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204 Old March Rd Lot 67 Y- -• J • DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street 3 Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5789-79-5851.67 Billed.To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#67 Reference Name: Location/Address: Old March Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4797 **NOTE**The issuance 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 ken as;guarantee that the system will function satisfactorily for any given period of time. 4 c� System Type:S.T.Manufacturer Sa Tank Date ! Tank Size ,oaD Pump Tank Size -fel-dj7 � System Installed By: �� E.H.Specialist: 1�YJ V`'� 12Gj Date: V p all NCW a � O� DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital'Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751--8786 V � s AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 989900025 Tax PIN/EH#: 5789-79-5851.67 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#6T Reference Name: Location/Address: Old March Road-27006 Proposed Facility: Residence Property Size: see map ATC.Number: 4797 --// Site Type: 1�IVew ❑Repair ❑Expansion **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 IN Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO �C 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�Basementfa'$asement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 6 .IQ q Qtr-c Type of Water Supply: P16ounty/City ❑Well ❑Community Well y System Specifications: Design Wastewater Flow(GPD) JV Tank Size�6 GAL.Pump Tank ��GAL., Trench Width 3 01 Max.Trench Depth 3 Rock Depth�� Linear Ft. lyU A 5 y0 -e&I c I fo 2,1 Site Modifications/Conditions/Other: _ e tact the Da menti ection for final inspection of this system between c, 8:30—9:30a.m.on the ftboinstallation. Telephone#(336)751-8760. -------------- 2J n IMP r ev �� t CN OL r;F Tr 1 _ Environmental Health Specialistoe dc Date: ( � d DCHD 11106(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751--8786 V, AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �+ �4 Account M 989900025 Tax PIN/EH M 5789-79-5851:67 Y Billed.To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#67 Reference Name: Location/Address: Old March Ro6d-27006 Proposed Facility: Residence Property Size: seemap ATC.Number: 4797 Site Type: l3Klew ❑Repair ❑Expansion j **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 �b Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO �1t 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�BasementQ`9asement plumbing '-;�k Non=Residential Specifications: Facility Type #People- #Seats Square Footage(or Dimensions of Facility) G q`6 �. Lot Size � LLcr-c Type of Water Supply: F�ounty/City OWell ❑Community Well y • ti System Specifications: Design Wastewater Flow(GPD) H% Tank Sized GAL.Pump Tank A///#-GAL.f Trench Width 3(- Max.Trench Depth 3 f Rock Depth-&& Linear Ft. 47 0 a 5-*' 1. Site Modifications/Conditions/Other: -ed L-c i 7fCJ J tact the Da ' ection for final inspection of this system between C.- 8:30-9:30a.m.on the da o installation. Tele hone#(336)751-8760. Ir W Y r 3 �� j lv �IQ4 Y Poo f ¢- ' OL Environmental Health Specialist Date:-- d DCHD 11/06(Revised) Dick Anderson 336 998 7279 p.1 �AI'I'LICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT C� Davie County Environmental Heatjh P.O.Sox 848/210 Hospital Street Iilocksville,NC 27028 DEC 2 2001 (336}751-876W Fax(336)751-87816 Application For: Site Evaluation/improvement Permit C Authorization To Construct(ATC) 0 B th Type ofApplicatiorr OewSystemORepairmExisting Sys(etn CiExpansionModificationoMistingSyst or FacititPVi40Nh7Ef1TALH DAVIE COUN FJ�L?N ••"IMPORTANT'•'THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed -&G& AnlJo N 06vs4a. Contact Person -b,e k �43aI��SoN Billing Address ab!J gWo /ftAry&_A FWpE 1 Home Phone &7l lit&—I City/State/7IP Ad&/Api tr _ M e_r. 7_7&v&, Business Phone B 7Z39 Name on Permit/ATC if Different than Above Mailing Address Z W td; g6 L4 V G City/State/Zip iL(� �, Z?O Z PROPERTY INFORMATION *Date House/Facility Corners Flaggg NOTE: A survey plat or site plan must accompany this application. Included:O Site Plan OPlat(to scale) (Permit is valid for 60 months'zvith site pian,no expiration with complete plat.) Owner's Name D;&k Alen D Phone Number T ff J z 24 Owner's Address_ W)i<apb6c0avu oy City/State/Zip 7-20 Z11 Property Address W*dXd A4%%J._R+L City rod tJA VQ r_ -"Q- Lot Size Tax PIN# Subdivision Name(if��pppplicable) Ir t At Section2ot# &7 Directions To Sita: GLe-e a � lti� If the answer to any of the following questions is"yes".supporting documentation must be attached_ Are