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199 Primrose Rd Lot 8 Y� •• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002285 Tax PIN/EH#: 5789-97-0344.08 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#08 Reference Name: Location/Address: Peoples Creek Rd.-27006 Pro osed Facility: Residence Property Size: see map ATC Number: 4475 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: (W 4 6 /U O 7 41-00—d 7W 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,"b t shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. LikP a/ 15 � rGGtSJ � U Septic System Installed By: Environmental Health Specialist's Signature: 4 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 �� IMPROVEMENT/OPERATION PERMIT t� Account #: 990002285Tax PIN/EH#: 5789-97-0344.08 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#08 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4475 **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: 210"" Garbage Disposal Washing Machine, Basement w/Plumbing-Zlr---�Basement/No Plumbing:❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply .Design Wastewater Flow(GPD)c--T-A6 Site: New❑ Repair❑ c/ System Specifications: Tank Size��iAL. Pump Tank GAL. Trench Width Z Rock Depth /67 Linear Ft7eya Other: As stated in 15A NCAC 13A.1969(5) Required Site Modifications/Conditions: accepted Systems may also be used INIPROVENIENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"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.**** a-P JQd Environmental Health Specialist's Signature: Date: t/ DCHD 05/99(Revised) MAP • APPUCAl10N FOR SITE EYAUTATION/WPROMMW PERMIT ii ATC Davie County Health Department —OT Eavlzvnmenta/Hca/tlrSectioa B.O. Box E45/210 Hospital street )4oc4avi114. PC 279313 (336)751-8760 e••ZCDORTAN7 -- 2825 APPLICATION CAW=BE PROCESSED MVXSS ALL 1758 Ritp4IRRD , INP =LTZW IS YSDv'Xn=.. Refer to the/.XN70HaGITZON BDLIMIlt for instructiono. .t wants wa . to be sllla, ( /'�}��11//Zt=��o/�64)S T-�.1/1G(�e—t.ct to.— LD/Cle�iV,�/�.8 dA) a/Y.11l.g&mroee Wi.1/r �✓f..0 Lam! v,ro.a rho, e/92-75'79 ✓cltr/ototomy [yl6[:4,--„gt/ict.E at! a70J$ —'aa.la•ss none 7.'L747 '--2. tie•oo p•culc/AIC xf •r•rt than Above Nallt.it aGdrw 'C.Lty/state/LSD Application fors Site IZra111atioa LX Ixprwenent Permit/ASC X O Both ,—s. sy.t•.la Sea-Leo,x3rouae M stabile ilio 13 suaineie CI Smdu&try 1V3 other ,,..i. xl'D•q•tea repu•ated. a eow•ntlonal C3 coo-oatloaal modified to lmovaclw mss. If kowidence,�/a Aovpla � a Sedrocme _ a Bathrooms w 1 PolalaMr L' —bog*DLDe-al wook"a kaaW ❑tasawt/Pluebteg 13wa••r•1/SN pl—bi.9 1. it awla.../ladastry/other: vrlfy type a D•oDle a slake a Goosed•& a r:weora a uncal. a Watar Coolers IP T00DSXXVZ N. d Beata W--ter t7&agv (yalieea Par dry) "—a. Type of.rater avppiy, a-saun:y/City O well ❑ Caumnaity S. m You antlelpate additions or expansions orthe facility this system Is intended to serve?E3 Yes 0To IfytY,trhatt _ ____ Dfroiz itM"•CI.iom dodo nETE THE REQUIRED PROPERTY INFORMATION REQUESTED ISEBlthtraPLATersrm L rBESMAftTrEDb tbeeltent with THIS APPLICATION. Lf Properly Dimensions: !If� RETE DIRECTIONS(from mocksvtmc)to PROPERTY: *Tax once M. a 799 Y763 LAI/ .1 o IBB M -vt S ' ZZ) P11 6 G'-s C-Ze -< --JProperly Addregr; Road Name !�ClJPL S C2FFL�/Zy Cuymp 40VA,v C6 AZ C x270,ZC f in a Subdivldoa rovide harormatlln,as falleivs: Marne: A14R AI&&Q4 C. rH/45� Section: Block: tat: date home eoraers Ihggcrt: 17.A&&'49 o4ZW 02ex•7"L.C. TLis is to certify that the Information provided is correct to the best of my knowledge.I understand that say permit(s) issued hereafter aro subf ect to suspension or ftvocattoo,If the site plans or Intended use change,or if the hnfarnsation submitted In this appllotloa is falsified or chantnl 1.s/aP, fncarred from ibis appiicatlaa I,hereby,give cement to the Authorized RepresentativC orthe Davie County health Department to enter upon above described properh•located in Davie Coumty and orcned by to conduct all tasting procedures as arc.Yaarr to determine the site sul v.DAT �l 'cZ.�i- S '-SIGNA7UttE -r.la�t�l THIS AREA MAYBE USED FOR DItAWMC YOUR SITE PLAN(Include all of the relloning: Existing and proposed property Gan and dimensions,straetuscs,setbacks, and septic locations). Site Revisit Ciarge Datc(s): Client Notification Date. Sign givenAccount No. Z Revised DIMI)(OSl03 Invoice No. .444f qw-i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION ccoun 5 Tax PIN/EH M 5789-97-0344.10 Billet)To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot# 10 Reference Name: Location/Address: Peoples Creek Rd.-27006 . 'Proposed Facility: Residence - Property Size: see map Date Evaluated: 3 �- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit - - Cut FACTORS 6 2 3 4 5 .6 7 Landscape 2osition Slope% 2 HORIZON I DEPTH O 4P Texture groupt/ Consistence N54C�34— Mineralogy HORIZON II DEPTH Texture group C- Consistence - Structure S k Mineralogy HORIZON III DEPTH 19 3 -4 Texture grou4S.9' Consistence r Structure Mineralogyr1C HORIZON IV DEPTH 4f 3 Texture groupCSI Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION =- #4 LONG-TERM ACCEPTANCE RATE O SITE CLASSIFICATION: 05 moi✓ 10 SAO" w/ it EVALUATION BY: S=)��q= � LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: �t-' � S v�^csv StTL 1rJ P1UcS � } LEGE D 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 Tcxture 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 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-Pristpatic Mineral= 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