Loading...
143 Maple Valley Rd Lot 16 ` 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#: 578497-0344.16 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase IV Lot# 16 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Property Size: ATC Number: 4504 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 CONS yUCTIION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: /Y�( Date: 3 Bc-o�zoorns CERTIFICATE OF COMPLETION614 7 **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken a_s_a guarantee that the system will function satisfactorily for any given period of time. 7 7' ` �d rt%- 10 cY ao` _.I L 43 !4.4 Septic System Installed By: -7 Environmental Health Specialist's Signature: �� — Date: DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT i Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 578tt97-0344.16 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase IV Lot# 16 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Property Size: ATC Number: 4504 **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 "12 #Baths �- Dishwasher: 17� Garbage Disposal: d Washing Machine: e Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size i lc 7 Type Water Supply ( 6 Design Wastewater Flow(GPD) Site: New e Repair❑ System Specifications: Tank Size%6D GAL. Pump Tank GAL. Trench Width Rock Depth ef,&Linear Ft.c-216--� Other: Required Site Modifications/Conditions: INIPROVEb1ENT/OPERATION PER IT LAYOUT- AP TER. RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: C ntact a represent ve of the Davie County H Ith Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or :00 p.m.to 1:30 1 L iu Udy 01 Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: f(/� Date: i DCHD 05/99(Revised) rt v cava-vt�Tar --.. L/14rrS rrrtkaor�vn --- --- _ aa4 .7Jo revs (�, t APPLICAHON EOR SITE EVALUATION/ISIPROVENE11i PERMIT A ATC Davie County Health Depattrngnt ' En vbvnmenta/Heath.Sectian Lo P.O. Box a4a/210 Hospital Street Mocks.able, NC 2793. (336)751-8760 •••ZUFORTAHT•-" THIS APPLZCATSON t:ANNCt'BE PROCSSSED MV=S ALL T= RBQITIRFD I1d8 FJMTZCN ZS YRu7X=.. Refer to theeIN70120=0Dt EIIS,LETIH for Instructio�n/s. ' t ✓1. treed to be filled / ,t'/-j!t//��'tJ /) 66VS(r' nes -Lt C.-e t P.cew, ZDAfle h`N -gdA) -/Ita111,rg Aadre.sz66a 14A";✓zw Lnl --w.Pao,,. yg�-7S79 ✓city/state/aa A4(, a7D2t4 q.?S-7-1-7q A,-2- Mar on ftc-1c/ATc if o •-rent tam Above Melltnq.Rdre.s Qty/Xcats/Lip Application For, 931to meluation t� I�rovemaq ermiVJITC 0 Both ,r1. Vy.%—to sere/ae,)(Nouse M Mobile Nona 0 nusinese 0 Znduatry O Other -,ri- Type ey.tce,requested, a eoa-entsooa3 eoa•eatiosal,odlftod 0 tmovaelw --s. If Xosidencet�/1 Popple 1 Hadroc m _ f Bethtmroo --�' 00`iAbwaMCr a.r3.9e Dlepenal scup Maekibo ❑tu-a-et/t•3ueblsg E3euwethN vlwbIwq T. it !wine../Iod,ratry/other: verify type a P-oplo 1 Sinks 1 Ca—du 1;2. ra a urinals •Hater coolers Ir r09DSmvzcEt 0 seat• Zatim9t-41 Matter gPage (cellos.P-r dry) --a. Type of..scar aupp3y, �Coua:y/City O Well O ConsauzL ty P. m Yeti ent1cipats addlcloaa or expansions of the facility this system is intended to serve?17 Yes 0-fle Ifyts,rvhatt �__-- LKlORT.4M-'•CL)C!'rf'r MfISTCO Fl"Z THE REQUIRED PROPERTY INFORMATION REQUESTED 6 Eithv a PUT ar StTE PL T SESUNAinTED by the el(mt with THIS APtLiCATION. tOpropertyDimensiosr._�? S O i Ijt��- F RITE DIRECTIONS(from Madisvlt)e)torROPERTY: e-y2xOffice�..Y: is 78 7pz�oye.F�C-ze-afz tPmperty¢address: Road Name n �lxyP�s*lG2.F�/& f ity2p -rzl , N C Z17azr flnaSubdlgillon rovldelafornutt3n,asfollotrs: Name: IM4/LC"W0114 c >/'k4S= 4 J Sectioir. Dloek Lor. �r+ffate horns eoracrs Hagpea): /2A F6�ti o`""� This is to tertUy that the information provided Is correct to the best of my knowledge.I understand chat any pertnit(s) issued hereafter ore subject to suspension or revoeotlos.If the site plans or intended use change,or if the inrormation submitted to this appllotloo is falsified or elrtn¢nl 4 ciao,intdrntand rhaf Jam resronubtsjaralf eLprgc incarrrd frow 1Ris application I,hereby,give consent to the Authorized Representative of the Davie County Ifcaith Dcparhncnt to cuter upon above described prvperM located in Davie County and owned by to conduct all testing proceduty as aecasm7 to determine the site ani t-�DATE -?-01.3-0 S -96NATURE 45-91 THIS AMA MAYBE USED FOR DRAWING YOUR STTE PLAN(Include all of the fallowing: P.aistinz and proposed property lines and dimensions,struclums.setbacks,and septic locations.) Site Rcvfsit Charge Date(s): Cheat Notification Date: EMS: Sign given Account No. Rcvisad DCIID(05103 1ureic-No I 60 DAVIE COUNTY HEALTI-1 DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLTC ° Rl1�r� 85 Tax PIN/EH M. 5 -P, 0RMAT10N /r b Billed To:' Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot# Reference 14ame: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well i 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 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: 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-Prisrpatic Mineralogy 1:1,2:1,Mixed dotes 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 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health SectionSECTION` LOT Soil/Site Evaluation APPLICANT'S NAMEDATE EVALUATED t93 PROPOSED FACILITY 'Y� PROPERTY SIZE q7 SUBDIVISION !L/I Z,110& J ROAD NAME 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 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: 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(O1-90) 15 13 '30 68 192 co CID 5 570 , c �d C-0 co 12 2 16 � 52 2 W N �O 1692 JI' 115 29 ,1 Q 48 17 r N . Q%