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1725 Peoples Creek Rd'ess 1725 Peoples Creek Rd d # Advance NC SINGLE FAMILY # ofb1&d[ooms: 3 # of People: 3 *Water Supply: N/A Basement: ❑ Yes ❑ No '_Proposed Improvement: Garage Property Location & Site Information Subdivision: For Office Use Only *CDP File Number 121123 - 2 G8-000-00-065-02 County ID Number: Evaluated For: HDR/WWC 'EjAAtT VALI D 0 4/ a a �/ UNTIL: Johnny Cagiagas 1725 Peoples Creek Rpz NC 27006 Phase: Lot Township: Directions 1-40 East tum right on Hwy 801 going South Peoples Creek Rd. Left at Advance Flower Shop 0 1 8 Type of Business: Total sq. Footage: No. Of Employees: It is the responsibility of the owner to maintain a 5' minimum setback between the wastewater system and any part of the structure foundation, including porches, decks, and any other appurtenances. If you are unsure as to the exact location of the septic system, please have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the --proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed. This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature: *Date: *Issued By: 2244 - Daywalt, Andrew *Date of Issue: 0 4 J 2 2/ 2 0 1 3 Authorized State Agent: **Site Plan/Drawing attached.* Total Time:(HH:MIM) Hand Drawing 0 Import Drawing 0 1 Hours 3 0 Minutes HEALTH DEPARTMENT RELEASE Davie County Health Department dA,,,Eo y 210 Hospital Street - P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Wayne Frye rty e Address: rAddress: t city: State2ip: NC State0p: PhA a #• (336) 462 86 Phone #: 'ess 1725 Peoples Creek Rd d # Advance NC SINGLE FAMILY # ofb1&d[ooms: 3 # of People: 3 *Water Supply: N/A Basement: ❑ Yes ❑ No '_Proposed Improvement: Garage Property Location & Site Information Subdivision: For Office Use Only *CDP File Number 121123 - 2 G8-000-00-065-02 County ID Number: Evaluated For: HDR/WWC 'EjAAtT VALI D 0 4/ a a �/ UNTIL: Johnny Cagiagas 1725 Peoples Creek Rpz NC 27006 Phase: Lot Township: Directions 1-40 East tum right on Hwy 801 going South Peoples Creek Rd. Left at Advance Flower Shop 0 1 8 Type of Business: Total sq. Footage: No. Of Employees: It is the responsibility of the owner to maintain a 5' minimum setback between the wastewater system and any part of the structure foundation, including porches, decks, and any other appurtenances. If you are unsure as to the exact location of the septic system, please have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the --proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed. This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature: *Date: *Issued By: 2244 - Daywalt, Andrew *Date of Issue: 0 4 J 2 2/ 2 0 1 3 Authorized State Agent: **Site Plan/Drawing attached.* Total Time:(HH:MIM) Hand Drawing 0 Import Drawing 0 1 Hours 3 0 Minutes Davie County Health Department Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Fax: (336) - 753-1680 Name: Z1l oir_ APhone Number �� L� -�s�b (Home) Mailing Address: (Work) Email Address: Detailed Directions To Site: Property Address: 3jv M EN//f1MLf/lmGi Please Fill In The Followingormation About The EXISTING Facility: Name System Installed Under: 4- Z .0 / Type Of Facility: Date System Installed (Month/Date/Year): Number Of Bedrooms:Number Of People: Is The Facility Currently Vacant? Yes � If Yes, For How Long? Any Known Problems? Yes 9f Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: l: l G Y —6 (C Number Of Bedrooms: Number of People Pool Size: Garage S 5 X Z L Other: > Requested By: QY�xx ' rr Date Requested: For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist, Date: W_J *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Check Money Order # Amount:$ Paid By: /� Received By: "{ o/ Account #: �q ? Invoice 12 1, Z3 Date: le,� r0-1. NDENBU GILYARD. 