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216 S March Ferry Rd Lot 41 i 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#: 5789-76-5851.41 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#41 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2789 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 WASTEWA CONSTRUCTION IS VALP F 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. fz—== J� r 1/ J� oo J_ Septic System Installed By: Environmental Health Specialist's Signature: Date:101 DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5789-76-5851.41 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#41 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre �7 C b?r: 2789 **NE* "phis mprovement/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 #BedroomsL #Baths _ A Dishwasher Garbage Disposal�Washing Machine;, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:❑ Lot Size Type Water Supply�Q— Design Wastewater Flow(GPD) Site: New❑ Repair❑ System Specifications: Tank Size/299P GAL. Pump Tank GAL. Trench Widtfs � Rock Depth • Linear Ft.= Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the 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 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** �l P, Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEL1ENT PERMR do ATC r Davie County Health Department D ' Environmental Health Section ' P.O. Boa 848/210 Hospital. Street DEC, 71999 Mockeville, NC 27028 (336)751-8760 ***IJl�ORTAt+IT**• THIS APPLICATION CVWM AE PR,Ommv V=811 ALL TAE REQ==D nUORMATION IS PF=D�/E]D. Refer to the INI�ORIWICH SULLZTIN for instructions. 1. Pam• to be Billed �/C/r Ft"ae/2bea1 6wb s7" Contact Person p1cle- /}i a&A-- 50A) Wailing address _A A!5 U ,?A)a. 4wAl , sone Ponhe _ 419;t- 7 57 P City/stat./s:P 121oCJe&V/t�L-. Al. C. a 7o.1& amino.@ Phone 1999-- 7A7 2. hams on Permit/ne it Differant.than Above fhilinq address City/state/sip s. Application tors Site =valuation 0 Improvement Permit/ATC 0 Both 4. sy.ten to servioel House 0 Mobile Home 0 Snsiness 0 Industry 0 Other s. It Residence: s People # Bedrooms r?1 3 i Bathrooms Dishwasher Y/Oarbage Disposal X1Whinq Machine O Dasemsat/Plumbiag 0 Basement/Ho Plumbing S. it Dosis/znduatry/Otho:: specify type # People / sinks Commodes I showers Osinals I Water Coolers IF 3=8ERVICE: () Seats Estimated hater Usage tsa3ams Per day) 7. Type of water supply: Kcou3lty/C:Lty 0 well 0 Community s. Do you anticipate additions or expansions of the facWty this system Is Intended to serve? 0 Yes �No oyes,what type? ***IMPORTANT"**CLIENTS MUSTCOMPIETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either s PLAT or SITE PLAN NIMT BESUBMIITED by the client with THIS APPLICATION. Property Dimensions: AMR0 A A/_A A AWRITE DIRECTIONS(from Mock Wille)to PROPERTY: Tax Office PIN: it SS�7 g "76— i 00) t10 7-0 S7 j V'O PsA3R4--a Property Address: Road Name ( "ISE/C 4 - /-E,=r (l�T M)a Yz) City/Zip MAIW j GU&U'n 3 Hie a Subdivision provide Information,as follows: rnQ,o G 9 Name: A R-C,4 U)06DS P•9820lu_a-qg 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(:) Issued hereafter are subject to suspension or revocation,if the site plans or intended ase change,or If the Information submitted in this application Is falsiAed or changed I,also,understand that Ian raspondble for all charges lncamd 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 owned by to conduct all testing procedures as necessary to determine the site saitab DATE /A-1 " 9 9 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. QHS Revised DCHD(07/99) Invoice No. / / Y 1 C 0 S J va 195 14th Qry ; l20 1 Z� II O �d 8 Ito 00' � I ,t X38) �1 s, 3t W 7 a`. a i o 04i r I w-� "' `• r DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5789-76-5851.41 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#41 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: '411100 Water Supply: On-Site Well Community