2,55 lc , Site Plan r t J: . * :) Environmental Health Specialist Date mid,# i.p.11-06 Dec 06 11 09:18a Information Services 3367531680 p.1 VE APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC DEC 2 Davie County Environmental Health t 20 I P.O.Box 8481210 Hospital Street �Yf Mocksville,PIC 27028 - (336)753-6780/Fax(336)753-1680 Application For. Site�uatnonAmprovement Permit 0 Authorization To Construct(ATC) O Both Type of Application: a New System DRepair to Existing System OE.xpansion/Modiftcation of Existing System or Faciliry •••IAWORTANT••s THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE-REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name 'b ' 1 _7 ) Contact Person G Address -') ` r Home Phone 37 l� 3 — City/StatelZlP AVIf;C /J Ve 7P1 Business Phone Name on Permit/ATC if Different than Above Mailing Address City,'State/Zip PROPERTY INFORMATION *Date House/Facility Comeis Flagged 2 Z NOTE: A survey plat or site plan must accompany this application. Included:0 Site Plan OPlat(to scale) i (Permit is valid for months with site plan;no expiration witli complete plat.) Owner's Name 1 6 KI Phone Number-g&. Owncr'sAddress f+' City!State/Zi f!1(1LIC5(l/1� �— 70 Property Address t City W ' (. LotSi=O,. 922 Tax PIN# S 2 (. o I Subdivision Name,(i�f.,a�pppl��icable) ?' a Section/Lodl �1 �G yt �P Directions To Site.- 'S t'D (SIS T�i 6 rgj /7LWI ,,hep O R .PRI MR!�SE 0 lfthe answer to any of the following questions is"Y es",supporting docum�rrtation must be attached: Are there any existing wastewater systems on the site? Yes /Ng. Does the site contain jurisdictional wetlands? Y%s _jlefo Are there any easements or right-of-nays on the site? /Yes N . Is the site subject to appro-M by another public agency? Yes Will wastewater other than domestic sewage be generated? Yes No IF RESIDENCE FILL OUT THE BOX BELOW IN People _ / #Bedrooms #Bathrooms_� Garden Tub/Whirlpool es 17-No Basement:OYcs 010 Basement Plumbing: OYes ONo IF NON-RESIDENCE FILL GTT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation_of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: onvcntional OAccepted Chmovative OAtternative-OOther Water Supply Type:l3'County/City Water O New Well OFxisung Well b Community Well Do you anticipate additions or expansions of&.c facility this system is intended to serve?C Yes 3'No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permil(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and Iota nd flag • or stakin the house/facility location,proposed well location and the location of any other amenities. ' Pfoferry owner's or owner's legal rep-rescQlative signature Site Revisit Charge ! D q n 0 O OZ6 li-Z J // Client Notification Data: Date EHS: ZOgIED R—A / LOU ELLA HOOTS ANGELL _ E PLAT BOOK 7, PG. 124 m ; LOT /22 \ ZONED R—A I d, •vtM LOT 023 : ti of si mu I 1 j t I � � MARCH WOODS PHASE II / PLAT BOOK 7, PC. 145 t'p R ZONED R—A oq / \ LOT #27 17 EMENr L0T 1 C61 a W= W / f1Y9T1WIWM1f \ t 1.802 AC. •Noc N / LOT #28 LOT 2 � x / \ 1.634 Ac. LOT 3 1.670 Ac. , / 0 fp4 20 os / / \ LOT /29 / 2m. / / \ LOT 4 1.816 Ac. ' LOT f30 \IN, / / \ LOT 26 \ 0.746 AC. LOT #31 IN, LOT 5 / ^v Ai;, IN, 2.448 Ac. Z O \ 0.697 Ac. ?4�,r LOT J32 \ � LOT to \ \ 0.945 M. / \ ` 05 LOT /33 LOT 24 a LOT 8 \ = 0.705 Ac. / "t•t , 2.556 Ac. a Ila, LOT LOT /34 ` / / LOT 15 1 �� LOT 23 0.784 AC. 0.690 Ac. 1 4"a LOT 13 a 0.747 Ac. 1 O " k � LOT X35 ��� "4•y LOT 7 X LOT 222.115 Ac. AC. LOT 0.692 . 19m.m1 / LOT 18 ` t LOT #36 p'•, 0.697 Ae. LOT 12 1 1 'fib 0.728 Ac. M•rr�!N' LOT 21 0.705 AC. M sv.,r• M n,a. +' 25L99 \ LOT 17 IN, .>0 0.703 Ac. m.•�rll•V LOT 11 0.922 Ac. LOT 8 7 LOT 20 "' ,� �P� � 2.437 Ac. 0.812 AC. � � 1 LOT 18LOT 19 \ 0.789 M. LOT 10 RR L CDRNER 0.707 Ac. // 1.032 Ac. L R LOT 9 '• .yy 0.920 Ac. BARB N 84•08.3!