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1496 Peoples Creek Rd f DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Se age Systems , ✓✓r 4- Permit Number Name_S i1C N2 7944 Location �' /r �d % :� r�F G,', ZL Subdivision Name Lot No. Sec. or Block No, Lot Size /a o�R�_ House —� Mobile Home —_—_ Business -_ Industry r No. Bedrooms �_3__.No, Baths �2_ No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO a Specifications for System: Auto Dish Washer YESNO ❑ , Auto Wash Ma^hine YES u NO Type Water Supply Srez *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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. Improvements permit by — *Contact a representative of the Davie County Health Department for fin inspect' of this system between 8:30-9:30 A.M., 1:00.1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Nu er. 70 34-5985. ��5 j Final Installation Diagram: SysIe In aIIed by Q� Y r 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. Up APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P 1 TLl/ Davie County Health Department TR E C E O V1E 0 lEnvironmental Health Section P.O..Box 665 DEC 191994 Mocksville, NC 27028 --------------- 1. Application/Permit Requested By Malling Address Y C A) r Altlolyeel D Home Phone 9,5"—8 yo 5l Business Phone M57 2. Name on Permit if Different than Above 5pq m 3. Application/Permit for: ❑ General Evaluation EK Septic Tank Installation 4. System to Serve: (3 House ❑ Mobile Home ❑ Place of Public Assembly. ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home:Subdivision Section Lot # ❑ Basement/Plumbing No.of People ❑ Basement/No Plumbing No.of Bedrooms O'Washing Machine No.of Bathrooms �� - ❑'Dishwasher Dwelling Dimensions p"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: IR Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor ? 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 5 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$ j�rD dN �e i� ► g /'��i la s C la i�/ X Fvjv&-t- This is to certify that the information provided is correct to best of my knowledge d I understand I am responsible for all charges Incurred from this application. DATE SIGNATURE CONSENT EM MM EVALUATION IQ 0 DONE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 9 1. I QM the property. ❑ 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 representi of the a ' C n Ith Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to deter nes id sl a suitabili ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(12.90) 1.88 c�,• , - 4, .,t•, r ,t', ; ` ` lie cF 3.26 App-wwi'•ls'. ,43 yr i 1+ i.r��•. ) y • 115) , (3 j ' N ' IN r y 59 AC s �I123.52 Ac) ♦ ! Roza (5A) 39 2 8.71 Ac 549 5p0 .. ` a ` ,0.`i Ai4rY 4 °` ^r` �5 . k � � � VSA y I� c. 8.03 T. a °�.+,< 5 Ac a: 41.8AC' r �s' �& . a' ci 10 8.05 R +� 16 �? 6.22AC? j' 8406 y�vt• . ..;. 4.6qc Ac 2,3 2.78„�, � t DV. •R 1450 I^ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME U �J1% DATE EVALUATED ADDRESS PROPERTY SIZE 11471_71' _r PROPOSED FACIILTY ZU S✓� LOCATION OF SITE � 43!� e�,�, < 412? Water Supply: On-Site Well Community Public L/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group C-- Consistence Consistence 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 , SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: r 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 :lay 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 ■■■■■...■.■■....■■■.■■■.■■■...■.■■.........■.■.......■...■....MEMO ■■■.■M■MMM.■E■...■.■.■.■■■....■■.■■.■■..■■MM■MM.■■MM.■E.■MM■M.MMM■ ■.■■..■.EMM..■M■■■..■■■■■■.■■.■■■■■■..■.■■■.■.M.M■.M■..M...■.MM■E■ ■.■■.■MM■M■M■■.■MMM■■MMM.■..■.■■■■■■MM■■E.■..M■..M....E.M........■ ■■.■MEMM.■■■.■■M...■■■■■s.■■MMM■.■■......■..■..■..■.....■.■.■■...■ ........................... ................... ■MMMMMEMMMMMMMMM■■ ........■......■.............■.............■..........■..■...■■.■■ ■...■■■■■■■.■■■■M..■....■M■.■R■�■.....//...■■.■Mi.M.EMMi■tit■ME■ ■.■...M■■.M.■MME■MM■MMM.■■■■■■■■■■■■■■■■■.MM■..■■...■.E■■....■..■■ ■.■.■..M■.M.■MME■..■M.■aM■..■■■M■.■M.M■.■EM.■..M■■=■■.■■....■■■.■■ ■MMOM.■MM■■M..MMO.■EMM■..M/.■/MMM■M..MM..MM■■■.M■■ M■M■■■■■■O■■.■ ■■...■■.........■..■■■■■■■■EM■.■.■�..0..■....N..Ee...■.■M..■MEN.■ mom ■■M.....M.M.■MMM..MMM..MM■M..■..�i.M.MMM.MMC.MMMM.EMM.EM.M..M.MM.. ■.■■■■E..■■.■■■.MMM■.NO.■■M..MO.■ON■■.■■■..Men.M■■�■...■■.■..■■ ■■■■.00M.O.MO.M...M■..E.M..■....■..■M..00MM...MOOO.■■ ■EMEO■MOM■ ■ ■.■■■M■■.■.■MMM■■■■OMM...■E..■■.■MMM...■■■.■..■..■ N.■....■.M■■�. 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Box 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 December 29, 1994 Gray Potts 57 Riverview Townhouse Dr. Advance, NC 27006 Re: Site Evaluation Peoples Creek Rd. /Approx. 12 Acres Dear Mr. Potts: As requested, a representative from this office visited the aforementioned site on December 27, 1994. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure