306 Marchmont Dr Lot 23��. .��- t �,,..� ,i �,r:�'- ...� -s-�`t,�, .x��;���6�,;r��j�r�.✓r`�w`�!Iy"drl.:✓t¢�=�'v��;.�' .,' ' � ✓X d
AUTHORIZVVTION NO: Q$6 3 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee, P.O.Box 848
Name: °' � Mocksville,NC 27028 Subdivision Name:
Phone#:704-634-8760
Directions to property:, 'r�%�r y Section: / Lot: +
AUTHORIZATION FOR f
WASTEWATER Tax Office PIN:# lf
SYSTEM CONSTRUCTION /
�SQ ` Road Name:,,,r
E.'.'5 Crkp tt!i tri
**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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal.Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH S ECIALIST DATE ISSUED
t,'�..y.��^.� � ��" 't� lel i .� f?"'�r ..Ifz.%.,,r r ,,�,,s��,roy,u,:ty. .> ;�A. ,+_`� e's ., ,yY, • r5,r., ati.n:n-...r .,:,,r 1> 7 ''n � �6fpy.
DAVIE COUNTY HEALTH DEPARTMENT
Mv
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Perlflittee s k22
'064,Ar Subdivision Name: � �
Directions to prope :
Section / Lot ' .
IMPROVEMENT �✓ ,
PERMIT Tax Office PIN:#.� r f/ e _ e 4k
k3o LARoad Name: j��� , C' p; '�a^1 0 �»
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation 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)
***NOTICE***THIS PERMIT.IS SUBJECT TO REVOCATION IF SITE ,
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS -e/'—#BATHS, ? #OCCUPANTS / GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS - INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY T DESIGN WASTEWATER FLOW(GPD) /cfl NEW SITE ! REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK 2GAL. TRENCH WIDTH,V1 ROCK DEPTH LINEAR Fr. )n
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
s
---------------
3aa i+
. t
**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 THE DAY OF INSTALLATION.TELEPHONE#IS(704)6348760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
P
V
,r
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 05/96(Revised)
f: ,
e,A-0
` ,r lP0A +. �� PLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM
V N � Davie County Health Department D
l Environmental Health Section c
P. O. Box 665 DEC 1.3 ft
Mocksville, NC 27028 (
ENRORM
1. Application/Permit Requested By W
Mailing Address 114 1-14uc v/e DR . g w Home Phone-W�//D '4V 3-0113 Z
"g-e5vi( CC- /u- L4 a7oluy o4 o, Business Phon9 00 661-5-2-5W
2. Name on Permit if Different than Above
3. Application for: *General Evaluation XSeptic Tank Installation Permit
s
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown (t(
5. If house, mobile home: Subdivision 09,7 747 1,-,IJ Section&'`/-/3,0/ Lot # 23
r
Basement/Plumbing t
No. of People ❑ Basement/No Plumbing {{
No. of Bedrooms % Washing Machine
No. of Bathrooms 3 Dishwasher
b;
Dwelling Dimensions&;O(t4 aaoo - :2&D rr. [Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals `
t
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures is
7. Type of water supply: Public ❑ Private ❑ Community
8. Property Dimensions AnMcv 75'0 X ADD Sewage Disposal Contractor 7
4.
9: Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No
If yes, what type?
I
t {
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvementst Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989. {
PROPERTY INFOKIATION REQUL'
Directions to Property: Tax Office PIN �i 571, -0,?- 0&60
D / SoKnr ?b r Road Name
�iy ��„�� 8 Aa✓A.vc� r 7uev AIt '.
Box # (if available)
Div -,erw4 ?a, 4,om y e fc � 7HQN
/,vTv M,4f1Q,frrwJT j1c/fr+TflTisn�, inuow »7a:n, Zlb A2clu,vD City
Rif, sjac or:.�);2s i�� Cru To ��� oar P,1vt7,�crivT.
/JOTC- -T 7b 551�3 c C C-4 LL m c= Tv M&Z-7- c/
44Sti✓1L( v i9di9i[F}i3CC� , C'ACc tnG av,rM Xd`3cr(-7-5 .45 CC,05t; DRTZ: :Cole 1,4CCr
Is 'bee- deo "—' , /4cis�
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application. }
/Z-/3-qS"
t
DATE SIGNATURE }
i
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. )9� 2. 1 DO NOT OWN the property.
If you checked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representativq of the Davie CounV Health Dep rtment to enter upon above described €
property located in Davie County and owned by �fL�D�GrCr �Ct-c-U � riAon,VT .455n-iIA7/6w
to conduct all testing procedures as necessary to determine said site's suitabili f r a ground absorption sewage treatment i
and disposal system.
q5—
DATE
sDATE SIGNATURE
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DCHD(1193)
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` . DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health. Section
Soil/Site Evaluation
NAME e � -DATE EVALUATED ��/21/4'
ADDRESS PROPERTY SIZE ��}C
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On-Site Well Community Public Z.
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH r9 Y t
Texture group '
Consistence go
Structure / �z
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:
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
3C-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
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Dade County Nealt!i Va
artment
. . and .dome Nealt§ eney
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634-5985
i
December 22, 1995
i
William R. Englert
c/o CCB
P. 0. Box 24727
Winston—Salem, NC 27114
Re: Site Evaluation
Marchmont plantation/Lot 23
J
Dear Mr. Englert:
As requested, a representative from this office visited the aforementioned
' site on December 21, 1995. Based upon the information provided on the
application for site evaluation and after the evaluation was completed, the
i site was found to be provisionally suitable for the installation of an on—site
sewage disposal system.
i
If you have any questions, please feel free to contact this office.
Sincerely, /
Robert B. Hall, Jr. , R.S.
Environmental Health Section
ERH/wd
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Enclosure(s)
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