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434 Peoples Creek Rd i � ` , •� � I DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003748 Tax PIN/EH#: 5789-70-5560.H Billed To: Wade Burns Subdivision Info:�/�,L3c� Reference Name: Location/Address: Peoples Creek Road-27006 As stated in 15A NCAC 18A.1969(5) ATC Number: 4349 acc�pted System, m�v 31s� be used AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST 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 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 Disposat Systems). THIS AUTHORIZATION FOR WASTEWAT NST --ION V ID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � Date:�� �_� �' 3 a�r�rzva rNs �s CERTIFICATE F COMPLETION i o �\f t� /� **NOTE** The issuance ofthis Certificate of Completion shall indicate the sys ' d on Improvement/Operation Permit has been installed in compliance with Article 11 of G�S.Chapter OA,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO W s a guarant that the system will function satisfactorily for any given period of time. �1` � G� � � 1� �22 'J ��� ` 2� �^'^'`�-,;� J�� '---�--1� �"�g=2.S C�tC�.K � ��Fk�Z G�� G���v ���,r-�g� /���Q1 t,,,J � O FtOA.� ��.J��v �L.1 �"'" W-I I I �! � ���'���r S�ic System Installed By: Environmental Health Specialist's Signatur : Date: �� � � DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ��� • ,_ '� , � Environmental Health Section . ' P.O.Boz 848/210 Hospital Street ' Mocksville,NC 27028 (336)751-8760 �-� �� �� IMPROVEMENT/OPERATION PERMIT �1 Account #: 990003748 Tax PIN/EH#: 5789-70-5560.H Billed To: Wade Burns Subdivision Info: Reference Name: Location/Address: Peoples Creek Road-27006 Proposed Facility: Residence Property Size: 35 acres **NOTE�*-Th�is�mpro4eme9nt/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 (�1��J� #People� #Bedrooms�_ #Baths �• � Dishwasher: � Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size���� Type Water Supply�JG�?�T Design Wastewater Flow(GPD)� Site: New�Repair❑ System Specifications: Tank Size�Q�GAL. Pump Tank GAL. Trench Width��`(F1 f Rock Depth f 2� Linear Ft.�c.e,�t As stated in 15A NCAC 18A.1969(5) Other: � �1S7�1g�fi1Q,J �,j(t,� accepted Systems may also be used Required Site Modifications/Conditions: _��}�'�,1.L � � `—�'�-jD��� �� c�� �i ('�� C.�1�IL,�J:?.L-��!'i� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF C►"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent 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���of installation. Telephone#is(33C)751-87(0.**** ���I� ��� I�J U�V�x F}-_�Sr ��,. �M�x T��c-H ��a`'�--N � b v-� �` + 3`� 1"� � b oc.t[ 30� � r� � � o �-I��� � � � ���� ,�= � r N '�, � b �tnf � `', � 'To� Y � � � Environmental Health Specialist's Signature: � Date: � �f�i�sl�tZ�A� y !i.- DCHD OS/99(Revised) �,jp,-� '�---'�j,p� ►�?�A�`+ ILL �L=hL'-� . � .�I�,N P��'� _.-� � (��-}r� ����'J ` 75'L �`l�1:� .i , . �j� �(} ,,��Y'�e . . ,�'" , 1 r' .� ',� �'�t'� ,e,��cS ` �. ' � - ' � � (c, C�l'f(UN FOti SlT�LVALUATlON/1hiP1iUVChiENT PLR�1117 S�1TC (� l� '' Davie County Health Departrnent � �✓ . � � " • Fnvironmenta/Heatt/��ection � � P.O. �ox £34II/210 fIo�pital S�rao - , S.