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1647 Peoples Creek Rd Lot 4 Pt;rrnitwe's DAVIE COUNTY HEALTH DEPARTMENT ' 'Nainec• Y�aG t" �1L L AJ Environmental Health Section PKOPERI;Y INF RM�TION' - 1 , P.O: Box 848 n Directions•to property: '601 10 �+%' "6=5 Mocksville,NC 27028 Subdivision Name: !' 1 �-•a Phone#:336-751-8760 o— °3 - _,,r{:-t1 K -n{ ►..t �J " Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION NO: 191 A Road Name: **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 icle I;I o�C�S"C6t}pter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVII�OiNTALiHErALTH SPECIALIST DAT ISSU D -1 � RESIDENTIAL SPECIFICATION:BUILDING TYPE�C1J�i#BEDROOMS .J #BATHS ' #OCCUPANTS GARBAGE DISPOSAL:Yes r o COMMERCIAL SPECIFICATION: FACILITY TYPE J#PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE`"`"�� 'PE WATER SUPPLY 1DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH S ROCK DEPTH I Z LINEAR FT. OTHER �/IS j L=►&>T i REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT �t I� L4 12-71OL4_— $t2lrl.r�c�1�4�-�h-� X Scr2 7 F�irLD v(fee ►��vJ � t►�� '� �S'(�� A� 01^1�t�a'11 atm r C Etch Ltxa t S LX. t •J b L t.3Z j1 c L R1�, T � i ----------------------- t r 35 *"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 (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: i t .'LAI, � 43 hS�3 xIZt1 �� AUTHORIZATION N0.0,4- l 4 OPERATION P IT BY: t DATE: LA **THE ISSUANCE OF THIS OPERATION PERMIT SH ' L INDICATE THAT TH DES SEISABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION 1900"SEWAGE 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 02102(Revised) s, DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION ' APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME__`V,4N eG �/ult/Sc/aI-V PHONE NUMBER 9�°"✓tea�s� ADDRESS �(,,�7 Rea.,a&j /'/�u,L'/� �G�d• SUBDIVISION NAME1VO4dAli-i A-, "V LOT # �t DIRECTIONS TO SITE l JIZ- -TGA tea/ .Z��Dc�� .�iy,�r s�. DATE SYSTEM INSTALLED IV NAME SYSTEM INSTALLED UNDER Uaac� ��c/aur TYPE FACILITY AoV NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY �'Dun7y SPECIFY PROBLEM OCCURRING DATE REQUESTED S-Zp'03 INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am re le for all charges incurrr from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT eek' �� Rev.1/93 t � DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE' OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sgtaary S`wge SyipA � _ �� Permit,y �b�er Name } Date NO f r 1�• r.� � . � •S',_ n,�}-' 1 .. )�f•.:J,..riL`�sa:� 1 j: . �`. �� j, tt .. `� J �'.�' Location Subdivision Name l Lot No. Sec. or Block No. ' Lot Size House Mobile Home Business __ Speculation No. Bedrooms No. Baths No. in Family v Garbage Disposal YES ❑• NO ❑❑ Spe�' i�,tjor�f�Sy�t . :_� '� Auto Dish Washer YES NO Auto Wash Ma shine YES }. NO Q. f7'd'�` 3 t \/ Z' hoc. 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 *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. Final Installation Diagram:_._ System Installed by VJ � f� . 10 � rt Y ertifi ate of Completion \�` -3 Date 'The signing of this certificate shall Indic to th t the system described above has been installed in compliance with the standards set forth in the above regul tion, but shall in NO way be taken as a guarantee that the system will function VXQ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE"OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a SqtWc gage S x a- - .'