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202 Marchmont Dr Lot 21 CONSTRUCTION For Office Use Only T AUTHORIZATION 'CDP'File Number 197463-1 aid N Davie County Health Department County ID Number. 210 Hospital Street Evaluated For. EXPANSION P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 1 0 / 1 5 / a 0 a 0 Applicant: Robert Braswell Property Owner: Robert and Sharon Braswell Address: 783 Fesmire Street Address: 783 Fesmire Street CRY: Asheboro City: Asheboro StatefLip: NC 27203 StatefZip: NC 27203 Phone#: (336)408-3934 Phone#: (336)408-3934 Property Location & Site Information Address/Road #: Subdivision: Marchamont Plantation Phase: Lot: 21 202 Marchmont Drive Advance NC 27006 Directions Structure: SINGLE FAMILY 1-40 exit hwy 801 exit, turn right , to Peoples Creek Rd on left after crossing RR tracks, Marchmont Plantation on left #of Bedrooms: 5 #of People: "Water Supply: PUBLIC System Specifications CFlowMinimum Trench Depth: a 4 : Provisionally Suitable Inches Minimum Soil Cover. 1 a OYes OQ No Inches 6 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a 7 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Septic Tank: 1 a 5 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: OYes ®No Pump Required: OYes @No OMay Be Required' Nitrification Field 8 7 3 Sq. ft. Pump Tank: Gallons No.Drain Lines a 1-Piece: OYes ONo Total Trench Length: a 1 8 GPM—vs— ft. TDH Trench Spacing: 9— ( Inches O.C. — Feet O.C. Dosing Volume: Gallons Trench Width: _ 3 2Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-II Septic Tank installer Grade Level Required: OI OII 0111 OIV Donn 1 of l COP File Number 197463 - 1 County ID Number. T ❑ Open Pump System Sheet Repair System Required:@Yes ONO ONO, but has Available Space rDesign System Trench Spacing: 9 E03 Inches O.ification: Provisionally Suitable - Feet O.C. Trench Width: QInches w: 6 0 0 - . 3 . V Feet Soil Application Rate: 0 .2 7 5 Aggregate Depth: inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Minimum Soil Cover 1 a Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches � - Maximum Soil Cover: a 4 Nitrification Field a 1 8 a Inches Sq.ft. No. Drain Lines 6 *Distribution Type: PUMP TO GRAVITY ' Total Trench Length: 5 4 6 ft Pump Required: @Yes ONo OMay tae Required Pre Treatment: ONSF OTS-1 OTS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. If there isn't enough space to add an additional 1,000 gallon tank and still have fall to the existing septic lines,pump and crash existing tank.Install a 1,250 gallon tank,reconnect to existing septic lines,and add 218 feet of 25%reduction system. *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for wastewater System Construction shall be valid fora person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)}If the installation has not been completed during the period of validity of the Construction Perml%the information submitted in the application for a permit or Construction Authorization Is found to have been Incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become Invalid,and may besuspended or revoked(.1937(8))•The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: . 1 0 / 1 6 / 2 0 1 5 Authorized State A - Malfunction Log OYeS @Hand Drawing Oimport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 197463 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 1 0 / 1 6 / 2 0 1 5 Q Inch Scale: OBlock ?�l _ ra ,,�o ti ization ONIA D � rr Y T _ L400 - f - } "� t w C5, CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: 197463 - 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: 10 / 1 6 / 2015 Click below to import an Image from an external location: Drawing Type:Construction Authorization . -D APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Bos 848/210 Hospital Street Mocksville,NC 27028 d '- (336)753-6780/Fax(336)753-1680 Application For: 9 Site Evaluation/Improvement Permit C Authorization To Construct(ATC) ❑Both Type of Application: []New System CRepair to Existing System VExpansion/Modification of Existing System or Facility •■•1MPORTAN7++'THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Ro b e r f [-j V Cl s W e-11 Contact Person Billing Address '70'3 I=e-s'rvt i r e- 51', Home Phone 33(0-4t7 --593 L f City/State/ZIP_$-6heloolo, K C 2-7 7,0- , Business Phone Name on Permit/ATC if Different than Above — 5 Cxv"e — Mailing Address City/State/Zip PROPERTY INFORMATION 'Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included:B Site Plan CPlat(to scale) S ee-Dvi cy,n n 1 Per m,� (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name- Robe v+ at-K.4 S hct rn v 3 rcxs w e_t l Phone Number 3 aro-408--3cl34- Owner's Address '7133 Fesvni v't 5't', City/State/Zip lk-SLAe_bVrc�N C 7-y7-y-0y0 5 i"c�- Property Address SUR Mar.h m o n t' p r r v�. City i ve yr ee 1V C_ Lot Size -�, 27 Ate.re. Tax PIN# R ec.# G�75 32'72.1 Subdivision Name(if applicable)Wl ztrch wovvf Pt a n a on Section/Lot# V Directions To Site:—,&(F Peoples C re-p 1c R©cid /*cLVA oce- nt If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? %Yes CNo Does the site contain jurisdictional wetlands? ❑Yes ISNo Are there any easements or right-of-ways on the site? ❑Yes)dNo Is the site subject to approval by another public agency? []Yes$INo Will wastewater other than domestic sewage be generated? []Yes 1allo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms 5 Garden Tub/Whirlpool❑Yes 9No Basement:DdYes ❑No Basement Plumbing: 5dYes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: �Conventional ❑Accepted CInnovative CAltemative COther Water Supply Type:W County/City Water ❑New Well ❑Existing Well 0 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 Yes X No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department 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 comers and local g an flagginging the house/facility location,proposed well location and the location of any other amenities. Property owneerrr''s or owner'ssllegall representative signature Site Revisit Charge Date(s): cl^Z S Client Notification Date: Date EHS: Sign given [I Yes 0N Account# WLiO Revised 11/06 Invoice# A DAVIE COUNTY HEALTH DEPARTMENT J, -I IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:Issued in Compliance With Article It of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name r , '� `r.X�. !i / Date /'.:. 'J`f N2 G 6 4 Location z� ► , Subdivision Name /���)•"1 gyp^ Lot No, i Seo-or Block No. Lot Size <%?� House Moblle Home Business Speculation No.Bedroonjs,- _No.Baths 'y No.in Family •P Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES ID NO p Auto Wash N. ine YES [p NO ❑ �• Type Water Supply 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation If site plans or the Intended use change. re Improvements permit by J_X `Contact a representative of the Davie County Health Department for final inspection of this system between 8:3D- 9:30 A.M. or 1:o0-1:30 P.M. on day of completion. Telephone Number:704-634-5985. Final Installa ion Diagram: System Installed by 1 o i Certificate of Completion !�� �� Date 'The signing of this certificate shall indicate that the system described above has been Installed in compliance with the standar s set forth In the above regulation,but shall in NO way betaken as a guarantee that the system wilt function satisfactori!I for any given period of time. _ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Po W'd:. ZM4RdjWojj4 _br, 33ba 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 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 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 MOW 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 LY9ttes 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 acceutance rate-eal/davM2 nrun ncrnc fID-4 AN OPERATION PERMIT or ice use nv Davie County Health Department *CDP File Number 197463-1 210 Hospital Street P.O.Box 848 County ID Number, Mocksville NC 27028 Evaluated For. EXPANSION Phone: 336-753-6780 Fax:336-753-1680 Township. Applicant: Robert Braswell Property owner. Robert and Sharon Braswell Address: 783 Fesmire Street Address: 783 Fesmire Street City: Asheboro City: Asheboro State/Lip: NC 27203 StatefLip: NC 27203 Phone#: (336)408-3934 Phone#: (336)408-3934 Property Location & Site Information r dress/Road#: Subdivision: Marchamont Plantation Phase: Lot: 21 202 Marchmont Drive Advance NC 27006 Directions Structure: SINGLE FAMILY - 1-40 exit hwy 801 exit, turn right , to Peoples Creek Rd on left after crossing RR tracks, Marchmont of Bedrooms: 6 Plantation on left #of People: *Water Supply: PUBLIC *IP Issued by. 