3f PETER T -'^ ter.,. X08000301 8120B000302 r x i sV 468 j N, _j IrMPROVEMENT PERMIT z xO . DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT —rAx.PN4�51ig39q�acP **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 6.5. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 0q0 NAME PROPERTY ADDRESS r����- � � K DATE LOCATION ` 1 S�� t. ��\ er. cb \ S - �\ y �Yc`7�4t>cL V"t)- I�A�� \",S"\ i) \ SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE V3%� �-" # BEDROOMS 3 # BATHSI_�-,_ # OCCUPANTS GARBAGE DISPOSAL:Ye No y 4 COMMERCIAL SPECIFICATION: FACILITY TYPE—, # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE:•Yes/No LOT SIZE %, C3 -c ---"TYPE WATER SUPPLY DESIGNWASTEWATER FLOW, (GPD) �� NEW SITE �. REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE)Ga d GAL., PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH I b LINEAR FT. 0 O OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE, YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. k IMPROVEMENT 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 THE,DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BYC,�(jSit_ AUTHORIZATION NO. Qjy& 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 10/95 �p /2 //Z 3 Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.D. Box 665 ""rk ►-'IN f� -57� '13 Mocksville N.C. 27026 AUT)(URIZATION FOR WASTEWATER SYSTEM CONSTRUCTION _ (Issued in compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems) .***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.*** c� ` \ c AUTHORIZRTION NUMBER W1=i \� R u\ \ 1� A �c �. X� DATE 1 - 3 - 1 1 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION ��es ��\ �� O P COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM - *"NOTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (S) YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE DCHD 10/95 APPLICATION FOR SiTE EVALUATION/IMPROVEMENTS PERM1 i Davie County Health Department t Environmental Health Section P. 0.. Box 665 : !OEC 15 9% Mocksviile, NC 27028 I 1. Application/Permil Requested By Sr) Mailing Address 4L90 MA i, A wlq-� 1 e `! 2)o o, nt7fi/,9, - Home Phone r7L 6 - Business Phone 2. Name on Permit if Different than Above ►'� 3. Appllcatlon/Permit for: EYGeneral Evaluation ❑ Septic Tank Installation 4. System to Serve: douse ❑ Mobile Home ❑ Place of Public Assembly O Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 3 O Basement/No Plumbing No. of Bedrooms 0 -Washing Machine No. of Bathrooms .Z 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: i�ublic O Private O Community 8. Property Dimensions (no �L �b . Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is Intended to serve? ❑ Yes El -No If yes, whit type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date Issued. Improvements Permits are subject to revocation, it site plans or the intended use change. Effective October 1, 1989. Directions to Property: 4/ 45 �Q '� �0 / �l G i � /1 1 4 Q ,?/ j��� (,t L:5 ti/'✓W /t ply 1, e1:5 e— �i�� Or✓ ✓� Fl Q G We Listteen! R E A L T Y 5342 Hwy 158 • Suite 1 Advance, NC 27006 This is to certify that the Information provided is correct to the best of 7myknow dge, and I understand I am responsible for all charges Incurred from this application. DATE SIGNATURE � • ► ► � : 4:�ffL�7►M�a� T�Z�7►1-moi- ► ; : �Pr�� : = � ' : a ' : a MUST CHECK ONE: O 1. 1 QM the property. 