} - �� Permit ! ��r Name Date NO Location 51-1 _ - Subdivision Name Lot No. Sec. or Block No. Lot Size ' , U� House Mobile Home Business Speculation No. Bedrooms " No. Baths No. in Family Y Garbage Disposal YES NO ❑ SRe ' Wiordiosy0w. Auto Dish Washer YES ] NO p Auto Wash Ma:hive YES NO v k� ;'-1 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. 1- 1 � � Improvements permit by _— *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. Final Installation Diagram: - _�:-----System Installed by 1�IGv� � :4 Certificate of Completion 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT � ' Davie County Health Department AUG 2 01993 Environmental Health Section P.O..Box 665 „_-_,„_„___.-__ Mocksville, NC 27028 1. Application/Permit Requested By V/1 fie'19 Ad Mailing Address �`�c'i- y��rrc� Tca) i�im�iscJ pr Ad0lMee, IJ(. -Q7nOG� Home Phone q0 SGSS Business Phone 2. Name on Permit if Different than Above S�a1j1-e-- 3. Application/Permit for: 99 General Evaluation ❑ Septic Tank Installation 4. System to Serve: IA House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision e- x &rr�l JAJ4r,0 S Section Lot # // ❑ Basement/Plumbing No. of People ` ❑ Basement/No Plumbing No. of Bedrooms _3 [Y Washing Machine No. of Bathrooms p-Dishwasher Dwelling Dimensions ❑ 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 No.of Lavatories No.of Water Coolers No.of Showers Water Usage Figures 7. Type of water supply: 0 Public ❑ Private ❑ Community 8. Property Dimensions 3, Ae-re S Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes JZ No 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. Directions to Property: /S� �=��s 8'D! S�t� I� ,(e psi �c�0[�S '!: P'7 � This is to certify that the information provided is orrect to the best of my knowledge,and I understand I am responsible for all charges incurred from this application. DATE $f ATURE r CONSENT FOR SITE EVALUATION TO BE DONE QN ABOVE DESCRIBED PROPERTY Fand ECK ONE: ❑ 1. 1 OWN the property. (9 2. 1 DO NOT OWN the property. ked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County ycalth Department to enter upon above described cated in Davie County and owned by 'ff//12 /`07,44AV!," all testing procedures as necessary to determin said site's suitability for a ground absorption sewage treatment al system. DATE SIGNATir DCHD(12.90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation J NAME V mss - o� S �� W DATE EVALUATED L " 93 ADDRESS W'Q PROPERTY SIZE PROPOSED FACIILTY �o se LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By- Auger Boring 1/ Pit L'111 Cut FACTORS 1 2 3 4 Landscape position L-_' Sloe 9. a' lie o -�° HORIZON I DEPTH T. Z 7" Texture group C t_ C. L C `" Consistence NP Structure R Mineralogy : I '► HORIZON II DEPTH Ll a- Li el iTrr Texture group C C Consistence Structure AB k 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 •3 SITE CLASSIFICATION: 2.-S EVALUATED BY: �� LONG-TERM ACCEPTANCE RATE: OTHERS).-PRESENT: o N Q REMARKS: ' ' `� •?s 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 Mineralog+ 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 ■■/■■■■■■■■■■■■■■■■■■■■N■■■■■//■■/■■■■■■■■■■■■■■■■.■■■■■■■ ■■■.MSM ■■■■M■■■■eMMMMMMM■■MMM/MMMMMM/MMM■■■■MM■■■Me■■■EM■■eM■■■■//■■■■■■■ ■/■■.■■M■■■MM■M/■MMMMM■■MMM■M/MM.M■■/MM■/eMM■■■■■■■■.■■■■■e■■■■■■■ ■■■■■■./■■■/■■/■.