'System Classification/Description: TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFO) *CA issued by: 2140-Nations,Robed Saprolite System? 0Yes (E)No Design Flow: 7 a 0 * GRAVITY-SERIAL Pump Required? DisttibutionType: OYes C7No Soil Application Rate: 0 - 2 7 5 *Pre Treatment: Drain field (Nitrification Field 1 7 4 6 SQ.ft• *System Type: INFILTRATOR QUICK4STANDARD o. Drain Lines 4 Installer FrdnkTransou Total Trench Length: 4 3 6 ft. Certification#: 2771 Trench Spacing: _ 9 ()Inches O.C. _ * Feet O.C. *EH S: 2740-Nations,Robert Trench Width: 3 Inches Feet Date: 0 6 / 0 7 / 2 0 1 6 Aggregate Depth: inches _ Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Approval Status - Inches ` � Maximum Trench Depth: 3 6 ® Approvetl 0 Disapproved Inches Maximum Sail Cover. a 4e / Inches CDP File Number 197463 - 1 Septic Tank County ID Ntfmber:• Manufacturer: shoat Lat. STB: 760 Long: Gallons: 1000 Installer Frank transou Certification#: 2711 Date: fa 6 / 0 7 / a 0 1 6 ` *EH S: 2140-Nations,Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter 1 6 ST Marker: 11 Yes ® No Date: 0 6 / 0 7 / a I7 ReinfarcedTank: ❑ Yes (E NO AppranialStatus y 1 Piece Tank: ❑ Yes [� No � ®yApproved❑�Dlsapproved Pump Tank Manufacturer Installer. PT: Certification#: Gallons: *EH S: Date: / / Date: RiserSealed ❑ Yes ❑ No Riser Height: ❑ Yes ❑ No (Min.6 in.) y A rovaiSfatus- Reinforced Tank. ❑ Yes ❑ No ❑ Approved❑ Disapproveda 1 Piece Tank: ❑ Yes ❑ No Supply Line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: *Schedule: THS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status ❑ Approved❑ Dlsappiroved Pump Requirement Pump Type: Installer. Dosing Volume: — Gal Certification#: Draw Down: Inches *ENS. *Chair: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ElYes ElNo Apptoval,Status PVC unions ElYes ❑ No F ❑=`A pproved❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No CDP File Number 197463 - 3 County ID Number: Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: ,Approval Status Alarm Audible E3 Yes El No ,=Q Appro-15 ved Disapproved Alarm Visible ❑ Yes ❑ No 2140-Nations,Robert *Operation Permit completed by: Authorized State Agent Date of Issue. 0 6 0 ? x 0 1 6 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal,15A NCAC 18A .1900 ef. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE III A. sewage septic system. Rule.1961 requires that a Type TYPE III A- septic system meet the following criteria: Minimum System Review By The Local Health Department: WA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: WA Reporting Frequency By Certified Operator.N/A Rule .1961 requires that a Type IV and V septic systems designed fora hometbusiness owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system. Rule.1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 197463 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: i I Olnch Drawing Drawing Type: Operation Permit Scale: pelock ON/A I } h } � I CONSTRUCTION For office Use Only AUTHORIZATION "CDP File Number 197463-1 Davie County Health Department County ID Number 210 Hospital Street Evaluated For. EXPANSION P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 1 a / 3 0 / a 0 a 0 Applicant: Robert Braswell PropertyOwner: Robert and Sharon Braswell Address: 783 Fesmire Street Address: 783 Fesmire Street City: Asheboro City: Asheboro StatefZip: NC 27203 StatefZip: NC 27203 Phone#: (336)408-3934 Phone#: (336)408-3934 Property Location & Site Information rAddress/Road #: Subdivision: Marchamont Plantation Phase: Lot: 21 202 Marchmont Drive Advance NC 27006 Directions Structure: SINGLE FAMILY 1-40 exit hwy 801 exit, turn right, to Peoples Creek Rd on left after crossing RR tracks, Marchmont Plantation on left #of Bedrooms: 6 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign ification: Provisionally Suitable Inches Minimum Soil Cover. 