12-26 DO NOT OWY1 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�u�tyHealth Department to enter upon above described property located in Davie County and owned by Dd// i />'iC� l lr" a ;(7A/ , jL to conduct all testing procedures as necessary t determine said site's suitability for a ground absorption sewage treatment and disposal system. zZ %�/- DATE SIGNATURE DCHD (12.90) ..i � r,. •.+, � �`,r�� � R/i �• � A, .i.'!.. .rW,�.{•:. w. �r ..: �tf 'moi:•i �'';��'r:V: lC tfi R d rt:•'� �J :��.� 2Ra �> .J. tl�+.� i'ttN „•�,;Y r 'i ., a,:. �.., •ytl. ''rit: .Y?,.11.i.Y'/ ��ygtir '! ih. .j+' ..'�.' t .1.:• .r •�i•!. i lIr �'ify.: :i. ;t`::Y!Y .I.�.i' 'r T`.C•�'►. 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',:+�.,, '1.'i \i. �•' Z Ai .+t.e '•r :.r+ •:J:r :.•.i•� �:,t 1� •1'• — • :y � .mss • ''r: J• t• •t' - t H �� • • Lt' '•y. t}t.. la.3:!(•< ..• •'1F• •b 5•s •2=t�f��, ,• .r/1„w ,, •j� .•:: .•�;;.}:� r�••;•dr 5, ..5:• •'115 •.25-ie¢AA, t���elo51' .� :+. 'i• 'i r• :•r•.::. .,: ;: r .r:��.:tR��• 11• - .� •, yn._ '•r .. 1 •:, i- :1: J;..• ..r: n a, �r:"t.wrt( •,:-a 1•C,,, ,” ,)3•,. .(';. �.r�(,� :..l i.:: J:'N. vAY..��l. �.:�t!•7, ^,•• ''S•'E• 'asli r• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` Soil/Site Evaluation NAME ADDRESS C.:�' Q' �\M9 PROPOSED FACIILTY Water Supply: On -Site Well _ Evaluation By:� i�_LAugerBoring 1/ DATE EVALUATED -� , 1 PROPERTY SIZE `� •��pC - LOCATION OF SITE����`�' Community Pit Public l/ Cut FACTORS 1 2 3 4 Landscape position S Sloe - IS"Z -Ta �' S -I L a HORIZON I DEPTH 11 E " Texturegroup_ .�- Consistence H Structure At - Mineralogy Mineralo HORIZON II DEPTH AZ, t\.)t" Texture group SC Sc Consistence F C' 1 - Structure \Z- ZMineralo Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S S S S RESTRICTIVE HORIZON -' --- �— SAPROLITE CLASSIFICATION 77 ,S •S LONG-TERM ACCEPTANCE RATE 10 3 1 7->t---5 SITE CLASSIFICATION: _R15 EVALUATED BY: C LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: '�3°\— REMARKS: -v 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- V -y 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 ■����������������������������/������������������� �■�����■ ���! 0■ ■���������������������R�����������n\���������\■ �������r\��\��■ �����%���������������������������������������������������������� ■����������������������■�����������■���������������������������■ ■������■�����������■��������������/���������������■����■���������� ■��■�/��■�����■��\�■���■�\�������\����■��������������������������■ ■�����■■���■����������■■���/�\�����■��■���l� ������� ■���������■■ ■������■������������������������i��/���:i��`7��������������������� ■r���������■����������■�«���►,!'����■��■�►�������■��� �■����������� ■�������■������■���������������r�N�������i������� ��������■����■ ■������������■■����������%��A�7/' ■������►!'�71�\`��� ■ ■�■■���������■ ■�■■������t�■���������������������������������:ii�rl����=�__����_������■� ■��������������������������_ a�����������u►�=.�� ���� ���t �������� ■��\�����■���������■������i�■����������/�■ ��� ������N �� ������ ■��������■���� ■������������������n�n��■�:,-��■ ■ ■ �� �i���■■� ■ ■���������■���_����������������������������������_ �■��_����������n�ii��i ■�■�■�������■��■��■�����������■:;::�r��u���►�������� ��■����������■�■ ■������������������■������������i ������������►���■���■���u■����■ ■�����������������������■������■u�������������������������■������� ■���������■�����■����������■■■����������r���►����__�=�■��H�������■ ■�����■��������■������■��►�.�■�����������.