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159 Maple Valley Rd Lot 19 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 989900025 Tax Purl/EH#: 5789-85-0550 Billed To. Dick Anderson Construction Subdivision Info: Marchwoods Lot# 19 Reference Name: Location/Address: 159 Maple Valley Road'-27006. Proposed Facility: Residential Property Size: 0.707 Ac. ATO Number: 5120 /6q V,111Zq **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 WAIT be taken as a guarantee that the system will function satisfactorily for any given period of time. �f 3 System Type: - S.T.Manufacturer j� C' Tank Date ` Tank Size r/ QOC� Pump Tank Size / /Q System Installed By: E.H.Specialist:4(ZM;�46e: -.! r/ GPS Coordinate: 2P d6v U 1 AA !1 Oa s DCHD 11/06(Revised) • DAVIE COUNTY ENVIRONMENTAL HEALTH ' 4 P.O.Box 848/210 Hospital Street ' Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 989900025 Tax PINfEH#. 5789-85-0550 Billed To: Dick Anderson Construction Subdivision Info.,-. Marchwoods Lot# 19 Reference Name: LocationiAddress: 159 Maple Valley Road'-27006 Proposed Facility: Residential Pcoperty•Size: 00.707 Ac. ATC Number: 5120 Site Type: Er ew '❑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. u � Residential Specifications: #Bedrooms ` #Bathrooms 3'5#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats r Square Footage(or Dimensions of Facility) Lot Sized •-70 Type of Water Supply: County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD).Z/40d Tank Size It to GAL.Pump Tank GAL. Trench Width G Max.Trench Depth L Rock Depth Linear Ft. As stated in 15A NCAC 18A.1969(51 Site Modifications/Conditions/ they: �rrnpted—�uat�rz�rrs ,Ise-},� 7�,.r Contact the Davie Countonvironmental Health Section for final in ection of this system between 8:30-9:30a.k pn the day of installation. Tele ho # 336)751-8760. f d 9� 4 `J 01 tiir 4 1 to, n� �c / f Environmental Health Specialist Date: DCHD 11/06(Revised) Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 �k (336)753-6780/Fax(336)753-1680 �� IMPROVEMENT PERMIT Account #: 989900025 Tax PIN,EH#: 5789-85-0550 Billed To: Dick Anderson Construction Subdivision Info: : Marchwoods Lot#19 Reference Name: Location/Address: 159 Maple Valley Road'-27006 Proposed Facility: Residential Property;Size: 0.707 Ac. ATC Number: 5120 **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 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permitis subject to revocation if site plans;plat or the intended use change. Permit Type: 0New ❑Repair ❑ExpansionPermit Validdffor: E13 Years ❑No Expiration Residential Specifications: #Bedrooms—q�l #Bathrooms 3 it People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: 'County/City ❑Well ❑Community Well As stated in 15A NCAC 18;1.1969(5) Site Modifications/Permit Conditions: accepted Systems rnay also h�_ usecd' System Type LTAR Initial c .t. O Repair o 1 c .7-7 Site Plan 1 taa lgy So Environmental Health Specialist Date i.p.11-06 1 APPLI FOR SITE EVALUATIONAWROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 9=10 Hospitd Street Mocks;Alle.NC 27= (336)753•6780/Fax(336)753-1680 �!pplic>Et�on Ear 'onllmprovemeett Permit �u@wrintim To ConstrucKATC) +gosh FTI�tT pe pf A ii;;tie t ew System (.'Repair to Existing System LtExpsnsionModificaion of Existing System or Facility 600WORTANI0'THIS APPLICATION CANNOTREPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Referto the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION �A Name to be Billed d eons LXcootact Person i��,44YcL r Sou Bolling Addresa JJ• C 14e— Home Phone • City/5tmdZIP to IJ '!.