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129 Maple Valley Rd Lot 15 DAME COUNTY ENVIRONMENTAL HEALTH ' :• - t P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 990002285 Tax PIN/EH#: G9090DO015 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods 4 Lot#15 Reference Name: LocationiAddress: 129 Maplevalley Road-27006 Proposed Facility: Residential Properly Size: 0.784 Ac ATC Number: 5973 **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�6j _ Tank DatgJ-no&tc Tank Size rel 600 Pump Tank Size _ / Bedrooms: "✓ System Installed By: . Ar,14lZ Installer# Date: 3 GPS Coordinate: . t 140 x& Environmental Health Specialist Date: 6 DCHD 11106(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990002285 'fax PIN, H#: G9090DO015 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods 4 Lot#15 Reference Name: LocationiAddress: 129 Maplevalley Road-27006 Proposed Facility: Residential Property Size: 0.784 Ac ATC Number: 5973 Site Type: Mew ❑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 _#B I athrooms ^I #People Basement54 Basement plumbinglO Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size R,t- Type of Water.Supply: ($County/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow(GPD) y90 Tank Sz� Q, Q GAL.Pump Tank GAL. Trench Width 3(d` Max.Trench Depth-Z b` Rock Depth Linear Ft. Site Modifications/Conditions/Other: 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. 1�•1ef°"l LO t�— . r Male 00'((en1 Environmental Health Specialist Date: n( ur) 11 mA(uPvkPd) Davie-County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680, IMPROVEMENT PERMIT Account #: 990002285 Tax PIN/EH#: G9090D0015 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods 4 Lot# 15 Address: , 225 Wing Haven Lane Location/Address: 129 Maplevalley Road-27006 City: Mocksville Property Size: 0.784 Ac Reference Name: Proposed Facility: Residential **NOTE**This Improvement 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 1 I 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: 1 New ❑Repair ❑Expansion Permit Valid for: K5 Years ❑No Expiration Residential Specifications: #Bedrooms _#Bathrooms y #People__BasementM Basement plumbingZ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):14 Sy Type of Water Supply: (County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: SystemType LTAR Initial .3 Repair Site Plan Nalk �T IN c . Environmental Health Specialist Date © Z i.p.l l-06 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 / (336)753-6780/Fax 36)753-1680 Application For: /Site�uation/Improvement Permit Authorization To Construct(ATC) ❑ Both Type of Application: CYNew Svstem ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the 1NFORMATION.BULLETIN for instructions. APPLICANT MFORMATTON Name Contact PersonAIJOrCT-SpAq Address Home Phone ,$' 29 City/State/ZIP T TD 9 Business Phone Z 19 Email Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/FacilityComers Flagged /Z NOTE: A survey plat or site plan must accompany this application. Included: Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no a .ration with complete plat.) Owner's Name .'D I C b Phone Number 3?6 1 'L• 7 S P Owner's Address LV City/State/Zip_MDG k.� U/GZ,er 2�o 2 e Property Address IZ MAPLE ljlq a FX 4D City Y,4MG E _ Lot size—Laug 4e Tax PIN# SJQ8'S Z q g,5— <5q09 0D001 Subdivision Name(if a plicable) Section/Lot# - Directions To Site:. 0 L /> L A-PC 5 C If the answer to any of the following questions is"Yes",supporting documen tion m t be attached: Are there any existing wastewater systems on the site? _Yes o Does the site contain jurisdictional wetlands? Yes _ Are there any easements orright-of-wayson thesite? Yes Is the site subject to approval by another public agency? Yes ; Will wastewater other than domestic sewage be generated? Yes �o IF RF,STDFNCR PITT,OI TT THF BOX BELOW #People •5 #Bedrooms V _ ,#Bathroomsl. _ Garden Tub/Whirlpool &Y—es— ❑No Basement: [res ONo Basement Plumbing: es ❑No TF NON-RFSIDFNCE FILL OUT THE BOX.I3FLOW 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: ❑Conventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: ❑ County/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑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 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 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 comers and locating and flagging or s e ho M�representative n,proposed well location and the location of any other amenities. Site Revisit Charge Pro erty signature Date(s): ,2r 2�7_ /a., Client Notification Date: Date EHS: Sign given ❑Yes []No Account# � Revised 11/06 Invoice# �r Lo-r 19 H vo oa 5 I R9 PtA?kC AI LL 15 ;s i t t� e r cFlGJ kiQ vLV -T Qr-' _�---u