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1225 Peoples Creek Rd (2)
, � �. , • � DAVIE COUNTY HEALTH DEPARTMENT � • ' Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 1L2� �,�`' Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 �w,,,,��2's Billed To: Elton & Patty Sawyer Subdivision Info: �'���+ Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility Barn&Guest House Property Size: 5.55 acres ATC Number: 4060 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his Form/Authorization Number should be presented to the Davie Counry 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: ,�/,�}'/� Date: �/��/�j� CERTIITCATE OF COMPLETION **NOTE** T'he issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation 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 guazantee that the system will function satisfactorily for any given period of time. � l� � �� �s' � Septic System Installed By: / Environmental Health Specialist's Signature: ,�^;t(�/fl Date: c� DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ��/ - • Environmental Health Section • � � ' P.O.Boz 848/210 Hospital Street ���_ ��� �-� ' � Mceksville,NC 27028 (33G)751-87C0 Q (p ��-�� � IMPROVEMENT/OPERATION PERMIT Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 Billed To: Elton &Patty Sawyer Subdivision info: Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility Barn&Guest House Property Size: 5.55 acres ATC Number: 4060 **NOTE**T'his ImprovemendOperation 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 STI'E PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type ��/�1 �.��5'��'Pe�op�e� #Bedrooms .,�� #Baths�� Dishwasher: � Garbage Disposal: ❑ Washing Machine:f� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�� Design Wastewater Flow(GPD)� Site: New�1 Repair❑ �� System Specifications: Tank Size�QGAL. Pump Tank GAL. Trench Width� Rock Depth� Linear F�� Other: IA5 yt�tod In 15A NCAC 18A.1969(5� �����€��s-R�ay-a�s�e-�-�mu Required Site Modifications/Conditions: INIPROVEh1ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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(33C)751-87G0.**** G���� �b�s�` ��f� �d� ,�- " � � Environmental Health Specialist's Signature:�_J����/ Date: `��� DCHD OS/99(Revised) . • DAVIE COUNTY HEALTH DEPARTMENT . . • Environmental Health Section ' � , , "� P.O.Box 848/210 Hospital Street • Mocksville,NC 27028 (336)75]-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 Billed To: Elton & Patty Sawyer Subdivision Info: Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility Barn&Guest House Property Size: 5.55 acres ATC Number: 4060 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 C' f�#People �� #Bedrooms�_ #Baths_�� 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 (�D Design Wastewater Flow(GPD)� Site: New�Repair❑ System Specifications: Tank Size�OGAL. Pump Tank GAL. Trench Width�6�Rock Depth���Linear F�,� Other: Required Site Modifications/Conditions: I]V1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF C,`�BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 930 a.m. or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone# 's 33C)751-87G0.**** �� �R �t� �� , � �� � ���s� ��U�� � � I- Environmental Health Specialist's Signature: �' �D�ite: � / DCHD OS/99(Revised) . � G15StLL hAYts rax:lU43b5y51Z Dec 15 2004 11:34 P.03 �— , _ , , ,� z- 1 -- �� ' ' � davie county envhealth 336 751 8786 Z .y0k 03:29p . . �- �:� ';J � p � � � � - ' , AI'PUG17lON FOR SITE EVpLUAT10N/1MPItOt'EN£trT PERMI7�r ATC � � � � Davia Counly Health department `^A/� �rrviroamerrta/Hea/tb Sedion V r��� _ 6 � �. P.O. 8oa 848/2ID Ho�pital Street ! J^ `.�locksville� KC 27028 LOO� l' (\����' ' (336)751-0�60 �NVIRpNp9£NTq ► R•*it�poRrArrr**+ TFixB A1'PLICATIoN C,.r�TOT E�PROCs3SE0 �Th^..S3S rI.L TFCE REQA�1tEp •DAVI�CO �N�A(rH \\' 72SF0&]IfATZON IS YROYIDBC. RefeT tv t�0 TNFORMATION BIILT,ETZR for iaae�cl•ioae. . ' U�vry � . ��1. xamo eo ba 8112ad �tL CbeCneC t�tJon �� .' ��"1���� -/n���i�e t�aar�oe �._oy1C�iCia r�J�j �Home Faon ��CSty/statc/ttY _ .ne��.7(C�Hvaanaas lAon � ' «. Naeie on 9�xsait/J�7C i,f DStierrnC than dbove � � � � . _/�,1� d �/'1/ �ii� ...rt4iling addreAo , Cicy/5C6ce�2ip ,,111� � / � ��U � r - �, • • '� Applicncioa For: �91te 3v�,uatior, [7 ImprovemoAt 8ez�n.ic/ATC / Botih � ; �, sy�e.m ee s�:.ic�, L►`i�xoune C1 Mobile Iioma d Businesa CI Iada�tXK YJ Oth U��('� � � �� � �:. iype �yace�y requeated: !d conveneion:i d con�.ac:onal modttiod , ❑ inno�i[i�o •• / �� - ��f. ZL Rasidence: 1 people: ..C_ r Hedrooma ,�_ � ��/7�����r�� � sat�ooroa i ntfAvaa��r Garbage Diapo-�al Na�ns.,�¢xa�nin� QBaae��nC/P1umDiaq Daancn�nC/No l3webiag �' . 7. I! B��Sn�i�/ZndusCsy/Othex: veriPy t�e � peoDle / �;aks . � ! Cbwrode^. A Ehorera y NCSn�lp p ►7Ater Coelare IF' BOODSHaV2CT.: 1� 3aata 8atzmetod Water Veaga (9�1100� yer day) �,�.�. 1'yp� at ��ter cµvply+ rl CounCy/City {Vel7. ❑ Community . ` �. na you eu��lelpaCc aaaiesona or CYPafISi0n5 oI Ihc(acility llils sYSfetu(5 1Dtcllde(�(0 bcK�CY O Yt6 . 191Vo ✓ 1(}�cr,�vl�at t)•Pc2 f�.�.��' � +�•IMP fTlJM�"*`CLI.EN'T5 MUSTC PLIP,ETIIL RLQUIR�D PROPERYY INFOrtMpT101V RCQUCSI'CU (SLOW. �iUicraPLATorSITICPI,ANMU TBE5U6M(7T�GDbyfl�cdicut n'1t11TNISAPPLICAT(ON. �roperlpA��nc�u;ona:�OrS�, (�YRITSDIREC'i10N5(fromhlotl'srific)torRorr�tr�•: �?$ i7 3St��� y �as OIIcc PIN: 11 -,�td r—5 �D Ta �;�i����i 5t+vf/�- . : �/�'r o p e r t}'A i l J r e s s: R o��i s�e » 7 3'7�Lo-i� 6 L�,-.��Y F�rt p�� C���,' , �� ,�t. ��G►+T��y�T City/ZiP�� � t� . 1!iu a S ' • . � 1�1i'l+Y([/t-11C:d<C �M4QCH"1��`t7� lvame:, _ Scet�on: ���J _ rcc l�omc cornc�s tlaggcd: 1..� l � 1 C`��� LD�5 �S � Th(s is to�....., ._,.........,..�,.�....�.1,��„�u�u i�eurrecc�o tLc Ucst of niy knniti•Icdgc. I undcrstantl tl1a[1ny pcntut(s) �-� inucd hcrcafter�i e s¢6ject tv suspc�uiou or rcvocatioii,if tlie sltc plaiu or intcnded ase ehnugq nr if tl�c informntion cubmif fn1 in this opplieativa is fatsitied or e1,aa6�J. .f,wlau,rurJera�tar�d d�nt I qi1�rr�nolr5lGlCJa�a!1 ChQ�eS ll�e�l�7Cti jrnp� , rl,Lt�ppricnrto,�. I,hv�b7;givc co�ase»t n�thc Auo�oriicd Acpresentnlivc o(tlic D•rvic County]fealth Dep�rtnmi�l, - - to¢nfer upon abovc lcsciibed pro�urty IucatcJ in Davie County snJ otie�ted b lo<a�J�ul nll t lin proccdiires as n�ces;�+')•lo Jetennine tGo site su;tnb' �•. • fI1A'I'E � (r7 � ^ C��NA7URL `. T1113 ARCA MAY J3E USED fOR DRA�vING XOUR SITE Pt,AN(Indudo all o(ll�c followissg: Exi9tiur aucl propastd - proper(y lines�nd�imctuions� structurc;;SC[backs, and srPtic lOcatious), SiteRcvitif Cua�'(C ' �c( ^ Datc(s): ' �� f���� CGcnt Haii[Icacion Datc: . l Z �4.