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157 Maple Valley Rd Lot 18 r iD ATION No: DAVIE COUNTY HEALTH DEPARTMENT Imo F Environmental Health Section PROPERTY INFORMATION :tee's �! /� ��5 � P.O.Box 848 Name Name: �/( /J 4 Mocksville,NC 27028 Subdivision Name: Phone#:704-634-8760 Directions to property: j"i1.�>,h�.S/rte:•Z Section:�p_Lot: AUTHORIZATION FOR SYSfEMAC NSSTRUCTION Tax Office PINp:# Road Name: fNA��PSp;;j�/On(j **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This FonTdAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In coi)mpliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) 7 6 ***NOTICE.***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION _rr _ IS VALID FOR A PERIOD OF FIVE YEARS ENVIRONMENTAL HEALTII SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE_& A BEDROOMS M BATHS R OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION:FACILITY TYPE M PEOPLE M PTPLEISHIFr Y SEATS - INDUSTRIAL WASTE:Yes or No IOTS¢E TYPE WATER SUPPLY ' V DESIGN WASTEWATERFLOW(GPD)��� NEW SITE L� REPAIR SITE SYSTEM SPECIFICATIONS:TANK SIZE Z"_GAL PUMP TANK GAL TRENCH WIDTH ROCK DEPTH LINEAR Fr.-5t96_ . OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT f, -*CONTACT A REPRESENTATIVE OF THE DAVIN COUNTY HEALTH DEPARTMENT'FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE k 1S(704)634-8760. OPERATION PERMIT 1 3� SYSTEM INSTALLED BY: t M'LL'. 0 � p 1/�r•►1C 'Dt'r�c !�^t� 7 r it's Hoot-.%* F AUTHORIZATION NO._j4&_OPERA ON PEIU.nT BY. DATE: 9 "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY DESCRIBE OVE 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. DCHD 05196(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 Account #: 989900025 OPERATION PERiTaTx PIN/EH#: 5789-85-1560 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods IV Lot# 18 Reference Name: Location/Address: 157 Maplevalley Road-27006 Proposed Facility: Residence Property Size: .073 t a l U I ATC Number: 4844 D � **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has beeninstalled 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 anygiven period of time. �� '\ � U � 1 � Da System Type. S.T.ManufacturerVQu�Tank Date Tank Size Pump Tank Size System Installed By: wf E.H.Specialist: Q Jc UDae: 4 c- i?-16o ina rl-© ti iti ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-z8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900025 Tax PIN/EH#: 5789-85-1560 . Billed:To: Dick Anderson Construction Subdivision Info: Marchwoods IV Lot# 18 Reference Name: Location/Address: 157 Maplevalley Road-27006 Proposed Facility: Residence Property Size: .073 ATC Number: 4844 Site Type: ONew ❑Repair DExpansion **NOTE**This Authorization to Constrict(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pemiit(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—#—#Bathrooms #People Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size v'7, Type of Water Supply: 05—unty/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow(GPD) Tank Size /4MAL.Pump Tank J AL. ,r 22 11 /. Trench Width J6 Max.Trench Depth y Rock Depth Linear Ft. A� Mated in 15A NCAC 18A.1969(a) �1�y �t G�GaN Site Modifications/Conditions/Other. Goepted Systoms =y b'sa bo i mr- 1I A 9r A . -Qavvpc � � Contact the Davie County Environmental Health Section for final inspection of this system b en 8:30—9:30a.m. on the day of installation. Telephone#(336)751- - 336 751- 0. i m 72 -71 `— - � 7 4' 53 L0 M;A Environmental Health Specialist Date: DCHD 11106(Revised) Davie County Environmental Health P.O.Box'848%210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Account #: 989900025 IMPROVEMENT PE]WAN/EH#: 5789-85-1560 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods IV Lot# 18 Address: 225 Wing Haven Lane Location/Address: 157 Maplevalley Road-27006 City: Mocksville Property Size: .073 Reference Name: Proposed Facility: Residence **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.l l 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: Rf' ew ❑Repair ❑Expansion / Permit Valid for: Years ❑No Expiration Residential Specifications: #Bedrooms / #Bathrooms_•J #PeopleA Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Typei" #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD)AbO Type of Water Supply: 21 ounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As stated in 15A NCAC 18A.1969(5) accepted Systems may'Visa Ce u3 System Type LTAR Initial A -c-c k--c--P O • —7 Repair -P Site Plan / 3 / C, 2 Ac W - ��l r[: f� avQlt' Environmental.Health Specialist Date ��� ck Anderson 336 998 7279 z a APPLICA OR SITE EVALUATION(IMPROVEMENT PERMIT&ATC ti �1 Davie County Environmental Health $ ZP,O.Box 8481210 Hospital Strtet t p Mocksvillc,NC 27028 (336)751-8760/Fax(336)7S1-8786 atiort/[mprovement Permit Authorization To Construct(ATC) Both }pb,oto New System Repair to Existing System Expansion/Modification of Existing System or Facility k� ;: ,'r--] 0RTANT'••TWS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION d Name to be Billed Contact Person Billing Address Z.S trN Ajc Home Phone City/State2Ip e Gr IGSili L - 4l- L'i d 4% Business Phone A3Z,.. -4?.S' -7 7-71 Mame on Permit/ATC if Di rent than Above Mailing Address City/Statetzip PROPERTY INFORMATION 'Date House/Facility Comers FI ed NOTE: A survey plat or site plan must accompany this application. Included: Site'Plan "-Plat(to state) (Permit is v_a{�lid for 60 months with site plan,no expiration withcomplete plat) Owna's Name -`V f c A W 6 A-60 -Phone Number 336-&Z7^17 D/ 43 OwmesAddress Z� Wlt ✓. uy City/Ste a rp fix-"JiL C. PropertyAddress CityW.Jee- Me', Lot Size .D73 Tax PIN# 51 X - 6 Subdivision Name(ifMhcable)-- 44 A-&C-h--U.10eel,5_Section/LoO �g Directions To Site: V&l 1 O PA00" Gua.-1x- ±2 MA-rwee.4 5 If the answer to any of the following questions is'yes supporting documentation must be attached. . Are there any existing wastewatersystems on the site? Yes <Z> Does the site contain jurisdictional wetlands? Yes Are there any easements or right-of-ways on the site? Yes qmz> .'Is the site subject to approval by another public-agency? Yes.csz�, Will.wastewater other than domestic sewage be generated? \Yes tea? IF RESIDENCE FILL OUT THE BOX U OW P 7t- fCE #People 4 #Bedrooms 4W # athrooms 6­5 GardenTuh/Whirlpool _.No Basement: Yes Bascmentnum ing: Yes IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FttcilityBtuiness Total-Square Footage ofBuildiae #People #Sinks p Commodes #Showers #Urinals. Estimated Water Usage(gallons perday) (Attach docunxntation of similar.facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: Conventio Accepted Innovative Alternative -Other Water Supply Type:. .CountylCity Water New Well Existing Well Community Well Bo yotranticipate additions or expansions of the facility this system is intended to serve? Yes CNo dyes-what type? This into certify.thatthe information provided on this application is true and correct to the best of my knowledge. 1 understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site it altered;the intended use changes,or if the information submitted in this application is falsified or changed..Lhereby.grantrighi of entry to the Authorized Represwaeve of the DavieCounty.HealthDepartment 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 corners and, to ng and fl ng or staking the houselfacility location,proposed well location and the location otany.other.amenities. Site Revisit Charge Property owner's or owner's legal representative signature �t Date(s): Client Notification Date: cut• t��g000� 4Co q7z Dick nnderson 336 998 7279 p. 1 Y Q i � i 1 � a \ t l 1 CIF,-{- ►� '�g j`i G i; �,d v-V0 GJ� ;V. -Vii iJN -----V it:A ftlltilt r'`SVII __� �' -' -- JJ9 +7�7Q tG /s7 (J• 1 APPLICA 11OV FOR SITE