Public l Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L. Slope% 3 HORIZON I DEPTH (7— Texture groupSCV ��- Consistence Structure MineralogyI 1 HORIZON II DEPTH -22 Texture group Consistence Structure k Mineralogy HORIZON III DEPTH Texture group GY �' + Consistence S Structure S�3 Mineralogy ` HORIZON IV DEPTH 12�4 Texture groupSr Consistence Structure Mineralogy SOIL WETNESS O RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE n Q SITE CLASSIFICATION: 1' EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 0.4 OTHER(S)PRESENT:' ► REMARKS: 7�,�t_L Cezae— FS P02>lTlo LEGEND Gco� 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 Mois 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 05/99(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street_ Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 990006154 Tax PIN!EH#: G9-090-130-041 Billed To: Jeff Sessoms Subdivision Info: Marchwoods Lot#41 Reference Name: EXPANSION Location!Address: 2161 S March Ferry Road-27006 Proposed Facility: Residential Expansion Property Size: 1 Ac ATC Number: 6047 **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 Tank Date Tank Size Pump Tank Size Bedrooms: System Installed By: Installer# Date: GPS Coordinate: Environmental Health Specialist Date: DCHD 11/06(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 M 990006154 Tax PINfEH#: G9-090-BO-041 Billed To: Jeff Sessoms Subdivision Info: Marchwoods.Lot#41 Reference Name: EXPANSION LocationiAddress: 216• .S March Ferry Road-27006 Proposed Facility: Residential Expansion Property Size: 1 Ac ATC Number. 6047 Site Type: ❑New ❑Repair qExpansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior t9 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. I2I4 Fpto 3 614 Residential Specifications: #Bedrooms' ' #Bathrooms _#People_Basement Basement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size _ Type of Water Supply: O'County/City ❑Well ❑Community.Well System Specifications: Design Wastewater Flow(GPD) Tank Size kiA Pump Tank A AL. Trench Width 3& Max.Trench Depth 3 l Rock Depth-4/'' ' Linear Ft._/o As tUted In 15A N%-IAC 18A.1989(5 Site Modifications/Conditions/Other: ,,,.,,�y,�a� cin n :y ��b 11rfm " f C.)n Contact the Davie County Environmental Health Section for final inspection of this system between 8:30=9:30a.m.on the da of installation. Telephone#(336)751-8760. a �q ------------ &.tC.c Environmental Health Specialist Date: DCHD 11/06(Revised) Davie County Health Department l> A 4`► $r Environmental Health Section fi . P.U.Bos 848 �� r EKED 210 Hospital Street ;� . .. REC Cornier# : 09-40-06 Dai; Mocks%ille,NC 27028 Phone:(336)-753-6780 Fax:(336)-751-8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection 70 Name: i ��.r S�5 s 0�^-S Phone Number 913 (M G (Home) Mailing Address: 7-f& 1��1ti✓L' (�✓�✓7 -q91 2-12) (Work) �T G J v�Lci JVG 1- (o b Email ,S cSSy��S Detailed Directions To Site: ( l Co S v c,_-tz, -- �a✓� o,go-otl Property Address: 2 b 5, . f a. FG ,( Please Fill In The Following Information About The EXISTING Facility: Q . M�11Zeh ulv(odS Name System Installed Under: I J l G�_ t AjenvS1v_' Type Of Facility: f��9•'►-� Date System Installed(Month/Date/Year): Zv U 1 Number Of Bedrooms:_� _Number Of People: Is The Facility Currently Vacant? Yes�� If Yes,For How Lone? i Any Known Problems? Yes No If Yes,Explain: Bei JI Y, V�►�.� �� Gs� Please Fill In The Following Information About The NEWFacility: Type Of Facility: A Number Of Bedrooms:Number of People Requested By: Date Requested: ( 1424 ///.3 (Siler ) I For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: e signing of ME Torm.By Me EnvironmenM TIME.Statt is In no way-intenctenor MUM a Men as a guaran ee (extended or limited)that the on-site wastewater system Nvill function properly_for any given period of time. Payment: Cash Check Money Order 4 Amount:$ Date: / / 3 Paid By: Received By: Account#: 17,11U 0 Invoice#: (�(6q