�'(i'1 . . £�$: � . �� 1 �� � _ Sign�ivGt �S Ateutult No. � c�� /�� �v!� �J • ltcti•iscd l)CI D(OSI03 t �J � ��p� 1n�o�«No. z �d �yo� �o� t4�� a�� +c���: �b� �.dC.�l _yOCZ 'ZZ ,��0 .,_ . , ' ; : ..;�.�� •. . • . ` : . . �5���'�'ti� �od��bfn-�`�'� ,�.� . �! ��''�. ' • . . �� ���-� `�� ��t� d �, ; � , . :T +'� //'' � . � •: .. / �� � . . • ' • . •ti` �� � `., , ,� . . fx�z ��'�a� � 6Q�0 �I 'F�" ` :�' _,, �:. �� - ��'-� '^,�� . . • . . 4. '�� � $ � . • -�-v„���a�,� �- �,.�, �a �� . •,. . �, ��, �.. � � ��a,, �,Q •U� .� �' � , �,L" •.(� � �� � •. 4' ; :.. • `�' `�� �� `=� ���ri'��`Y �, � . �� � ,. �r r �x ,��� .�o t• �� � �� w� bATA A.LOHCt S�UTI�ERN 1�/)f' ,�. •. 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M 55:s. ;•;tli$'��T��-1Q),�y�o. � IftG.{g TDTAL • • � , t••', � ���� .; 4, $ t�02, �� -_. . •... . + 7a7AL. 572,j3�3E'Ol• y ovtRLnF }�� d � r ' �-f <'O,^ 09.g� "�.x+ "• . ne� 'L+ d ��r h , ••a M r � ! � . 134,y• � � L"'' �^'+� � � �nLa�V•�' 1Ai . � Q►P ��' �v �"' y1S.6 'J � O) a � i , �� � _ �' .r' .y � i j '1 cv ! �it'Sv-- -tR `_ "'" � �� �`� ,,. e �_ i�Z � . ? . c., j aai., � �ii�� � , � � . , , , • , DAVIE COUNTY HEALTH DEPART'MENT ' � , ' • ,� ' ' Environmental Health Section ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 Billed To: Elton& Patty Sawyer Subdivision Info: Reference Name: Location/Address: Peoples Creek Rd.-27006 � Proposed Facility: Residence Property Size: 5.55 acres Date Evaluated: ��/l"�-S Water Supply: On-Site Well Community Public Evaluation By: Auger Boring /� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition ,L, � Slo e% HORIZON I DEPTH �` �� '<r /, Texture rou �' �L � Consistence � Structure Mineralo HORIZON II DEPTH �� �� �� ^ Texture rou Consistence i- / r- -�` Structure yQ b!C J /' Mineralo /.'� HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,� , SITE CLASSIFICATION: �� EVALUATION BY: �1�t '!"/ LONG-TERM ACCEPTANCE RATE: � � �� L 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-Tenace 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 Mineralo�v r-� 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[o soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gaUday/ft2 DCHD OS/99(Revised) ; � ■���■��������■■��■���■��■��■�������■�■�■�\■������■��■�■����������■ ■����\���■����■����■������■�����■■�������■�����������■�����������■ 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Box 848/210 Hospital Street � Courier 09-40-06 � Mocksville, NC 27028 �� � �' � (336)75187,60�' � ` � � . ., rv C, P u S � �a.«...,ca.........�.rv.+...,e..x�r....,.w..c........n.wr......+,..�+.w. �.....oA,_.u_-..__....�..,v...w,c..e�.....ro.,..,�r,�....�...r...,...a.v.«....,. ,.�w.w.Y. ..r�,.u�.«a�,...,...n.sur..v�.�� � - January 12, 2005 Elton Sawyer 41155 Stonebrook Farms Road Greensboro ,NC 27406 Re: Site Evaluations/House and Barn locations on Peoples Creek Road Tax Office PIN: #5789-97-7377.06 5789-97-3054.05 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, January 11,2005. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the sites,the sites were found to be provisionally suitable for the installation of on-site sewage systems. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, � �a�►'�`����• Robert B. Hall, Jr.,R.S. Environmental Health Specialist RBH/dlf Enclosure(s) SENT BY: ACANTHUS ARCHITECTURE, P.A.; 336 721 2103; h1AY-4-05 10:09; PAGE 1/2 � • A � AN 'I' I� U S ARCHITECTURE .r;:� �`/ ' OS / f ?'D : �vG r� �� �.N V I/L-d N /L�'G N�L, (*��/t"C-�'�-f 7��G�/�C_f �� 'f�2 c/',iN : (j�-� �G.c/�s Tr-Yl `l�b n.g-v�� ��) � - � /7�-42 ...�2. J-C,q-�,.,� � L/t/L �` � L. � ``�'JL!r / 1' /I ! � � �./{w �� � ✓ I�"�-•/ �V�� f V �2V v� �r jN�v�.M�r o.� ��v tJtR/ !1-�`�/4/t-r7r�✓(� 1�C1/L �''R-o P �'1'L7-Y a�U � �v v L c`.S C`2�t-� J�--v�-i0 . 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N .D �� ��� - � . , y ��y�','C'4I1�.�.. __ .N .� � �',�^ 3E5.�: rc�,r, \ _ ` o »� ._ _'_y -- S �t:�goo: 1 f � 1 '—� . �- '.�. - ~�: � Tl f !�o P�z'.�v c.c.c.�� � ,�rj_��--,�, ~�;y 6 �, .:,- ��-- Gu(�S( GoTT.4Gtl ?M�5`�S�l��� ^';,�'?, f�E'�.�Tn2�}„ �. . �.1 ' �� Y •-`�. � � _s�r� - � �^ Tf�ACT 5 ---- _ °�:� �.���� �c. � `' TnAt�T 7 � H w - ����� •� 5.Q3g AC. � .:z.� , � =��e-- �`�,�.. ; � 2 � , �=+h..� TDTn� �• • 1ora " B3'aro�. V OvERUP ",�--�•��r�- .� �` 5)2.75 r+,' . :OS_" : `�'"--r '�=%'w.`.•• - nnr• 'i' --GAP 2Q9 v4 1 '�__.ia""R �-�u��ts ,,- „�,�t-�.7 � f � � e�.I ����. �._ �� .� Tn�TAL= 68b.60 ,�+ , f � Y C7f . 1 � p� � L�1 j ';� r ' � ` T312.M' -16B.67~ � � �� • g _�T' ��' � 0 4' 1 �^ � t z o. ! � I o��'`'�C j.._. �..._' �:»_���-�--�` 4'�; 1 cr� o, 7 ! w a. � • � � � t ""° CO2''ET7'E GR. �� � m� �► oa � J t � �,a 1 r � r `'' � , ``'-- t �v - t �� 1 � � ! �z Q � z 1 , r z�o w-- 1 -' 1 �' a' o' ! JOE f. MORG� �ai z� t � i � �,a, f .�ct Q Q a o �� : �� l ,�^ l Q� 1 Q . j Q 1 D.B. 196. Pg. . . 0..: � > _ _ .� z�- J _ +- _ N ( . � . DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section • .�'� P.O.Bog 848/Z10 Hospital Street Mocksville,NC 27028 (336)7�1-87G0 IMPROVEMENT/OPERATION PERMIT ' Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 � Biiled To: Elton &Patty Sawyer Subdivision Info: Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility Barn&Guest House Property Size: 5.55 acres ATC Number: 4060 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 C f�#People�_ #Bedrooms�_ #Baths_�_ 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 (�� Design Wastewater Flow(GPD)� Site: NewYJ Repair❑ System Specifications: Tank Size�OGAL. Pump Tank GAL. Trench Width;�6�Rock Depth���Linear F��� Other: Required Site Modifications/Conditions: I1�IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6"BELOW FINISHED CRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m:or 1:00 p.m.to 130 p.m. on the day of installation. Telephone#is(336)7�1-8760.**** �. QR r r �oUCS� }f�u�s� � �— i Environmental Health Specialist's Signature: D�te: DCHD OS/99(Revised) � May 13 OS 02:25p p. l • • �� ���_ � ��-- g � r � ' � � �• APPL(CATjON FOIi SITE EVALUATI�N/Ih1PI�OVEhiCNi PEBhiIT 3c ATG O � ' Davie County Health Department ��O FrtvironmentalHea/th 5ection �� P.O. Box BQ8/210 Iiospital Street ��� • Mocksville, NC 27028 r � {336}752-Fi760 3 �O � *�*SMPORTI►N1'k** THIS APPLICATION CANNOT 8E PROCESSED UNLESS ALL T23� RE4UIREA El�f� INFORMATTON IS PROVID�D. Refer to the YNFOTiMATION IIULLETIN for inntructions. �iV'�1t�,,j .a � '`��/f�0'��H `j. Hazne to be IIillcd ��-��h� �� "'N 7' �t^�Y?