���■� � ��■��������■�■ ■������������������������cc��������������c,������ �����_� ������� ■��■������������■�■���■���:►e_���■ ■ ����r��� . �u �����■ ■ ����■ ...........................�•.���.._.......••.C...=�.�..... ..=..�C ■■■��������■��������■������������e��������■��i�=n�� ■ ���■■��� _� ■�■��■�■������■��������h�ll�li���������Nv� ��u���������■ �0\ ■������������������������������� �������� ■ ���������������� ■������■�■�����������N������■��������■������� ������������� � :C::::::::::::::::::::::C:C::::::::::::::::::. 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C..... ................. .......��.......................il....=....... ................ ........��............ ................ ......�':................ ........��............�................�.......................... ........��......................................................... ■����/��11■�■�������������������■������N�■���������v������������� ■�������/1�����������������■��■�������������������■■��������������■ �����������N��������������■�����:�����n�%���������������v���� ���������\����������������������������������������������������� • � � �� � � �. Davie County Neali Depallmeni and .Moine AedAli .'�Tyefli y 210 HOSPITAL STREET % P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-5985 January 24, 1996 Darrell Lamb 4020-A Whirlaway Ct. Clemmons, KC 27012 Re: Site Evaluation Peoples Creek Rd./4.46 Acres Dear Mr. Lamb: As requested, a representative from this office visited the aforementioned site on January 23, 1996. 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, Charles E. Little, R.S. Environmental Health Section CL/wd Enclosure(s) C -HEY ` uo a. Plione: (336) - 753 - 6780 Name: Mailing Address Davie County Health Di Environmental Health P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 2702E ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection . Fax: (336) - 753-1680 Phone Number /7�°'. �•f� J (Home) ( Work) Detailed Directions To Site: k Property Address: �oG�Q+{a,iL K.CA Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under:�1�'Ii'� L1>%! l c� Type Of Facility:��'/L�!Tiq� Date System Installed (Month/Date/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? Yes If Yes, Explain: Please Fill In The Following Information About The NEW Facility:.r�/� Type Of Facility: yG'L- r C Number Of Bedrooms: _ C Number of People Requested By: � t%/ Date Requested: r✓OJJU ignature) For Environmental Health Office Use Only A, pprove�c Disapproved Comments: Environmental Health Specialist C UWLV IWr1� � Date: LZI',—M6D *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash C e Money Order # S3 to 4K Amount:$ IW`0 Date:—4/- y 10 Paid By: Received By: D, Account #: IP( 007,3%3 Invoice #: 7 atoq I . . _.... . � __.... ____ _. � . _ _ __. ___ _ - -�- ,' i � _.__._ 1 _._._;_._.__.�.... � �� /�_ ; . _.:_ ; � .� I j'^ i � i � j �„ �J_ _..______:... _ . , r7...�_�__..��-..�.1 (.?f -....-�_�-~-..:"�i�<,'., � .�. �,,F,� 1 ;��;:�'1�— , i;���� i ,�.�:- -jy�. � �=�,..�'��,.. i ._ r� - �`.' . !I f r I-�:;i; �,3�+{:i� e2`C} ' i �?.� �"���,'%.iiC•,�.�. � ' ,_ � Pnn� , r����.__�.. ,�' JG ` ���'�___ r': ,�__-_____��' .� I ���- � �� � C�� t ��> J /s>=` r , �____-------_-----' ; , � �: , , lf � , �� � , , � ��/ .- , ,g�, -�� i ���� ; ,,`r; � � _ �_ y- Z`7 �v�� 1"M C__./' �` _.. _ , ' __._______— 1 , --___.. ; ------ r ....._._----__-__- _----- � � ___ ._. _. _ _ � i r - ----------- _ _.. . � .�....... i � i ; i i� i i - s � j � ' r � i � i � � r ` � i ; ; 1 ,' i � , r� +� � � , , ; I f ' � � , i � j , ���," i ; _.___.. __�_._....__. _______ �_--___�__�.� .._,._ � _. i • , ,. _ _._. ___ , . � .. ..- . „ . . ; _. , r: ..