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1401 Peoples Creek Rd Lot 12 .. .r e..:-;v•"';.="�:.r•.�.`,.q aF,*.:.v`.m.+},'w+.x'hr'4i+:-+.rsFr:i.i...w witid7�-...v--,..--,w„c.-,,y,Jy3 •T•:':.wg"°ti,++P-'a'i'i" y-"a.�Nr----w.—fir----Y::..-r-r.--•r,w"''�`T r•""c Ana. DAVIE'COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Ch per 130a nita Sgwage Syste f lye, J�� Z PermitNu �jer Name Avid Vim/-/7�°r R?/�/ lt4ic 5i Date 7^ NO U v 1 Location — Subdivision Name �'1lC Lot No. f`2 Sec. or Block No. Lot Size House Mobile Home _1/T Business Speculation No. Bedrooms 7 No. Baths No. in Family J — Garbage Disposal YES ❑ NO ❑ Specifications for System: .:.Auto Dish Washer YES ❑ NO ❑ � Auto Wash Ma thine YES ❑ NO ❑ ,GOD Y3 v�� •, Type Water Supply --- /r *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`we 3 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— 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. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION •NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a / Sanitary/, Sorge geSstemsS � �2 Permit Number r,4,.Name Date 7-2 NG 68.5 Location — Subdivision Name !j Lot No. Sec. or Block No. Lot Size House _ L,-'— Mobile Home _T Business Speculation No. Bedrooms No. Baths -� No. in Family_:Z _ Garbage Disposal YES ❑ NO ❑ Specifications for System: , Auto Dish Washer YES ❑ NO ❑ Auto Wash Ma.hive YES ❑ 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. v t F 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 _ 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. r/ AT R EVALUATION/IMPROVEMENTS-PE APPLICATION FOR SITE Davie County Health Department �) Environmental Health Section P. O. Box 665 Mocksville, NC 27028 4 � . 1. Application/Permit Requested ByHEALTH DEPT. Mailing Address :6Z4 Y� ms's- L sM.rid�1c >• 2'1 0�2 Home Phone C- G�E:) Business Phoneg!)T R q 4- 2. Name on Permit if Different than Above 3. Application/Permit for: 49-General Evaluation ❑ Septic Tank Installation 4. System to Serve: O'louse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # 12 9-13'a No. of People ❑ Basement/No Plumbing No. of Bedrooms -Washing Machine No. of Bathrooms --I) 4=- B hwasher Dwelling Dimensions Q-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: 4D�ublic ❑ Private ❑ Community 8. Property Dimensions gab'I,I 1 ov -, <F S O Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes EI-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: P�.opy�� lop 7�•7 • 7=- This This is to certify that the information provided is correct to the best of my knowledge,and I understand 1 am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. I 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 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 said site's suitability for a ground absorption sewage treatment and disposal system. DATE d SI NATO E DCHD(12-90) OD 47 (b J Aj • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section //`' Soil/Site Evaluation J NAME _ l lie'el'V 4 DATE EVALUATED ADDRESS PROPERTY SIZE 7�q-a PROPOSED FACIILTY "*�71" LOCATION OF SITE Water Supply: On-Site Well Community Public L� Evaluation By: Auger Boring ,/ Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group C C C Consistence C' Structure l/, ! Mineralogy ' 1117 14 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE _ CLASSIFICATION 79 LONG-TERM ACCEPTANCE RATE-1V I SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: c y 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..eee■ee■■■ ■■e■■.e■■..■e■■.■e■■■■eee■■■eee■ ■■■■■■■■■■■■..■e■e■■■■■■■.■ee■ce�■■■.■■■■■..eee■■■■.■■.e■■■■■■■■■ ■■■■■.■■■■■■■..■■■■.■■■■■■■■■..■■■■■■..■.■■M■...■■.■s■.■eee■■■Mee■ ■■■■■e■■.■.■.ee.■■ee■■■■■■.■■■■e■.■..■..eee..■..e.■■■■■.■■■.■■■■.■ ■i■■■■■■■■■■■■■■■.e■■■■ecce.■■..■■■■eee.■■.■■.■■■■.■.■.■■■■■■■■e■ ■.eee■.■■■■■■■■■■■■■■e■■e■...■■■.■■.■■■■■■..■..■..■.■.■.■■■.■.■.■■ ■■■.■■■■■■■.■■■.ee■■■ee.■e■e■e■■ ■.■■.■...eee.eeee.ee.i■..■■■.e.■ ........................... ......■.....................■......... ■.■sMMM.■■■■MM■■■■■■.■...■...MM■�.■MMc:.MM..M.■............■■..■■ ■■■■■■■■■■■■.■■■■■e■.■■■■..■■■.■ ■■e.e.eeee.■■.ecce■.■■■■■■i■■■■■ ■...■■....■■n...■..■■■■a■see.■■■■■■■■■■■.■■..■.■..■.■.■.■■■.■.e■.■ ■.■■..■■■........■..■..■■....■■.■■ .■M.MM..M11.M.......MM■■■.■.■MEN ■■.■..■.■■■■■■..■■.■■■■..■■■■eeeee■..■■.■■.off...■■■■■..■■■eM■■�■■■ ■■Mee■■■.■■.ee■■..ee■.Mee■■■■■.■ ■e.■■■e.■■■■.■■■.ee...ee■■ee.ee■ .................................................................. .................................................................. .................................................................. ................................ ....■........................... ................................................................. ■.■.■.■■■.■.e.■...►�■■w■.....■■..■■.■ire.■..■.■■ri��.■■....■ Monosson ■■■..■■■■.....■■■■I�■.■■.11�ooC:ooMo�i�M.■.■MM■..■MIS■MMMMM.M.■MM■.■M■ iiiiiiuiiiiiiiiiiiiiifniiiiii iiiiiiM■iiiiiii■iiiiiiii ■■■■■M.■■■M.■■M■�...■■■��M■■■M■■MMM■■�i■■■MMM.MM.■.■MMMM■M■.MMMM.M■■ ■■■.e.■■■..e/■...■■■■e.l�.■■■Mee.■■■.<1■.....■....■ ■■ Moon ■..n.o. .......................:::...:::� �. ..........�.■CNOME CMonsoon ■■M■■MMM.■.■M■■■■...■■�..■■••�.::■■M..■■MMM..■=■MM■.Mn.MC..■..M�M ■■M■■■■Mr�MM��.■e:.■MM■.■■.MM.■■MMM■■■■■.■Mn..■■■�■M■....■■■.MMM■■■ ■■■.■■n►��■■.■Mn...■■..■■.■■Myr■..MMMn...M■...■■■MMM..■M■ n■.■.■.. ■■■■MMM■M.■M■M■MMM■■■■MMMM■MMe■■■MM.■.■■.■MM■■■.■�M■■■■.M�■■MMMM■■ ■.■■.■■s.■■■.■■■M..■■■■■n.■...■■ ■■..■■MMM■...M ■.....■■.■.■.■■.■ ■MMM■■MMMMMMMMN..MM.MMM.M■■■...■■MMM■■■■.MM■■M..MM■■M.M■MM.M.■■■■ MEMEMEMMIMEMMIMMMEMEM= ii�iiiiiiiiiiiiiiiiiiiiiiiii=iiiii ........................................... ..................... ................................ ................................ ■.■■.■.■■e.e.ee..■■■e.■■..ee.e.e.■eee■■■.eee■..