a..n-nnsat•r :s ort --- -- -- JJS! .7X70 1s: ra S + APPLICA l70,Y FOR SITE EVAUTATION/IMF`ROVE&1LVr PERMIT&ATC l Davie County Health Depattrnent T- Envlrunmental Health Section 1 P.O. Box a48/210 Hospital Street - Morx4gi119, NC 2793$ (336)751-8760 r••ZffMR7AL`7 • T=S APPLICATSOH CAMOT BE PROCBSSID MUXSS ALL TR8 R=VZRRD XNYOIWATION IS YROv==. Refer to the XN7Q SV=0K BULLETIN for instructions. ✓s. xaed to be sslled„ /Cc/q�Itf//Jds&d 6-as vGu,,,c.cc src.w, )JCe?Vi A06: 0A) ✓kstiing Aadrese _ (�V/A/ri-AAawLW L/1/ it.rh000 ✓city/atatelta /YIAr t-S tI�t1E �l .7025 �„asa...Yon. `lgrlE-7�7� v 2. V--ou Per-Lc/ASC S!o rrrrt thm Above Matllaq address - C1.cy/Sesta/tip ,—i. ApplleatlOn For: XSits Evaluation ❑Improvement Permit/ATC 11 Both y4. Dr.%-I.8rs+lar,ff uauae is Mobile IIomr. ❑ Business Cl Zudustry ❑ Other �S. Type system requested, n Coa+entlaoal ❑ eoaveatiooal awdlfied El lsaovotive 1s. ,I.f Xeesidence,,,/s People r Hedrocaw _ tl Bathrooms -� DODi,lurasirr L7a.rbyr Dlsyaxal rs),Lae 1YaWe ❑Darewt/Plubtig ❑aarpyrt/xe alu.Dleq 7. if susiaess/industry/Ctbsr: verLfy type a !scale a SLnks I Cosmddae I orlsals a Nater Caalers Ir rool)SERYICSt 0 Seats, =Ptimgt.d M3taxr Vragg (gauaca per dry) ---a. Type of.star o:pplys Li Coun:y/city D Well Ll Community s. m you asticLpate additiods or expansions or the racitity,this system is intnlded to serve?0 Yes cro ITyes?whatI 1MPOItTANT"CLIWr.i MUSTCO PLETE THE MQUIRED PROPERTY INFORMATION REQUESTED Be Elthtra PLAT er SRGPL �yT BES(/Bb/r7TED b the client with THIS APPLTCAnON. (-�►operty Dimensions:�: . S�i aC eJ T-WRLTE DIRECTIONS(fr..Mocksvttk)to PROPERTY. t Tax0mctPIN: s 79 763 q • I . l58 r& �r g rp ---PrVKrty Adder; Road Naha nn,,��acyP�s C�Ee/ZO CilylTiPG300--- AJ(-.Z702K fin a Subdlpidan favids Inforssutlan,u fallolrs: Nan:e: 2CF�L1/ b/1 cIlrS� Section: Block: Lot: a 2fate hors careers Ehgged: This it to certify that the tntortaallon provided is correct to the best army knotvicdpe.I understand that say pernlit(sJ issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the iarormation subm)tted In this appllotlon is falsified or dsanct-1 l•sL+v,tnm4ratrandrhsi Ja+e relPonst7ltSjor aJf eLprgo tncorrcd front Misapplication. I,itertby,give rattunl to the Authorized Reprtscntativc or the Davie County Health Dcparfintnt to cater upon above described propert-locattd in Davit County and awned by to conduct all testing procedures as aeccssary to determine the site sul i t---DATE r2_a.3 - o S stcNATURs THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all or the rellotring: Existing and proposed property lines and dimensions,struetuivs.setbadt; and septic locations). Site Revisit Charre Datc(s): Client Notification Date: EH& sign even 6 Account No. Z $ 5 Revised DCHD(t15t03 Invoice No. R DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation . APPIi,ICA4fffHq(.(%Q 85 Tax PIN/EH#: S -eR .jW,ORMATION Billed To:' Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot# W"' Reference Name: Location/Address: Peoples Creek -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: IMP Water Supply: On-Site Well i i Community Public A. Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position PIS Sloe% b HORIZON I DEPTH Texture group Consistence RE Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure tuwL 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 1 JJ SITE CLASSIFICATION: P EVALUATION BY:_011c " 6w1j (t LONG-TERM ACCEPTANCE RATE: '�✓ OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nosc 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 ISIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE joist VFR-Very friable FR-Friable FI-Firm VFl-Very firm EF1-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-Prisrpatic 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 C :CCCC'::::C:CC::':C::CCC:C:::::::::::C:C:C:C:CCCCWOMEN : E ■E: ■/■■■.■■.■■■...■:■......................■..:■...■ g ■ ■■■■■..e■■■.■■■■.■..■..°.■....■..........■...■..■■■. no ■■■■■.... ..■■■.■.■ ....■.■.■..■......■.......■... 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DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION—TO—: LOT Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE d SUBDIVISION i /` � J©U ROAD NAME Water Supply: On-Site Well Community Public !� Evaluation By: Auger Boring Pit Cut FACTORS 12 3 4 5 6 7 Landscape position Slope% 5 v HORIZON I DEPTH p c i Texture group G Consistence r L Structure r 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 4. LONG-TERM ACCEPTANCE RATE - SITE CLASSIFICATION: s5/ EVALUATION BY: ,J�✓ ` N m�s��4 LONG-TERM ACCEPTANCE RATE: �' +� OTHER(S)PRESENT: REMARKS: o �'(� 6" L b ' l' G'� 6✓ 4) 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(01-90)