1 a ystem? OYes QNo Inches w: 7 2 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 .2 7 5 Maximum Soil Cover: a 4 Inches "System Classification/Description: "Distribution Type: GRAVITY-PARALLEL(eq.d-box) TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 Gallons "Proposed System: 25%REDUCTION 1-Piece: OYes QNo Pump Required: OYes QNo 0 May Be Required Nitrification Field 1 7 4 6 Sq.ft. Pump Tank: Gallons No..Drain Lines 4 1-Piece:OYes ONo Total Trench Length: 4 3 6 ft. GPM vs— ft. TDH Trench Spacing: _ 9 Onches D.C. Feet O.C. Dosing Volume: _ Gallons Trench Width: Inches 3 - "Feet Grease Trap: Gallons Aggregate Depth: - - inches Pre Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01 Oil 0111 OIV Donn I ^f'1 CDP File Number 197463 - 1 County ID Number. ❑ Open Pump System Sheet Repair System Required:®Yes ONo ONo, but has Available Space rDesign System Trench Spacing: 9 O Inches 0. . ification: — ©Feet O.C. Trench Width: Inches w: 7 2 0 _ 3 @ Feet Soil Application Rate: 0 a 7 5 Aggregate Depth: inches Minimum Trench Depth: a 4 Inches *System Classification/Description: TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Minimum Soil Cover. 1 2 Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Nitrification Field a 6 1 $ Sq.ft. Maximum Soil Cover: 2 4 Inches No. Drain Lines 6 *Distribution Type: PUMP TO GRAVITY TotalTrerich Length: 6 5 4 ft. Pump Required: @Yes ONo OMay Be Required PrePre-Treatment: ONSF OTS-1 OTS-II 1 - "e) "Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. "Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall bevalid for a person equal to the period of validity of the Improvement PermI%not to exceed five years,and may be Issued at the sametime the lmproveme t Permit issued(NCGS 130A-336(b)}If the installation has not been completed during the period of validity of the Construction Permit,the Information submitted in theapplication fora permit or Construction Authorization is found to have been Incorrect,falsified or changed,or the site is altered,me permit orConstruction Authorization shall become Invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps.Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: . 1 a / 3 0 / a 0 1 5 Authorized State Agent: Malfunction Log Oyes *Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 197463 - 1 X210 Hospital Street P.O.Box 848 County File Number. Mocksville NC 27028 Date: 1 2 / 3 0 / 2 0 1 5 Olnch Drawing Drawing Type: Construction Authorization Scale: . OBtock O N/A r� C :> -z_ I o a _ lip I jj z { - _ _ CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 197463 " 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: 1 .1 / 30 / 2015 Click below to import an Image from an external location: Drawing Type:Construction Authorization � f o� / Ck CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 197463- 1 •" Davie County Health Department County ID Number: 210 Hospital Street Evaluated For: EXPANSION P.O. Box 848 '��...� Township;.. Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 1 0 / 1 5 a 0 0 Applicant: Robert BraswellProperty Owner: Robert and Sharon Braswell Address: 783 Fesmire Street Address: 783 Fesmire Street City: Asheboro City: Asheboro State/Zip: NC 27203 State/Zip: NC 27203 Phone#: (336)408-3934 Phone#: (336)408-3934 Property Location & Site Information Address/Road#: Subdivision: Marchamont Plantation Phase: Lot: 21 202 Marchmont Drive Advance NC 27006 Directions Structure: SINGLE FAMILY 1-40 exit hwy 801 exit, turn right , to Peoples Creek Rd on left after crossing RR tracks, Marchmont Plantation on left #of Bedrooms: 5 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 CSaproliteSystem? Provisionally suitable Inches Minimum Soil Cover: 1 � QYes (9 No Inches 6 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a 7 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE III A.CONV SYSTEM>480 GPD(EXCLUDING SFD) Septic Tank: 1 2 5 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: QYes ®No O May Be Required Nitrification Field 8 7 3 Sq.ft. Pump Tank: Gallons No. Drain Lines a 1-Piece: QYes ONo Total Trench Length: a 1 8 ft GPM--vs— ft. TDH Trench Spacing: _ Inches O.C. 9 Feet O.C. Dosing Volume: Gallons Trench Width: _ 3 O Inches ®Feet Grease Trap: Gallons 1 Aggregate Depth: inches Pre-Treatment: O NSF OTS-I OTS-II Septic Tank Installer Grade Level Required: 01 011 0111 O IV Page 1 of 3 CDP File Number 197463 - 1 County ID Number: ' ❑ Open Pump System Sheet Repair System Required:®Yes O No O No, but has Available Space CDesign System Trench Spacing: g O Inches O. fication: Provisionally suitable — ®Feet O.C. Trench Width: O Inches w: 6 0 0 — 3 ®Feet Soil Application Rate: 0 a Aggregate Depth:7 5 inches .� *System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Minimum Soil Cover: 1 a Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Nitrification Field 2 1 8 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 6 *Distribution Type: PUMP TO GRAVITY Total Trench Length: 5 4 6 ft. Pump Required: ®Yes O No O May Be Required Pre-Treatment: O NSF OTS-I OTS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Characters If there isn't enough space to add an additional 1,000 gallon tank and still have fall to the existing septic lines,pump and crush existing tank.Install a 497 1,250 gallon tank,reconnect to existing septic lines,and add 218 feet of 25%reduction system. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Remecr�9 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued at the same time the Improvement Permit Issued(NCGS 130A-336(b)).If the Installation has not been completed during the period of validity of the Construction Permit,the information submitted in the application for a permit or Construction Authorization Is found to have been incorrect,falsified or changed,or the site Is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? O Yes O No Applicant/Legal Reps. Signature- Date: *Issued By: 2140-Nations,Robert Date of Issue: 1 0 / 1 6 / 22 0 1 5 Authorized State A _ Malfunction Log OYes ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 ' CONSTRUCTION AUTHORIZATION 197463 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 1 0 / 16 / ,2015 O Inch Ilca�inu nra �Eo ti ization Scale: O Block Q N/A - -- t7---- ------- _ --- ,e (� ;------------- ----- - � ' _� j + .. .- --- - ........ _. ........ ..... x(06 i ------- ------- ---------- ---------- -- -------------------------- ----------------------------------------------------------- ........ ------------- ------------------- . 1 - - --._ ......... _--- --- _ ........ ......................!... --................. ..... ....... ......_.._ .............. ------ -- _ --- -- -t_ -- ------ -- _ _ . ..._ -- ................__. _...- } _. _. .___........................_................. ........................ -- ---................._..................._.......-_.................. .._.... ---..—--- _-...........-...... --............. ............................. -- 1 - -- _------------------------------------_-------------- ---- ----------------------- ----------... -- -- - - - - ---- Page 3 of 3 Pi P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 197463 - 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: .1.0./ 16 / .2 0 15 Click below to import an image from an external location: Drawing Type:Construction Authorization Page 3 of 3 P1 P2 DAVIE COUNTY HEALTH DEPARTMENT IMPbOVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 2=gyp 'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name Date >�/� N2 6,j F,` Location r r�;,=.�..,i .