� ConGact Person � U�.� T'� ���(� Hdiling TddxoaA ���� ���-��cGf�� �4�'1..�w 7iome Phone (9 City/S[ate/zIP �"'�Y�����►C�CY�� r�1e .'�7HC�lc IIuaineae phono J-3�O^���� [ a 3` -�2. Namo on Pacmit/11TC SE OSGEorant tha�a Jlbove ��'i�' 1�-ri IQ1��G' Mailiag Addieaa City/Stato/Z1p �d. Application For: D Evaluation �'Zmprovement Permi.t/ATC ❑ Hoth �GL��S"�- '�wS� _{. Syc[em to Survlcei�iause O blobile Home ❑ IIusinesn ❑ Induatry 17 Other �. lypo eyoiem raque9ted: ❑ Conveational ❑ conveational aodi£ind ❑ itutiovativo ' 6. Sf Residance: Y Paople � ! IIedrooa�s _� 8 Dathroome � � IJDSahraeher lYciarbage Dlapoaal JIOWauhing Machina �IIa9ement/Plwnbing ODaucmont/t�o P1umUing T. If 8velnaue/Iaduntry /Other: verify type • People M sinka i Coamwdea � Shoirora d Uriaala 9 Nater Goolera ZF FOODSfiRVICE: � SOats Estimated Watar Usage (gallona par dayl e. �ypa ot ra[or euppiy: I�County/City L] Well Q Co�unity � �v. ao you anesctpaea .�dditlone or expansions of tkc facilify tl�is systcm is intcndcd to scrvc?D Ycs �Tlo If ycs,tivl�at typc? `�*lA1POltTifNT°*t CLIrTVTSAfUSTCOAfNLG7E7'I!E.r.EQUlltED PROPLRTY INFOILAIKCION KEQUGS'CEU iTELOtiV. tiither a PLAT or SITE PLAIY AlLST BCSIJIJR!lTIED bq thc elicnt wiUi TII1S APPI.tCATION. �fi ropertq Dimcnsia�s: .� ��e.r-s ✓},YRITE D1RL•'C'f[ONS(f�v�u Mocks�•ilic}�u I'20PL'it'Cti': T orr�e rin: u�Z,P 9- �?- 36S�f` n5 t-(� -�� `'•�o t 5en1 Tr� `PropertyAdctress: Ro�dNamc IZC9 �i'�5L'�S i.Q�- ^ ��? �� rB'��� C�� �� . c;iyr�i� �,1 a�,.t�_,:.� �t�t G — f�.�i nf>,�Tv 8 f9 lF� A�T.r,C, If in a Subdivision providc iniormation,as tolloNs: ����"�w� ����'K�'� Namc• Scction: litodc Loi: atc Lomc corncrs 17agbcd:��� DJ �--�-+t �.vl D C.-�t�1 4�5� �f;`,S.ys�,.. �r o�-t-t-�`��,z.J s is!o e�erG"fq tliat tlie n[ornsation pro►•iJed is corrccl to tl�c bc:t of�ny I:notiricdga I aadcrsland lliat any permil(s) issued 6creaflcr are subject to suspensiuu or rewcation,iC qte siie pl�ns or intended use cl�ange,or it tLe Iuformafiou sobmilted in Uus applicaliou is falsificd or cl�angcd. I,olso,a�rdcrstaad O�at I anr resporrsiGle jor aJ/e/raiges incrrrred jram lGls nppficNiox. I,8creby,givc rnnseni to ihe Autborized Rcpmscul�tivc of tl�e Davic County Ile�ltli Drpartmcut to cuter upon abore ttescrtl�etf propcYfy located in Dai•ic Cvunty aiui o+ri�cd by (o canduci a1!feFliug procedures as necessary ro determiue tlie Site suitabil' �J1hT��/ZI/C.� 'v-SIGNATURE . � ' TIIIS AI2LA IYfAY B�US�D POR DI2AWING XOUR S7T�YLAN(Includc a1t of(Tic follotrittg: Lxisliug and proposcd pYoperty lines and dimm�sions,structures, selbadcs, and septic locatioas). Sitc Kevisit CL�rgc . ; Datc(s): Clicat Notificalivn Datc: �FIS- Sigu givcn /" v Account Pta. � ���� � / Revisal ACFID(OS/03 Invacc No. , � . . • DAVI� COUNTY HEALTII D�I'ARTIVILNT ' - ' ' ` , ' Environmental Health Section ' Soi]/Site Evaluation API'I,ICANT iNI+ORMATION PROPER7'Y INFORMATION Account #: 990003449 .Tax PIN/EH#: 5789-97-3054.05 Billed To:. Elton & Patty Sawyer Supdivision I�fo: � Reference Name: � Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence �roperty Size: 5.55 acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cu[ � rACTORS ! 2 3 �1 5 6 7 Landsca e osition Slo e% HORIZON I DEI'TH Texture rou Consistence Structure Mineralo HORIZON II DEPTH Tcxture rou Consistencc - Structurc " Mineralo HORIZON I11 DEI'TH Tcxturc rou Consistence Structure ' Mineralo HORIZON TV DEPTH • Tcxturc rou Consistcncc Stn�cturc Mineralo SOIL WETNESS RL•STIZICTIVG FiOftIZON SAPROI�ITL' CLASSIFICATION LONG-TERM ACCGPTANCE RATE SITE CLASSIPICATION: CVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: RGMARKS: LLGEND � L�ndscapc Position K-Ridge S-Shoulder L-Lincar slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convcx slope T-Terracc FP-Flood plain H-Head slope Tcxturc 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 ' CONSIST�NCE ois VFR-Very friable FR-Friable FI-Firm VFI-Very firm LFI-Extremcly firm Wct NS-Non sticky SS-Slightly sticky S-Sticky VS-Vcry Sticky �, NP-Non plastic SP-Slightly plastic P-Plastic VI'-Vcry plastic 'lrucl �rc 'SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky . SBK-Subangular blocky PL-Platy PR-Prismatic VLiincralogy � 1:1,2:1,Mixed oe � . Horizon depth-In inches ' ' Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface `. Saprolite-S(suitablc),U(unsuitable) ' Soil wemess-Inches from land surfacc to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitablc),PS(provisionally suitablc),U(unsuitablc) LTAR-Long-tcrm acc�.ptancc ratc-gallday/ft2 . � f�CI IO 05/99 (Rcviscd) � . . . — • DAVIE COUNTY HEALTH DEPARTMENT ` , .. Environmental Health Section � � � ��p �� ` . _ • ` P.O.Boz 848/210 Hospital Street � Mocksville,NC 27028 (336)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 Billed To: Elton &Patty Sawyer Subdivision Info: Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility �e�e�ee� ��9f� PropertySize: 5.55 acres ATC Number: 4060 **NOTE**This Improvement/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 #Bedrooms���=-�t� #Baths � Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size S r s-��L Type Water Supply�� Design Wastewater Flow(GPD)� Site: New❑ Repair❑ System Specifications: Tank Size��j�iAL. Pump Tank GAL. Trench Width�lRock Depth���Linear Ft. ��� Other: Required Site Modifications/Conditions: I1�IPROVEh1ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6"BELOW FINISHED CRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparlment for final inspection ofthis 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(33fi)751-S7G0.**** � f' - � Environmental Health Specialist's Signature: ��''��� Date: �, �S DCHD OS/99(Revised) , . _ ,. - . '' DAVIE COUNTY HEALTH DEPARTMENT • - � � Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990003449 Tax PIN/EH#: 5789-97-3054.05 Billed To: Elton&Patty Sawyer Subdivision Info: Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility Residence Property Size: 5.55 acres ATC Number: 4060 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs 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. Septic System Installed By: Environmental Health SpecialisYs Signature: Date: DCHD OS/99(Revised)