– L7 Business Phone Name on PcmtWATC ifDiiftrent than Above Mailing Address City/StatelZ PROPERTY INFORMATION ;Date HatwRacility Corners FI ed NOM- A survey plea or site pion must wwmpany this application. Included:0 Site Plan OPlat(to scale) (Permit is►slid for 60 months with site plan,no expiration with complete plat) "9'12-7? Owner's Name.b_i_t!IL Aad 4'�.,d ru Phone Number�3�fi Owner's Address 2.Z5 :wLw as L gty/S t ip t7i O- 7,7 1 AB Property Address g. City 41 O.L.. 2'.100,4. Lot Sirs 010 Tax PIN# 57 -R, -0 O /9 ��2 Nei- axdf/Stl� ��"/Z:-/o ioa ( - SubdivisNamo(if is le) M O sextiew/Lotu Directions To Site Ifthe answer to dry of the following Questions is`yes".supporting documetuation must be attached. Are there any existing wastewater systems on the site? C Yes am Does the site contain jurisdictional wexluds? UYes Iwo Are there any easements or right-of-ways on the site? L'Yrs tt m Is the site subject to approval by another public agency? C Yes Iwo Will wastewater oder than domestic wwage be generated? I Yes titin 'IF RESIDENCE FILL OUT THE BOX BELOW 0 People #Bedrooms d Bathrooms 3,95 GardenTublWhiripool[:Yes 14340 Basement--.]Yes tW6 Basement Plumbing: 9Yes &No IF NON-RESIDENCE FII.L OUT THE BOX BELOW Type of Facility/Busiaess Total Square:Footage of Building #People #Sinks *Commodes #Showes #Urinals Estiauted Water Usaae(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Typasysu-rcqucstdd: alConvemiocat I]Aeupled ninnovative OAlternative OOthcr Water supply Type:'�otmtyiCity Water O New Welt C Existing Well n community Well Do you anticipate additions or expansions of the facility,this system is intended to sone?J Yes +ytdo lfym what type? This is to certify that the infemmtien provided on this application is true and correct to the best of my imowledge. I trderstard that any pervtiKs)or ATC(s)issued hereafter are subject to suspension or nevocatioa if the site is altered,the intended use changm or ifthe information subnined in this application is falsified or changed I hereby gran right of entry to the Authorized Representative of the Davie County HUM Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that l am responsible for the proper identification and labeling of property lines and comers and toe i 1 alcing lbe bouse/faeility location.proposed well location and the location ofany o&a smetuitics. Property owner s mowser's legal reI Psi ntati siguni ueaiure Site Revisit Charge Dak(s)- O - oro Client Notification Date: Date EHS: Srgn given I1 Yes ONo Account i d 0 N26' Revised 11/06 Invoice It 15� �'d dWC0 60 80 AON Z 0 0 co EE� 0 f � t v V Z'7 2. 3 r r N t , = Map Frame Page 1 of 1 Davie County, NC - GIS/Mapping System. ! iL1 Click Here To Start Over Active Layer. ❑� Use Map Tips Quick Search:(County ID or Owner Ni oU�� _ Ma PARCELS(Map Tips Avail able} v� Addre ' 161 j 1 Z/I, f x �cr .171�J cOs. l•il-. 1 3 Y ti Q(X7 D AQ. .�.1 19 295f 1]5ED -153 1 �3'-,� � r 2')'�� 17n ) ,yii171J 17'� 219ay 135 O 17_'Y { 2215 3. 187b — -229 I 23.1 f — i. jw 133y 155 1554 13 /`191y r 1 -�159 . _ ~ 37 ! 15]ji2J2Y{ 233 133 . l Or===15, ft \ http://maps.co.davie.nc.us/GoMaps/map/mapframe.cfm?CFID=4129&CFTOKEN=61640... 11/12/2010 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5789-85-0550 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot# 19 Reference Name: Location/Address: 159 Maple Valley Road'-27006 Proposed Facility: Residential Property Size: 0.707 Ac. Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape p2sition Slope % HORIZON I DEPTH Texture groupG Consistence L5 Ar Structure Mineralogy HORIZON H 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 nl SITE CLASSIFICA ? TION: /" EVALUATION BY: LONG-TERM ACCEPTANCE RATE: t�• a ? 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 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 �-_zssification-S(suitable),PS(provisionally suitable),U(unsuitable) \'R -T nnv-term arrentnnr•P rate-oal/rha/ft7 ■■■■■■■■■■■l■■■■■■■■■■■■■■■■■■■■■■t■■■■tree■■■■■■el■■■■■■■■■■■■■■■ ■■■■l■■e■■/i■ee■t■e■■e■te■eet��e■■e■to■tt■■■e■■■t■■ttttt■et■■ee■ttt■ ■■■■■■■lIl■■■■t■■■■■■l■■■■■■■a■■JJ■■■■/■tll�■■■■■■■■■■t■■■■■■■cell■ ■■■lrnt■e■t■■■e■■eltelle■le■■■■l■ ■■■■■lt■■te■■■e■■■tl■■l■■telle■■ ■I�IG�i■■■■■■■■■■■■■■elle■■■■■■■■■■■tlt■■■■■■■■■■t■■ell■■■■■■■■■■■■ ■■■■l■■■■■t■etre■■■■■■■■■■t■■■l■■■■■■■■■■■t■■■■■t■■e■■t■■■■■■■■■■a ■■l■■■■l■le■■■■■■l■l■l■e■ll■■■■■■e■■rte■■ltte■■llt■l■■ltl■■t■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■ ■■eeleeeee■el■eeeleeeeete■lee■e■ ■■este■eele■ll■llll■■■l■■■t■■■■■ voviw 4.2 tea ui ; T+7(' uit:h f1f141Cf 5Vf1 ` APPUCAI lONI f0$SITE EYAItfATIOVMPROVE1tM PERMIT d ATC Davi*County Health Department Env/ronmental Health Section P.o. sox Baa/zla Hospital street Mock.jvi31s. hQ 2793* ' (336)751-8760 •••MIMSTAHr—, 24125 APPLZCATIDN CJLNf 7 BE PROCSSSED SSS ALL 7M V=1VIRIM INB MKTI01r IS YROYXn=. Refer to the XNMMP=ON BVI MXN for iuetsuctiona. .