■■■■/■MMM■■/M■■M■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■MMMM■■■■MMMM/MMMM■M/MM.MMM/MM ■■/MMM■■M■E■■MM■e■N.N■ee■e■■■■■■ ■■■Me/M■EM■■MM■MM■MM■■MM■M■■MEM.M■■■MMMM■■■■eN■■■.■NM■■■■■■■■■■.■■ ■■■■■■a■EM■■■■M■■■■■■MEM■■■.■■■■ ■■■■■■MM■eNEE■■■■M■■N■■■MNM■■NN■ iiiiiiii■iiiiiiiiiiiiii■i�iiiiii�iEiiiiiiil�iii�Miiiiiieiiiii■i=iii ■■■■.■..■..■.■■■■■.■■■■■!■MI i■■■■\l.■■■■NEEM■Il■C.■L.■■.■e■■■�.■■■■■■ MOON ■■/■ecce■■■■■■E■■■■■■ee■\/■{i■■■■■I■.■■■■.■■■IJ■Iltellt.■■.=..■. ■..■.■■ MMEMME rF,iMINNEEMENOMEN ■■■■■■■■■■■■■■e■■■■e■■e■■■■■■■t.■.■■■. 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C::'::::::: ::::::EM:::::::::: _ ■NOMEMME MEN MMMNIMMMMMMMMMMM on ■■■■■■E■■M■■■■EN■■■e■■■■■■■■`;�:•■ ■NE■■■■ ■■■■■■■M■MM■■MM■■■■ ■■■■ ■/■■/■■■■■■■■■■■■MEMM■M■■■■eMulc� ■■EMM■■ ■■■e■■■■M■E■■■M■MEM■eE■■ ■■■■■M■M■■■EMMe■■■■Nee//■■N/!!�■■�■��■eE■■■ ■eN■ E■■■■■■■■EN■e■■■■■■ ■■■■■■■A■■■MM■.N■M■■E■e■ ■1./�!fi'�■1\E■H■e M■Ee�E■E■■EN■E■e■■■Nee■■ ■■■■■■■■E■■■E■■M■eE■ ■■■■■■\<eY■■■/l■■■E■■■e■■■■N.N.N■EMM■MMM■MEN ■■ ■■■■■■■N■■■■■■■■■■■e�ieN■■■■■\\Me�►M■M■■■M■MeMM■■Nee■■MMMMMM■EMM■■■ ■■MM■■EEM■MEeee■■M■MM■■M■■MM■■\:rjMMMMMMMMMM■MNOWN MMMMMMMMM■MMM■M■ ■Nee/MMMMM■■MMMMMMEMM■eee■MMMMMME■■■■MMMMMM■e■M■■■■■■■■■■eNeeEME/■ ■/■MEMM■■MM■■MMMMMEM■■MM■■MMMMMMME■■M■■■■■eE■■■MM■■M■E■MMEMMMMEMM■ ■■■■■■■■■■■■■/■■■■■■■.■MME■MMMMM■MMMMEMMMMMMMMMEMMMMEMMMEMEMMMMM■ ■■■MEMMMMMM/MMMMEME■MMEMM■MMMEMMEEMM■M■■■■M■e■M■■■■■■■■M■■■■■■N■■■ ■■M■I=.■M■M■■■■■■■■NMN■■■■N■■■■■■EE■■■■■■■■■■■■■E■■■M■■■■■■■■M■■■■■ ■■E■ ■■M■■M■■■■■■MM■E■■■■■■M■E■■UM■■MMM■M■M■■M■■e■■E■■■■■■■n■■■■ ■■■■■■■M■■■■■M■MMME■■M■M■■■MME■■ ■■MNM■■■EMME■MM■■■■■E■M■M■■■■EM■ ■■MEMEMM■MMMEMMMMMM/EMM■N■■eeM■u■■■■■■■N■■■E■■N■■■■M■■■■■■■■■E■■■ i • " " DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME _ /yo0�� /1 DATE EVALUATED c'y ADDRESS P'QOAIPS �r.� PROPERTY SIZE PROPOSED FACIILTY llloarY LOCATION OF SITE dl� Water Supply: On-Site Well Community Public fl Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 Landscape position L L t L Sloe % G HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH .501v Texture group Consistence r r- 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 ,3 SITE CLASSIFICATION: r. EVALUATED BY: LONG-TERM ACCEPTANCE RATE: /9 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(01-901 ■■■■.■.■.■■.■■.■■...■■ee■.■■■e■■■■■n..■■■....ee■■■■■■■.■Mee■■■..■ ■■■■.■.■..E■M■■■■ee■■Me■.■■ e.■■■■■■■eM■M■eee...e..e.eetsEM■■ee■.■ ■■■■■...■■■■■■■....e■■.■■..e■■■■■■ecce■■MMe.■■■■.■eee.e■eee■■■..■■ ■■■■■■■EM■■■■■■■■■■■■■■...■■.E■■.■■■.e■■..■eee■■...e■eE■eM■■.■■■■■ ■.......■.■..■■.■...■Mee.■■...■■ ■■.■■■..■■■..■■..■■■■e.■.ee■e■E■ ■■■■■■■■■...e■eee■.......■.■■M■■■�.i■...■■■■■■e.■■..■■■■■..e■.■.■.e■ ■■■■■■■■■e.eecc■■■■■.■■■■s■■e■■■.■ ■.■■..Mee■ee■e■ee■e■e■ee■■■■e.■� ■■■■■.■■■..■■...■■■■■■.e■■■■■■■■■■ ■■■■.■■■..■■■■.■.■■■■■■■■■.■■■■ ■.■■.■.n■■■■■.■■■■M■e.■M■■■■■■■ `� ■■eee.eeE!■.■.■■.M.M■■■■.... ■.■ ■■■.■■■.■.e■eee■■■■■E■■M■■■■■■es�..�e■e■■e■■■■■■■M■Mee.■■■■■■■■e■■■■ ■..■.■■.■■■■■.■ecce.■■..■■■eeE■■�.r�.■e■■■.■■.■..■■■■■.■■■.■■■.■■■ ■■■■■■e■EE■■■.■■■.■■■eee..■..■.M.■■■■■■■■■.■■■■■.EeeE■■es■...e■ee■ ■■Ee.eeM■E■E■E..M■.MM■e..■■■■e.■ ■■Eeee■eeeEEe■..■.■■.EEEeeeeeeE■ ■e■eeeee...ee.e■eee■■e■ee■■■E.■■�■■■■e.■■■■E■eeeeeeee.■..e■■.e■■■ '.Mee■.■■.■.■■.■■..■■.ee■■.■■■■.■eee■.e■■■..■■■.■■.■.■■e■■.■.■■■■■ ..................■............................................... ........■..............................................■.......... 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