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114 Oak Hill Rd Lot 73 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . P.O.Boz 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900025 Tax PIN/EH#: 5789-79-5851.73 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#73 Reference Name: Location/Address: Old March Road-27006 Proposed Facility: Residence Property Size: see map **NOTES* I his�mprovemeent/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 1 l 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 at.s 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 Design Wastewater Flow(GPD) Site: Nevk Repair❑ System Specifications: Tank SizeYGAL. Pump Tank GAL. Trench Width Rock Depth 1� Linear Ft. 8� Other: Required Site Modifications/Conditions: IMPROVEMENT/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.**** ,6,,e �,�� ��► Environmental Health Specialist's Signature: Date: T DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 Account #: 989900025 Tax PIN/EH#: 5789-79-5851.73 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#73 Reference Name: Location/Address: Old March Road-27006 ATC Number: 3649 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 ARS. Environmental Health Specialist's Signature: �f Date: J 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. Cab i�j Septic System Installed B eP Ys :Y Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) 40, .� APPLICATION FOR SITE!±VALUATION/IMPROVE&IENT PERAIIT& '110 Davie County Health Department I Environmenta/Health Section V P.O. Box 848/210 Hospital Street A11Ay Mocksville, NC 27028 + (336)751-8760 UWII ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL�'T � l IACTII INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions-._ 1. Name to be Billed �jG/C�gger (%W) r_0,c _S7 �.y c_ Contact Person Mailing Address -2 -2�S W)AJ(,- /Z-AZE-A2 ZV Home Phone c7�7� � , - City/State/ZIP /r/�Gg'/.AL rf - �l,�. 70, Businoss Phone - -)-A 7 2'. Name on Permit/ATC if Different than Above Mailing Address City/State/'Lip _ 3. Application For: Site Evaluation ❑ Improvement Permit/ATC II Both 4. system to Service: F/House ❑ Mobile Home ❑ Business ❑ Industry CI Other 5. If Residence: # People # Bedrooms 7 t) Bathrooms D 1.1 Dishwasher LI Garbage Disposal 1.1 Hashing Machine LJ Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/Othor: Specify type # People I! Sinkn # Commodes # Showers # Urinals It Water Coolers IF FOODSERVICE: it Seats Estimated Water Usage (gallons per day) _ 7. Type of water supply: County/City ❑ Well I:I Conuitunity Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes I:1 No Ifycs,what type? ***IhfPORTANT***CLIENTS d1USTCOAMETETHE REQUIRED PROPERTY INFORMATION REQU 'STED E BELOW. Citlicr a PLAT or SITE PLAN AfUSTBSUDA TTED by the client whitTHIS APPLICA'T'ION. � S:rrJ��r ill/SlE Property Dimensions: TZ) wRI'fE llIIZECI'IONS(from Aloclssvillc) to I'ItUPlat't'1': q Tax Office PIN: # 5-7 0- 17-7 9-ST S'i 3 Property Address: Road Name Oe-!o M'g1zCW -1'?0 mo(le sE//c-cc /_0 /749,11,20V Cc ..f/W -a City/Zip 4011AWC4E X 700! LF,eT o,u X?zq (/) s�i cmc If in a Subdivision provide information,as follows: TZ) M4,,eC1,, U/00/) ,15 OA) ler-. Namc: 6boys Section: �J' A Block:Nl lei Lot: Date Property rlaggcd: �r m=il O/-- ��/a 'I� This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permits) issued hereafter are subject to suspension or revocation,if the site plans or intended use cthange,or if the information submitted in this application is falsified or changed. 1,also, undersland that 1 am respuusihIefor all charges incurred finis this application. I, hereby,give consent to the Authorized Representative of the Davie County Neal!!! Dept to enter upon above described property located in Davie County and owned by _ to conduct all testing procedures as necessary to determine the site suita DATE J^ �o — O �. SIGNATURE •l /`)_ 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 Dale(s): Client Notification Date: EHS: a lip �eAccount No. � ')o0o z s' Revised DCIID(07/99) �' 3 Invoice No. y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900025 Tax PIN/EH M 5789-79-5851.73 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#73 Reference Name: Location/Address: Old March Road-2700 r/ Proposed Facility: Residence Property Size: see map Date Evaluated: 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 ,( Consistence Structure Mineralogy HORIZON II DEPTH Texture group (� Consistence i Structure Mineralogy i HORIZON III DEPTH Texture group 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: REMARKS: ���P �i'//Q /P 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 Mineralog 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) APPUWION FOR SITE EVALUATION/IMPROVEAIENT PERMIT& t + 0 Davie County Health Department U Environmental Heath Section P.O. Box 848/210 Hospital Street AIRY Mocksville, NC 27026 f 5 �Ir)O2 + (336)751-8760 • ENV11MA1441 ***I1+SPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALM-TH, )04 t�IITH INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inst-ructio s-.-,�� 1. Name to be Billed 1ST --L�u r_ Contact Person Mailing Address Z home Phone -7 7 c ,ten �S ')-A ------- City/State/ZIP J r/(xJGst//car_ �l �. .mac 7d.2�' Business Phone J �� — 7 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: X Site Evaluation ❑ Improvement Permit/ATC II Both 4. system to Service: House ❑ Mobile Home ❑ Business ❑ Industry IJ Other 5. If Residence: # People # Bedrooms —.7) 11 Bathrooms 1.1 Dishwasher LI Garbage Disposal 1.1 Washing Machine Ll Basement/Plumbing 11 BasemenL-/Llo Plumbing 6. If Business/Industry/Othor: Specify type It, People II Sinks # Commodes # showers # Urinals It Water Coolers IF FOODSERVICE: 11 Seats Estimated Water Usage (gallons par day) —_ — 7. Type of water supply: County/City ❑ Well 1-1 Community Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes I:I No Ifyes,what type? ***IAfPORTANT***CLIENTS h1USTCOMPLLTETHE REQUIRED PROPERTY 1N11ORMATION REQIJ ;S•11"'D Ott BELOW. Either a PLAT or SITE PLAN AIUSTBESUBAf/TTED by the dicnt witliTI IISAPPLICATION. QC 4 41D �Ut C` s:t��i� Ttl/ Properly Dimensions: �% TO WRITE DIRECCIONS(frow h7ocksville) lu 1'It(11'1?lt'l'1': y Tax Office PIN: # 6-7017--71—S-9 Q , y Property Address: Road Namc Oe-4 41'g&Csy A moC/csdiccz /-0 �dflnVCc" ..�l�v b City/Zip AOyA'vC' $ 2.7006 LF•,cr— oC/) cE If in a Subdivision provide information,as follows: TL /ni4i2Ct-J GUoo/n.-j 0,0 27- Namc: / Ape-c./-1 Section: /� Block:'y�►�4 Lot: Date Property Flagged: 4) il_ O"'z- �/q I This is to certify that the information provided is correct to the best of my knowledge. I 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 ani responsiblefor all Charges ill cnrred• vIll this application. 1, hereby,give consent to the Authorized Representative of the Davic County Health Departnicid to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suita DATE O a. SIGNATURE ---- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed properly lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Da tc(s): Client Notification Datc: EHS: Account No. 7 Doo � S Revised DCHD(07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5789-79-5851.74 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#74 Reference Name: Location/Address: Old March Road-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position �- L Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy ' HORIZON III DEPTH Texture group 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: lt`` LONG-TERM ACCEPTANCE RATE: ` 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)