there any existing wastewater systems on the site? O Yes wro Does the site contain jurisdictional wetlands? Oyes(ritQo Are there any easements or right-of-ways on the site? Dyes PNO Is thp site subiect to approval by anothera e ?,,_0)Les VQ_, Will wastewater other than domestic sewage be generated? OYes•i3No IF RESIDENCE FILL OUT THE BOX BELOW *People .5 _ #Bedrooms #Bathrooms_ Garden TubA V*hirlpoot es ONo Basement:OWt:s ONo BasementPlumbtng: 'mss UNo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FatcilityBu3mcss Total Square Footage of Building It People #Sinks #Corrunodcs #Showers #Urinals Estirnated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:.JConventional ❑Accepted lllrinovative UAltemative OOther, Water Supply Type:t<ounty/City Water O New Well OExisting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to save?0 Yes w< 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 permit(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 orehanged. I hereby grant right of enlry to(he AuLSorized 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 locating and flagging or stat' e houselfici" Iocation,proposed well location and the location of any other amenities. Site Revisit Charge Proper owner's or owner's legal representative signature Date(s): 1 Z— !Z—"---)7 Client Notification Date: Date SHS: Sign given OYes ONo Account# I Revised 11106 Inrice DAVIE COUNTY ENVIRONMENTAL HEALTH /�QI P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900025 Tax PIN/EH#: 5789-79-5851.67 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#67 Reference Name: Location/Address: Old March Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4700 GO y O(off AA ct ec.�0 o a1 Site Type: ❑New ❑Repair ❑Expansion **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 J #Bathrooms 3 #People S BasementPf Basement plumbing❑ Non-Residential Specifications: Facility Type #People—#Seats Square Footage(or Dimensions of Facility) Lot Size 0 . C,3 a C J.e_ Type of Water Supply: Bounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)3G0 Tank Size 1/600GAL.Pump Tank GAL. Trench Width '56 _ Max.Trench Depth Rock Depth Linear Ft. q3 Site Modifications/Conditions/Other: As stated in 15A NCAC 18A.1969(5 Contact the Davie County Environmental Health Section for final inspection of this system"between 8:30—9:30a.m.on the day of installation. Tele hone#Q36)751-8760. CA I-e Ut- 7• -� of / - 5-rell C— lice to room 5 4 4 15-1 Sc _ o MiA Environmental Health Specialist ate: / ✓� DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account M 989900025 Tax PIN/EH#: 5789-79-5851.67 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#67 Reference Name: Location/Address: Old March Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4700 **NOTE**The issuance 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 Tank Date Tank Size Pump Tank Size System Installed By: E.H.Specialist: Date: DCHD 11/06(Revised) .run til u1 six: �� k��Rnderson _ 336 998 7279 2 p. t APP LICATIQ OR VALUATIONAMPROV EMENT PERMIT&ATC , 1 CC Davit Dusty EnvltonmenralHcaltll J�\► P.O. oz 848!210 HOSpital Street ksviilerNC2T0�8 1-876w Fax(336)7::1-8786 rt�CP' Application-4\1 �c ; etxoremeat_PmaiL._ Cl Authorizuton To CvAsmict(ATC) 0 Both Type ofAppliwu ery System i ltepair to Existing System OExpansior M"fication of Existing System or Facility, IMPORrAN7" 'nWAPPLiCrTR7N CAW0TB5PR0CF.SSED t M s S A<y OF THE REQUIRED INFORMATION 19 PROVIDED. Rsfer to the INFORMATION 6UL1 r.•rN for instructions. APPLICANT INFORMATION �NamrtabrBilled �C.�1.�1QC -5[71f ContactPctson bt Billing Address Z W a uCl��_A/ 1c6,utom, Horne Phone G 1- City/Sule/ZIP a '-to r_� rU�"L.7laz�-Business Phone Name on Permit/ATC ifDii ferent than Above Mailin Addrea city/StatefLip PROPERTY INFORMATION 'Date 110kneTacility Comers Flagged NOM AmoveyplatorsltepLmymstaccwq%my8tisappRatiea Imisded-l"SitePlan.Qrtat(toscale) . (Permit is valid for 60 months with site plat,no expiration with complete plaL) Ownes.Nante ZiCK A .c✓tOAl Phone Number b714((i '.S Owner's Aldress 2Z$ d; 'IMi titer k16 A #ZiP- Property Address 924pCi Lot Size,_ .1a -Are— - Tax PIN# _ SubdivisionName(ifa liwble) Scetion/Lut•# � Directions To Site: D 4 Sl t. ,yt _ v r_,t If the answer to any of the following gxstioas is'yes.supporting,documentation must be attached. Are there any cristing wastewater systems on the site? Dyes 6 tom Does the site contain/nrislic dooal wetlands? - rlycs-v?ra- Art that any tasemem of flog-of-ways on the site? ayes OW lathe site subject to approval by anotherpublic agency? Me$ONO Will wasct:wawtilheithan 6,mesdcscwagebegenerated?' CYmoNc-r- IF IMMENCE FILL OUT TIIE BOX BELOW _ t.People #Bedrooms It Bathrooms:�{- Garden TuNWbirlpoof UYes a. Basunent: es vivo B:tst:mcntPlarnbiag:*et UNo IF NON-RESIDENCE FILL CLT THE BOX BELOW Type of FacihtyBt3siness Total Square Footage of Building #People 8 Sutks lr Commodes B Showers _ 11 Urinals.