EVAUATION/WIPROVESINT PEFL41T&ATC I 'Davie County Health Deparbrnent 'EnvlrvnmenialHealth Section O P.O. Box 843/210 Hospital Street mge4tl-1119. ICC 27935 ' (336)751-9760 •••zxpmTAVT... rats AP)rLTCaTION CAMvD•r BE OJEOCSSSED WV=S AU 7= R==RFD =701=T=N z8 "MVXIX8S1. Rofer to t:hs 3MVM =0N BUW=XN for instructions. vs. IIese to be sill., �1/�fR��I�,t'/Dt �3ot)6xis -LTJ[C coot—t r.rwn 101c/C�N�y �'8CA) a/ltailing Afdress�_,,,7�W/N(i-��✓�l� ZAI Vfrc.e DAa,w 7�"�5�7 ✓city/aute/za__L�Ar(^S✓ICL0 At 2709 —'a"Loass psoas 948-7 79 t�2. Mase on 1WftLC/ATC lf.PLUeront then Above M.11Leq Amro, city/state/zip �1. Applieatian Fors x3its rValuation ❑Iaprova=x;t Permit/ASC ❑ Both ,rt. syK..e to aetvlee, Cd IIoaae b mobile home ❑ Rosiness CI Industry ❑ other --,s. Type eyateo requoteed111. a Coamentiooal ❑ eoo•otiosal codified imovative mss. ht/k/asideaees 1 People i Badroc= a Bathrooms -r IdDlAlwsLor t�rbyo DIADeNal aaltag ltsa►L• ❑tueret/Plussleg ❑euosrsthls plrabls9 1. If ausieeA./Industry/atbers verify type 1 DeoDlo t Stales I css000d.A •fSeeera a urinals a Yater coolers xr rooDSERWCE: N seats, Nati stood xatsr Ilragv (galioos P.r day( •�-t. Type of vats[supply, G'Coun:y/City 13 wall. a Coamunity S. ao you anticipate eadttioda oe expansions of the foo'Iity this system is intended to serve?13 Yes C3'flo Ilycs,whatt ' ___ IMPORfAM�`•CLI&YM MUST Ct7 PLbTE THE AE'QUIRED PROPERTY INFORMATION REQUESTED sE EttheraPLAT orSITGPI rNESIZSWZTLD by ttseclient wth THIS APPLICATION. L.—Property Dimeasioar. S S� Alf- -9FRITE DIREC"OkS(from Macksvitle)to PROPERTY: , .✓YaxOffice Pr.V: P 6,729 9,7 q .2) IRB ro flv( S CCK _—Propertypddrw— RgadN> f-3„„ -OPCS C2�/� Cl1y�P ATO VAu GE S."17a.ZK ftoaSubdivision rovideInformatim as!allows: Name: An42CF4(Van/1r, 1/456 L Section. DloeB: Lot: 9'� c Tfate home earners Ragged: C2ACi Cr15) dca C t2eX/76, This is to certify that the taformtion provided Is correct to the best of my knowledge.I understand that say perntit(s) issued hereafter are subject to suspension or revocation,If the site plans or intended use change,or if(he information submittedInthis appHotloaisfatxifiedorchaaCCAL 4a/sr.rrndrrtrandcher/n1prrspanst�lsjoralleGprrerincorredjron Osis appl/cadom 1,liereby,give Consent to the Authorized Representative of the Davie County health Department to cater upon above described property located in Davie County and owned by to conduct al,testing procedures as necessary to determine the situs sul L.—DATE ..! 's�.�i - O S "SIGNATURE / THIS AREA MAYBE USED FOR DRAWNC YOUR SrM PLAN(Include all of the fallowing: Existing and proposed property Sties and dlmession;strudrucs,setbacks,and septic locations). Shit Revisit Charge D2tc(s): Client Notification Date: EHS: Sign given� - Account No. ) 5 Revised DCHD(05103 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation A1'PI,1CA'4-f" NVfA0+ffiW85 Tax PIN/EH#: JTjWWjfff4jRV0RMATJON Billed To. Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#,f' Gt W r Reference Name: Location/Address: Peoples Creek Rd.-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 S 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 CONSISTENCC is VFR-Very friable FR-Friable FI-Firm VFI-Very firm . EFI-Extremely firm 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 i oto 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-tern acceptance rate-gal/day/ft'. McT DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LO Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY 6 J� PROPERTY SIZE w SUBDIVISION 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 L, Slope% HORIZON I DEPTH Texture group Consistence l Structure Mineralogy Pk- HORIZON .- HORIZON II DEPTH Texture group Ci Consistence Structure (1 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: ^� !� � /�✓�lo�''. /e w /1/���.a✓ Landscape Position LEGEN 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)