•Y 8 D.B.10 2�tn Al 211. ZONE 0298121•Y M+mN TRACT 3 300.031 I N 86 09.2•v °p arow+,m a TRACT 4 I I 41133 HIDDEN MEADOW TRACT 5 BBAD.BRBARA K.'70PMORGA2N PLAT BOOK 7. P0. 238 ZONED R—A ZONED R—A I i' a •_~-•� (J i RI q V.� IZ Rf t s f i 3 1 3 v c 6i GJ V.7 4l ; -r+rt- m A,%;rS rinw t r:� Qi I JJ9 JJo r�r�+ N, s -- -----.. -- _.....---- --- •-- - -- APPUCA1111Y FOS SITE EVALUATION/IMPROVEMM PERMIT&ATC NYie Coynty Health Department Env%/vnmenta/M021W sec:6017 P.O. Box a4e/210 Hospital Strout ' 11964ayi314. NC 27029 (336)751-8760 eeeZNPDRTAVT•e• THIS APPLICATION CAJM=HE Pl:OCSSSED MV=S 1L±L TRS V==RBD , INPORI1&TIO1i ZS PRDTZnvn.. Refer to the IrtP+OB M=DN MVWMIN for instructiooun.,,ems , ✓s. Mese to be allied / A"Lq&:Gf�/���ST (�tont.e6 s.s.on /��,�L t'7N�CT�C.II dA) a,fr.lilMj tlddress _S_L(J /-A/ Virc.io rboo. 9;l-7577 ✓city/suta/LII /Y]n��s✓I[�E• d1�. .17o1$ t-1.ioss.ph.. 7.178 Y 2. tr...,oo tate;t/ATC sf o .art than Above M.11l.q Morass City/state/alp r-3. Applleatson For; x1lits 1Z7aluation ❑Iaprovrmeat hermit/ATC O Both ,—t. or.%—t.S.■.Le.,ffIIouae M Mobile Boma (7 Business C1 Industry O Other _4. T39e ayste repuestod. Q coo-ontional (9 eoova.tlo.al agdlfled Q lmwetlw rt. If kosidances t People r Hedrocow •Satbroome •1 idDistraalrr t'lwrl�.a.Dlasa.al ukLp lueWe i]Duewt/p3uesleg i�suar.t/».pl..bley !. I1 awloss■/Industry/ether.- wrlry type t People I slake I Co.eadsv a f]or.rs I Urinals a Mater Coolers Ir 1rWDSt1RYICS: A so4�te lstim9t.d Mate; IIpagj (yla]l.. per dry) ..—/. Type of.rater supply, Gl un-y/City O well tJ Community s. Do yc.,entlelpate addltlaal ar expanriatn of the Inanity this System is intended to serve?13 Yes ofic, J Ifres.+vhatl ____ L1ftOBTittYl"1e Cl IENT.i MUSrf17 Pf t.'PE THE REQUIRED PROPERTY INFORMATION REQUESTED 8E22ff,.El1Iwr2PL.ATorSMPL raESU3MrTEDb Theellent M1thTHIS APPLICATION. L--Yroperty Dimensions: S V9' 6-,e�RITE DIRECTIONS(from Morksvlite)to PROPERTY: _Property/Iddrem 992dName f'h:0Pe-A!r:S 1Cf2lff4e/ep Citylzip f in a Subdividen rovlde Informad:ut as fallowr. Nmne: IMq/zCFI L1124 c RMS6 4 Seaton: Block Zot: e.Ifate hotue eorarrs Bagged: 12A6t125� FdC 6 TUN is to certify that the Information provided is correct to the best of my knowledge.I understand float Bay permits) issued hereafter are subject to suspension or revocation,If the site plans or intended use change,or if the information submitted In this application is fabTified or changed.4 alio,tn!Iu7rQadrhet Jmq retpdnsr7ffgjorall ELarra incurred from tkis opplicatlom I,hereby,give consent to the Authorized Representative of the Davie County health Dcparttntal to eater upon above described prvperl:•located in Davie County and owned by to conduct all titin;procedures as accesmry to determine the site sus i DATE _a.3-O S —SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Eaistin:and proposed property tines and dimensions,structures,setba"and septic locations). Site Revisit Ctrarte Datc(s): Client Notification Date: EHS: Sign g(vtn hZ Account No. Revised DCIID(QSl03 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INEORIV�ATION_ PROPERTY INFORMATION 5 Tax PIN/EH M 5789-97-0344.14 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#14 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Rsidence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 #�[ Landsca aposition Slope% !� HORIZON I DEPTH O- C7- 2 Texture groupL L- S4- SCt Consistence S �� Structure _ ^✓' Mineralogy � f %I HORIZON 11 DEPTH "Z �-2 12-3,( - ©13 el Texture group2 Consistence CIV F.CIV FO Structure u"eG Mineralogy HORIZON III DEPTH 2- Texture group Consistence Structure r Mineralo S : .