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208 S March Ferry Rd Lot 42 DAVIE COUNTY HEALTH DEPARTMENT -�5�� •.� Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5789-76-5851.42 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#42 Reference Name: Dick Anderson Location/Address: Peoples Creek Road 27028 Proposed Facility: Residence Property Size: 1 Acre **NOTE'S*Tliis�rnprovem0ent/Operation Permit DOES NOT authorize the construction of aseptic 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 ILI #People #Bedrooms #Baths _ Dishwasher: J! Garbage Disposal: Ef"'-'Washing Machine:0"— Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width<:O� Rock Depth/o� Linear Ft.c?60 Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 G°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: 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#: 5789-76-5851.42 Billed To: Dick Anderson Construction 'Subdivision Info: Marchwoods Lot#42 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2700 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 WASTEWAW CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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. ,od Septic System Installed By: Environmental Health Specialist's Signature: ,('y Date: e-6 :2L—a DCHD 05/99(Revised) APPUCATION FOR SITE EVAUTATION/IMPROVEMENT PERMIT do ATC r [S @ [E 0 W } Davie County Health Department D Entlionmenta/Heath 8ettfon P.O. Box 848/210 Hospital Street DEC 71999 Mookoville, NC 27028 (336)751-8760 ***nV0RTA M** THIS APPLICATION CST lilt PRO=MW U=88 ALL THa RIEQUIR>ZD Ii=MWXCN IS PROVIDED. Refer to the INr0ti1MATIO1l BU=TIN for instructions. 1. Now to be Billed ACIV 4"12446 6d 6qAJS7- Contact pereon I)/C1e-AArGA&-AdA) Mailing Address phone WA— 7 57 9 citr/state/asp 1RoC.lc-Aymt,--. A16• Q7o fr Business name 1999- 7-2-7f s. Itw an peewit/= it Different.than above Mailing Address citr/state/sip a. Application for: Site =valuation 0 Improvement Permit/ATC 0 Both e. systen to services VHouse 0 Mobile Home 0 Business 0 Industry 0 Other s. If Residence: f People Bedrooms 0'Y!_ d T- 3 Bathrooms Dishssasber �(QWx ge Disposal XUW Lng Machine O Bas--sVt/?1�J2Mb4nq O Basament/lto PlumbiaQ 6. If Business/Industry/otherr Specift tnm # people • sinks # Cosseodss + shossers I t:rinals i later Coolers It 3=8ERVICS: # Seats Rstimated (tater Usage (gallons per day) 7. Type of rater supply: County/City 0 Well 0 community 9. Do you anticipate additions or expansions of the 4eility this system Is Intended to serve? 0 Yes �No If yes,what type? ***IMPORTANT***CUENTS MUSTCiOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AfW RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: AA XV K A I-a A A C RITE 3IRECTIONS(from MockWile)to PROPERTY: 015 �yz O 7-D FSO/ �z Tat t7/ice PIN: F SZ 2'? 7 G S l� _/�� Property Address: Road Name ( 96,01C — 44,=r (1-Y I'YII Lf Y-D City/Zip MplP.M G )=M 3. U In a Subdivision provide Information,as follows: M40 G 9 Name: MA204 U)orsOs A wl qg Section: Bloch Lot: �� Date Property Floacilt This is to certify that the Information provided b correM 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 I ant responsible for all charges Incurred from thb 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 the site Wish DATE I•� l " �I cI SIGNATURE /✓ 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): Client Notification Date: EHS: Account No. Revised DCHD(07/99) Invoice No. Pd 3--7 -o v .,`J� 1- p L O i , J 149' t� V B . 40 , 120IZs' 47 00• (34 i t � J 74 1•7D� 0< OSl . j 16 f r � I `\ - DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH M 5789-76-5851.42 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#42 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: 2 I0 Do Water Supply: On-Site Well Community Public f Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position t_ Slope% (070 HORIZON I DEPTH - Texture groupL - .- Consistence S S Structure MineralogyI HORIZON II DEPTH Texture group Consistence Structure Mineralogy1: HORIZON III DEPTH I to-Z Texture aroupG Consistence Structure S Mineralogy HORIZON IV DEPTH Texture group Consistence Structure k Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S CLASSIFICATION LONG-TERM ACCEPTANCE RATE C SITE CLASSIFICATION: S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: �►C�E, REMARKS: ! �E3� Ot F�Dnti-C� Y� %oq_ LEG ND 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 Mois 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)