■■.■.e■■Mee.■Mee..■ ■■■■■■■H■.■■■■..■.■.■■■.■...■..■■...■■...M..■.....M.■.■MMM..■■■.■ ■.■■..eee■■■ecce■.■■e..■■e...e■■�.eee■■eee■■.e..■ee..e■■■e.■...e■ ■■■eco■■■■■■■■■■■c■■■c■■c■■c■■cccc■■cecc■■■■■■■eec■c■e■■■ece.ccc.■ Mee■■■ecce■ecce■■eee■■■■c■■■e■■■■■■■■■■■ee..e.e.....ee■ee.■■ee..e■ ■■e■■■e■.e■■.e■■..■.e■....e■...■eee■eee.■■e.■■■■..e■■e■■e■■■...■■■ ■■■ce.■c■■e■■e■■■■cee.ee■■c■e■■■ ■■esc■■c■■■■■■■e■.e■■ee■■.■ecec■ DAVIE COUNTY HEALTH DEPARTMENT vL- Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS Aea/PS `ate,C PROPERTY SIZE Ir. PROPOSED FACIILTY Ile LOCATION OF SITE ,�/)� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit . Cut FACTORS 1 2 3 4 Landscape position Slope % �- HORIZON I DEPTH Texture group1'•L r',C. L S'L Consistence Structure Mineralogy HORIZON II DEPTH Texture group (o Consistence r !3— Structure ,r 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 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 watef 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 ........................... ..........................■.■......... ■.■..aMMeM■.MMM■MMM■M.■■■M■M..■■■■■■...■.■.........■■■■■■■■■■.■.■■ ■■■■■.■■■■■■■■■■■.■■.■t■■■■■.■■■ ■■■■■....■..■..■■....■■■■■i.ME■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■ ■■■■■■■■■■■■■■.■■■■■■M■■■■E■■■I1 ■■■....NM.■■.MMM.MMM■■M■.■.■■■i�■■.MMMM■.■.■....■....■.■■... .I/M ■■■.■■..........■.■■..■.■.......■...■o��n■■■■■■■■■■■.■■M■■.■■■.MMM■ MOMMENMENNENMENNEN ■.■■■...■■■.■■■....■.■■■■■■.■.■■.■■►iii■■■■■■■■■■.■■�■■■■■■■.■;.■■■■■ ■■■■■..■.■■■■■■...■■■.■■..■...s�r�.a■.■■■■.■■■.■■.■■■�■..■....■.■■■■ ■■■■■■■■i■M■■■■■t■■■■.■■S■■■OI■�: ■MM MEMO■■■■ ■■■M■.MMM■■/IM■■■■ ■.■■.■■■■MMM■■■.■■M..MMMM■■■/�►�M.■■■M..■■■■■M■■■■■■■.■■■■■MI.M ■■■■ ■■■■■■■MME.■■MMMMMM�/■■■��OMM■■■M■ MMMMM.n►�MMMMM■ MMMM■■■M�J1M■■MMM■■ ■MMM.■..■■■■■■■■■■■I/t■■II■■■■.■■■�■M■.■■V:/■■■■■■■■■■■■■t/M■■■■■.■■ ■..M■■■.■.■■■■..■M.��■.��.■■■■MM■t■MM■■.■■II■.■■■.■■■■■■MSI■■MM■..■■ ■■■■E■■ ■■■ ■■■■.■��■.■.■■.M■■■■■■■■■■■■■■■■■■■■.■■■r�■■■■ ■■M■■ ■■t■■.■■ ■■■ ■■■■■■■..■■■■■■■■■.■■■■■■■■■■■■■■.■■■■■■■ll■■■■■■■■!■■ ■M.MMM■MMMMM■■■.■■■■■■■■■■■■MME■ ■■■■■MMM.■E■MM■■MM■■/M■■■t■■■■t■ ■■■■MMM.MMMM■■■■■■■MMMM■■M■MM■■M■■MMM■■■■MME.■■.MM.■MI■M■MOM■■■■t■ ■t■■MMMN■EEEM■■■MMM■■MM■O.M■■.M■MMM■M■MM�MM..MM..M.MI�■MM■■.MMMMMM ■■■i■■■E■■MOM■M■■■■■ ■■■■■■■■■■■.■i■■MMM■■■MM■M■M■■■M�1.■■M■■.M■■M■ ■■MMM.■■.■M■■■.■■MMM�MM■MM■■■MMM�MMMM■■.MM.MMM.■■M■■11MM.■MM■MM■■■ ■.MMM■■■■M..M■.MMM■■■MMM■■■MM■■■■MMM.MMMM■MM■■■MM■MMI/.■NONE■MMM■■ ■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■■■■■■■i■.ti■■■■■■■t■�/■■■■■■Mitt.■■ ■■■■■■■■■■■i■■■■■t■■■E■■t■■■■■■■■■■■■■tit■■■■■i■■■■■\ii■■■■■■■■■■■ ■■■MMM.■■MMMMMMMM■MM■MM■M■MMM.MM■MMM■.M..MM■M..■..■■►�■■M.MMMMM■■■■ ■...■■■M■■■t■■t■■■■t■■■■■■■.■MMM■■■■MM■■MM■■MM.■MMM.M1■...MMMM■.M■ ■.■■MMM■MMM■■■■■■■■.■■.■■■■■■■■■■■■MEMO■■■■■.■MM■■■Mi/■■MMM.M■■M.■ ■■.■■■■■■■■■■M■■■■■■■■■■■.■■■■■i�■■■■■O■■■■■■■■.■■NII■■M■■..■.M.■.