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)
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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
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•
� � �� � � �.
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
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