- Estinated Water Usage(gallons pox day) (Attach do,utmcrrtation of similar facility water consumption) FOODSERVICEONL.Y:#Seats.. Type system requested•GGonvcntional JAtxepted Oknovativo OAlt=ative uOttur� Water Supply Type.tl u /Chy Water D New Well UE:;ist[ne Well C Community Well Do youaoticipatc additions orexpaw4oca of the facility this system is iamnded to serve?[I Yrs P"T_ Ifycs.what we _ This is to certify OW the infomration provided on this application is bne ardeorreet to-thebest ofaty knowled®e-Lemderstand that any permits)or ATC(s)issued hereafter are subject to soup tasm or rem Otao if the site is altered,the intended use changes,or if the ipf srhrtirttdiaOds app iwtion is falsified or chanted.I bemby gnat ri=ln of crtry to the Authorized Representative of the Davie County Health Delmommi to conduct necum"insptclIew to deren®e corWhaneewiibappkaw-Laws aacl tines. 1 enderstand that 1 am responsible foo•the proper Wcatifiation sad labeling of ptoperty lines anti corners and locutirtg and(laggiog ot-stattieg the Mwetfaatity lacatiakproposed well loratim and the location of any other amenities. Site Revisit Charge YropertyOwner's _ Datc(s): - Clicm Notification Data Date EHS'— Siga given oyts ONO Account @ gqq obo ZS' Revised 11106 Invoitt 1r / Dick Anderson 336 990 7279 p. 1 -- -- .; Y ��U/ ------ } DT 76.tits �-_ 27 1 ` �— S 29'46100, y '7jt� - ,JfFV NEW FRON 103.83 t CJ.p.0 iJ ► ► 1 I _ ► r A �� m _ of y :C zcEl� � t V6 z Cw So iv 33-p5D '48- 7AWA--- t its• -_ , 1 zy APPLICATION FOR SITE EVALUATION/IMPROVE&IENT PERMIT& A l� Davie County Health Department ly Q '� E!!virnamental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ��Y 5 2002 + (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL Z�X(J� UlTff INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instru�c/]tao d �/j 1. ame to be Billed �jL/C� �'Ti(11J��}d,,/ r-UL(1.$7 -Ldp c_ Contact Person t! 61- Mailing Address r ,� bV GA4 - 4t/E=oG/`A) Home Phone %tea- 7J 7 City/State/ZIP IyIL�JGB✓/C_L r_ �,C. Business Phone 7- 7 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC II Both 4. System to service: ((House ❑ Mobile Home ❑ Business L1 Industry U Other 1 5. If Residence: # People # Bedrooms -2)i # Bathrooms :) AI.- 11 I/11 Dishwasher ll Garbage Disposal LI Washing Machine U Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People 0 Sinks # Commodes # showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well II Conununity Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes U No If yes,what type? ***1A1P0RTANT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQU 'STED BELOW. Either a PLAT or SITE PLAN MUST BESUBMlTTED by the client with THIS APPLICATION. -7i�l410 , L)/6C 1 774/S1r Property Dimensions: TLS � � WRITE DIRECTIONS(from Alocicsville)to PRON'RTY: q Tax Office PIN: # 6-7 0 9-7`-.Srg �1 . Property Address: Road Name UG/Q /Yf142coy49 /-0 /749dFloyct' CAvy �fa/ City/Zip 40VA7)UCr 2.7006 LFAT o•uc`c If in a Subdivision provide information,as follows: 7.6 /y'JK Zc,y U/00/),5 0,01f;-- ! Name: 1 'I r4 PLP 6tL�90,01 Section: /i4 Block:N�►'g Lot: (0 Oate Property Flagged: i74 . This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permit(s) issued hereafter arc subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I,also,understand that I aon responsiblefor all charges incurred•%rrun this application. 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 owned by to conduct all testing procedures as necessary to determine tine site suita DATE J^ �o — C) c�i. SIGNATURETHIS AREA 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 Chr age Datc(s): Client Notification Date: EHS: Account No. Revised DCHD(07/99) Invoice No. O" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: - 989900025 Tax PIN/EH#: 5789-79-5851.67 Billed To: Dick-Anderson Construction Subdivision Info- Marchwoods Lot#67 Reference Name: Location/Address: Old March Road-2700 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public c/ Evaluation By: Auger Boring I Pit Cut FACTORS 1 2 4 5 6 7 Landscape position (� Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupe, Consistence Structure r Mineralogy HORIZON III DEPTH Texture groupCL Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON ./ SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: �f, `^O REMARKS: P� G(��v4� 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)