- - T / Subdivision Name /'>>�7 ." �= Lot No. Sec-or Block No. Lot Size f/J r House 1� Mobile Home_ Business Speculation No. Bedrooms �� No. Baths No. in Family T" Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES Q NO ❑ Auto Wash Machine YES p NO ❑ ,Type Water Supply 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by /.Z� 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number:704-634-5985. / J > Final Installation Diagram: System Installed by f f�� �J S " Certificate of Completion _Date �j� 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation,but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. f i DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION f `NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit"Number Name Date N2 6064 Location eo�z�e&'2 AD 2m��2c6wa � Subdivision Name '2-0Lot No. See-or'Block No. Lot Size rL�'7 House �'` Mobile Home _ Business Speculation No. Bedrooms -- ? — No. Baths No. in Family Garbage Disposal YES ❑ NO Q' Specifications for System: Auto Dish Washer YEST NO ❑ / � "�'L�� Auto Wash Machine YES NO ❑ /Op��� r`� ­Type Water Supply — 4 *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. .�• lam' rA 1 Improvements permit byy�� *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. f Final Installation Diagram: System Installed by `r Certificate of Completion ZI Date "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. 1 l APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department g Environmental Health Section CO �VN Z P. 0. Box 665 R` Mockaville, NC 27028 1 . Application/Permit Requested By z _ Mailing Address y K -2- All)k1,11VCE: AIC Home Phone ��� -73 9� Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: C) General Evaluation U/S/Tank Installation 5. System to Serve: //House +HA,13,9's/-1_' Mobile Home 0 Business -] Industry u Other 0 Unknown 6. If house, mobile home: Subdivision ln19 .})l40'0l - Sec. Loty No. of People Dwelling Dimensions k No. of Bedrooms ,^ylasement/Plumbing No. of Bathrooms �" ` Basement/No Plumbing Washing Machine /' i,�1 /*UI�r^C�-/ dishwasher 0 Garbage Disposal j 7. If business, industry, other:: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers S. Type of water supply: /public 0 Private Q Community 9. Property Dimensions .CST ` X//IR7^/7L,�,,,iaT.e.� 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes k-9'0 If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to trig_ best of my knowledge, and I understand I am responsible for all charges incurred from this application. Date Signature Directions to Property :. D A P_2 C-1 L EF 5 Crit mac: Te i�tiD 3 3 ,4j g"q "Al—1 1��✓�c � � Cru c sS /�,� DCHD (10-89) • DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) no 1. I am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. 6-,Z P—?,-> e/�,j DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: _Owner only ners designated representative Anyone requesting results Only those listed below DATE SIGNATURE DCHD(11/84) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE _:Z417 PROPOSED FACIILTY -�L � LOCATION OF SITE 1�rL' Z�zCr Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH �� �• �� Texture groupS S' Consistence Structure r Mineralogy HORIZON II DEPTH �/ Texture groupj Consistence G' C C O Structure -e;41 S' 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: ' EVALUATED BY: zz 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-Finn 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(01-901 ■.■■■■■■..■.■...iii............■■ ...........■■■.■.■....■.■■i.E..■ ■■■■.■■/■.■■■■■..■■■■■■■■.■■■.■.■■■■■■.■■.■■■■■■■■■■■■.■■■■■■.■■■ ■.■............■■!�I>...■..■■....■ ■...........................�■■■ ■■■■■■■■■■■■■■■■■tai■■■■■■i■■■■.■ ■■.■■■■'�.■■■■■■■.■■■■■.■■.■■■■.■ MMMMEN iMMOMMEMEN ON Ems ■■■■■■■■■■■■■■■■■■■■.■■■■.■■■■■■■■■■.■■■■■■■.■�■■■■■■N.■�■■E■■■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■■■■■.■ ■■ ■■■■■ ■ ■■■■■■■■ ■■■■■■■■ ���■■■■�■■■ ■■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■.■■ MEMO■ ■■OMEN■ ►iiw�■���:Awa.■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�.■■■■ ■.■■..■.■..■■..■......■........■�■.■.......■....■■■..■■■■.■■ NOME .■.OM....■■■■■....■■■■■..■■■■..■ .NOON.■e.■.■■■.■■■■■■....E...■■■ ■..■■......■■......ONE........■■........■ ■■■■■■■.■.■.■■.....■■■■■ .................................................................. ..................................................................