The URL can be used to link to this page

151 March Ferry Rd Lot 27 DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section r P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 y— A.,y—s j (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5789-76-5851.27 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#27 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 3373 **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 #Baths o�S Dishwasher:.Z Garbage Disposal:1200" Washing Machine: 2�— 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/&'7&1b GAL. Pump Tank GAL. Trench Width T "Rock Depth /—I Linear Ft.32)0/ Other: _ Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISERS) IF 6 "BELOW FINISHED GRADE. ****NOTICE: Contact a representative o e 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 1:3 o y of installation. Telephone#is(336)751-8760.**** r- Environmental Health Specialist's Signature: Date: / DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT 1 Environmental Health Section P.O.Boa 848/210 Hospital Street Moclksville,NC 27028 (336)751-8760 Account #: 989900025 Tax PIN/EH#: 5789-76-5851.27 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#27 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 3373 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 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. y 1 oal� Septic System Installed By: �] Environmental Health Specialist's Signature: �+&4 Date: DCHD 05/99(Revised) APPIUC4TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC ` R @ [E 0 V IE - Davie County Health Department D Envfienmental Hgwlffi SaVon P.O. Bos 848/210 Hospital Street DEC 71999 Mocksville, NC 27028 (336)751-8760 ***nVCRTAHT*** THIS APPLICATION C WM BB PROt' SMV UNLESS ALL TBE REQUIRED 1100 MATION IS PROVIDED. Refer to the zNi"OR=TIOH BULLETIN for instructions. 1. Name to be Billed D/Ul 4",0/646 a/'6AJS ' contact Person _ 1 1C1e-A f4t&,4& A) Nailing address - a A S t IA)G-14Ay F.y L. Boa. thou. 07A- 7 57 9 cite/state/xxv MocIcay/Lt e. Al.. C. Q ZOAR Business m me q,?- 7-'X7� Z. Maas on pewit/nsc it Different than above _ Nailing address city/stat../Zip 20r 6L �-� 3. Application For: Site Evaluation O Improvi=atsPrmit/ATC O Both 4. systas to service: House O Mobile Boma O Business O Industry O Other 5. If Residence: f People f Bedrooms rA 3 # Bathrooms Dishwasher )�aarbage Diaposal `j�Nashing Machine O Bamement/Plumbing o Basement/Ho pluobinQ 6. if Business/=nduatry/otber: "cify `type / people # sinks ! Commodes ! shower- I urinals 4 water coolers i! BOODSERVICE: # Seats Estimated Nater Usage gems per day) 7. Type of water supply: county/City 0 Well O Community e. Do you anticipate additions or expansions of the facWty this system Is Intended to serve? O Yes �No Hyes,what type? ***IMPORTANT"**CLIENTS MUST CUMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITIED by the client with THIS APPWCATION. Property Dimensions: AAVIW A /1 .A A 4 WRITE DIRECTIONS(from MocW11e)to PROPERTY: Tax Office PIN: # 9Z i 9 —76 _s�4L27> 10 '70 7-D $O l V,-0 pR.'Is kd—ca Property Address: Road Name ( "iQLE/C — GIFT (/�1 /YIl L YD CityiZip /)qlaj2o)4 U) H in a Subdivision provide information,as follows: Name: 10A C,14 98 Section: Block: Lot%-— Date Property Flagged:-.- - This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation,Ifthe site plans or intended ase change,or if the Information submitted in this application Is falsified or changed I,also,understand that I am responsible for all charges Incurred from 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 awned by to conduct all testing procedures as necessary to determine the site suitab DATE 1A ''/ " 9 9 SIGNATURE /✓ . THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include sH of the following: Existing and proposed property Imes and dimensions, structures, setbacks, and septic locations Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. O-�7 Revised DCHD(07/99) Invoice No. Q 3--7 ley c D 7-V ko I J I � I i ' - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5789-76-5851.27 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#27 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: Water Supply: On-Site Well Community Publicy Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON Il DEPTH Q G r y Texture group Consistence rl Structure L Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I PS 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 M is 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) LIAR Long-term acceptance rate-gal/day/ft2 DCHD 05/99(Revised)