( 1;( HORIZON IV DEPTH l0 Texture group Consistence �S Structure Mineralogy SOIL WETNESS 75 1 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ^ AA L LONG-TERM ACCEPTANCE RATE O. , Q', SITE CLASSIFICATION: w> �-V_AL3 EVALUATION BY:=—o LONG-TERM ACCEPTANCE RATE: oOTHER(S)PRESENT: REMARKS: J 04Y JhEd &CIZ &V" C07 21 LEGEND �`nI7� 1i9Q XAln/ 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 slop Gtr Textur 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. 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Refer to tho INFOBl0.TION Bt7U== for instructions. ✓l. uaa. to be bill.. / R'AAlel5leSad COVSI.Le-C euot.ct r.cwn D[aC�iVG��'-8dst� ✓rralllry Aedr..e 5 UljZ&=dyA +ZW 4n1 clt7/3teta/Zxr- /YIAr•,t�-st//ct.E- ill<. �?DJ$ t�aaln■s■anon■ �tq&-7.P.7q T. gree.oa,OtsLt/AI'C it o • rent tbm Above sr.ill.q addrw ctcylscace/tip rI. application For: x3its I.lraluation 0 Ixprovosaent Rermit/it.TC 0 Both fit. Vy.tu t.8..ele.,)(II0rue 0 Hobila Soaso 0 Sumineae Cl Induatry 0 Other --s. Type.7sto rapo.stad. a Cowantlooal 0 eoo..atioaal oodltt.d 13 s•awersw .—s. If X/eesidences /Peopla 1 Bedrooms _ f Bathrooms •r hlQDiaawsMr (Swrl.y.Dls0anal uktaq IteaWe ❑lasar■t/Pluab4ag Da.eese.t/.ss 7l•abl,.q !. It Susanoss/Ioduetry/Gtbsr, verify type t 7.0010 1 Stake I Conrad" a Eh ca I vrl■als a/tater Coolers IP rOODSERVICEr. M�Soatt• litim9tod Nato; troagr tyalioas Per d.y) --4. Ty"of"tar Supply. L(County/City 0 Well Ll Coamuaity S. Do leu ■oticlpate addition&or expansions of the raolity,this system is intn.dcd to serve?f]Yes 01go Irycs,wbatt ' L4f4F0lt7AN7— Wt7Yt`iMUSTfl7 PCE7ETH IREQUIREDPROPERTY IctiORMATIONREQUESTED S ElrheraPLATerSri'GPL .pryTBESUBMITTEDb tAedient srithTHIS APPUCAT10N. fil troperly Dimensions: S I i 6GP�RITE Dumcrtotts!from Mo ssvm)to PROPERTY: Tax OIGee PIN: p78 '� ./ 158 TL) _-XroperlyAddrvs; RSadName f-40P4'e-S C/tAe4ze/ZO ah'tZiPVAz C,'--- f to a Suhdhpirlon rovlde laformatlla,as follows: Name: magxy ll/2Re /7j4SE 4 Seerlon: Block: IAr:J. e+D"ate home comets flagged:_62- Q-1r'26'2 Fan- 42e&/76r of This is to certify that the iafornastion provided is correct to the best of my knowkdre.I understand that say pCMIR(s) issued hereafter are subject to suspension or revmfloo,It the site plans or intended use change,or if the infornsation submitted In this application is falsified or dsanrtz! I,s/so..mdcrrland/herJ a!q respenst6lgj0r ahreharres incusrrd from tAis app/Icarlon. I,hereby,give consent to the Authorized Representative or the Davie County Health Dcpartmtnt to enter upon above described propertr located in Davie County and owned by to conduct all testing proccdures as accessary la determine the site sni n i L--DATE ^GZ. 512 -O S a-STGlVA7UItE - THIS AREA MAYBE USED FOR DIt,kWI11C YOUR SrM PLAN(Include all or the following: ExWing and proposed property lines and dissensions,struetutws se(backs,and septic locations). Stte Revisit Clsarre Datt(s): Client Notification Date EHS: Sign given Aeeount No. Agvised DCHD(05/01 invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION ccoun 5 Tax PIN/EH#: 5789-97-0344.11 t:.r Billed To: Dick Anderson Construction Subdivision Info: . Marchwoods Phase 4 Lot# 11 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 3141,E Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit '� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH - Texture group :5c- - Consistence S Sse Structure Mineralogy HORIZON 11 DEPTH <t< • Z Texture group G C_ Consistence V. Structure Mineralogy5� HORIZON III DEPTH Texture groupS i C Consistence Structure Mineralogy HORIZON IV DEPTH Texture group c ; Consistence S Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ID• SITE CLASSIFICATION: Ps EVALUATION BY:— -� r� LONG-TERM ACCEPTANCE RATE: d` 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 Dist . VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Met 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-Prisrpatic Mineraloev 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/112