- ✓i. V.se to be villadA) /GC.I�i�t1//zCs��/cad`D�IJSF-lit/C.(�,�,t•cc r.r.un L7�4lClG�iN�r C-B e/Iteiitey AAdr•se GV/q/G-H4y,! l/ 4AI Vlfw•then. 7� 75''7 ✓city/dc.celZa NJA��SL/lL�E i{l(' ;170340 c—aa.L .,.Phone CtQifl-7a.7q t�—r. Me—— P--Lc/A=3t o er•et tam ADay. M.ilt.g addr—. ctcy/scua/sip Application Yor. KSita Ivaluation ❑X=Provtmet}t Dermit/A.TC O both --{. &rete.to&e.-la•. rd 1louse ❑ Mobile Mcno ❑ Sunine.. CI xnduatry 13 other ,eerie Trp.•y.t—reduuteedl. ❑ co ontsoaal (9 non-e.Uow x-odirted E) Sano-atia• .:tea. If kkoosidence. ✓f People I Bedrocow —3— h — a Batroo= -r R-Ol,lw.Ler 01—ba&•Dlayehal a.liuy keaAL• ❑8uer.Vrlu btsg ❑auw.tht►plueblwg 4. It Dusloea./Iodustry/Other: verify type A People a Stnko - a CoAendu a 1]o-are f urinals a Vater Ceolera It MDSMVXCN. # Saaa/t& =&tuna-- w4tsr, IIPage (yauooa Pr d.y) -tea. Typo of.racer.apply. tL COun:y/Cit r ❑ wall ❑ Catvouai ty s. m you aatictpat*additions or expansions orthe fatuity,this system is intnrded to serve?❑Yes 011f0 Ifyts,svhatt . ____ LNP01t7R17—CLIvyriMUSTCO PGLMTHEREQUIREDPROPERTY114FORMATIONREQUESTED 6 VOrcraPLATorSITEEL ryroz=Ih f7TEDb tbeelleat xitbTHIS APPLICATION. roperty Dimensions.�3 . S Si �pJF_C;- TRITE DIRECTIONS(from Mocksvltk)to PROPERTY: . —Tax office PIN: P 79 9 Y 7 G 3 S 158 M &JI s • yz) P156yeE-S Cl leF —,Prapertyaaeressp RnadNarm I��JPe-&s�1CII� Citymp��LC,E /1/.0 j270,,-X f in a Subdivide- roAdc informatim,as follows. Name: 1".46K"1VW24 a R14SE- el- moo,. Seaton: Block: Lor. "� cDate hamc eemers RaerW: �?.4Gt�7� ,e2 v�� /76c-cl This is to certify tbat the information provided Is correct to the best of my knowkdge.I understand that lay perinit(s) issued hereafter are subject to suspension or rtvoeatfoq If the site plans or intended use change,or it the infornution submitted in this application is fahifird or ehangcd.I.alae,imlrrsrpndrhef[afq rerponsillsjor atf tharges inearred from this applicaden. I,hereby,give cement to the Authorized Reprtscncatfve of the Davie County Health Dcpariment to enter upon above described propert:•located in Davie County and owned by to conduct all testing procedures as accessary to determine the site snt r✓DwTE ..1-A.1- O s --SICdATOttE CT THIS AREA MAY IIS V=FOR DRAWING YOUR SITE PLAN(Indode all of the following: Existint and proposed property lines and dimension;structu:ts,setbacks, and septic locations). Site Revisit Charge Dak(s)• Client Notification Date: EHS: Sign given 6 Account No. R"ked DCHD(95M3 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION 5 Tax PIN/EH#: 5789-97-0344.22 t.' r Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#22 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 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 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-Prisipatic Mineral= 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 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAMEDATE EVALUATED PROPOSED FACILITY PROPERTY SIZE Z �G SUBDIVISION � ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit f Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% o HORIZON I DEPTH Texture group ' Consistence Structure 1 Mineralogy C147 HORIZON II DEPTH y �� Texture group Consistence i Structure /G 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 /� r SITE CLASSIFICATION: 62 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(01-90)