�-�--e,� e � 9 �05 Mocksvillo, N� 2�a28 �� � �.a �,�,� SE (336)751-8760 � � ** `rIiI�' ICATION CAN2dOT IlE PROCLSSED UNL�SS ALL Tli� RLQUIR�D IP7FOI • T OVIALD. Refez to thn zrrroFu�iATION DULLETI27 £or i.natructionn. � 1. Nama Lo be Dilled !1,'i�Qf= �S` /�u�`���5 Contact Ycraon �r7/Lf1� t•failinc� Addre�n ��� �V'�TG��� /��v ' 12ome Plioiie /'� G I/ CiLy/Stata/ZZP /�G��'��C�, �l r�L/C� �� Du�inonn Phono l7`?�'� �T G Z-- ' 2. Namo on Pcrmit/I►TC it DSLPoront ttian ]►hovo ��%� '� �— �Y J� ldailinc� Acidzoaa City/State/Zip 3. J►pplication For: � SiL-e �valuata.on , Tmprovement PermiL'/ATC Doth 9. Syalcui co servico: iauue � Zdobilc� Homo ❑ III131I1CJJ ❑ Induu�ry ��ner . - 5. Typa o}•nl-am roque�L•od: ❑ Convontional ❑ convontional moAificd ❑ innovaCivo pacCepre� _ . G. If .Rc�idenco: 1! Pcople �_� tt Bedroom� � � il DaL2ir�na/_�__ ` ' --,�— ❑Dint�z�n�har ❑CarUago Di�posal ❑Washing :4acLino ❑Ba�ciaent/Flun�inc� ❑Uaacmcnt/2�o Plun�tnc� 7. Ii IIuninean/InduaLzy /Ott�or: vcrify typc II Pcople I� Sinka . Il Commodou � 11 Showora � Il Uzinala — It PlaLar Coolora -- IF I'OOD��RVIC�: �k SeaLo �a�ima�ed i9ater Uaage (gailona per day) 8. Typo of wator nuppiy: L�YCaunL-y/City ❑ Wcll ❑ CommuniCy �. no fou aiiticipato adcliL•iuna or cxp:U1510115 OC�I1C CJC1Ll)�this syslcni is iu(ciiQccl to scrvc? C� �'cs o ir���s,ti�•hat typc? ***I�1fPORli1N1�`*'�CLILIYI'ShIUSTCOA!!'LCTL'I'lIL lZtQUIIIL•D PROI'LIt7'Y INI�ORI1•IA'i'tON IiLQUI3S'flsU I31ii3O�1'. isiflicr a PI,AT or St7'I;PLAi�'�1fU.S7'IlESU11Af17'7'!:A bv iLc cJicot �vith TIIIS AI'I'LIC,A'('ION. 1'ro[�crt)'D1111CAS1UIIS: �� r����s� 1VIil'1'I:DIRI:CI'lOi\S(1'run�11•Iucl:s��ilic)tu I'It0!'Isii'Cl': •i•:�a oa«� rirr: i� ��:3`� 7�5.5:C�C'> ��CT 1t /��� �/w,U ,9�i �5�,�a,—�11 I'ropert��Adc1c•css: Road Namc ��/ ��DP/-�'s C`�efr�C /�/�, � �L /�1/�CFS' ?��,��C�" � LE.�% d� Ci(y/'Lip ACfJl��/<�� ��C Z�GDt� � ��c�l�L�S ��F� � �� �'L1_�/�C�� If i»a SuUditi�isian proti�ic►c iuforu�ation,as follotivs: C�/�[l/�l'i� — ����'�f'i 1J ��S/�� �4/�/�,t-i� Namc: �'J� %u�jo.,1� � , Scclion: I31ocl:: Lot: ll:tic IlOI]1C C01'IIC1'S II:��gci1: / l �--� 'I'6is is to ccrtilj'II1:1L �I1C 111C01'Ill:ttioii pi•ovidcd is coi•rcct to (Iic best of�uy�I:c�otivlcd�c. I Up(ICI'SI8lI(I Ill;it atiy perit�il(s) 1SSl1C(��1Cf'C:1f�C1':1J'C SUli)CC��0 SUSPCI1S1011 Ol'I'CYOC:1�1011�!r t�1C S1�C I)I:IIIS OI'1p�CJ1VCV IISC C�I:111bC�UI'ir��1C 1i1101'111:I�IOII subu�i(tccl in lltis applicalion is fsilsiCtccl or cltan�cd. I,alsa, tt�crlcrslcunl!!!aflnm res/�o1�siLlcfu�•n!1 chrr�b�csi�rcrrr•rcrlJru�n t/ris applicnlioa. I,l�crcby�,bivc conscnt ta thc Autl�orizcd Rcprescutati��c oC tlic Da��ic Couuty�IIcal(1►llcpartuicnt (o cn(cr upon abovc cicscribcd propert}�locatcd in Davic Couuty aud o�ti•ncd by to conduct :tll t• (ing proccclures as�icccss:�ry to dctcc•tniuc thc si(c suitabili�y. /! � Dil'1'J: � �� ?aG°? SIGNrI'I'URL � ��� �l. ./�'-� • TIIIS ARI'sA A��iI'13�USLD rOR llI2A1VING YOUR SI'1'I;PLAN(Includc all of(I�c follutiviub: Lsistinb nnd proposcd property lii�cs and diuicnsions, s(ructures, sciUacics, anJ scptic Iocatious). � �r � ' Silc 1Zcvisit CI�arPc � � c. �'��� Datc(s): ,�d i � � fi� • �R,,,�,� � � ci«nc rcoccr�lt�o��na��: o�✓� � ��^ � , `� Lr�is: hA�"'`' `H • i���� • � Sign�ivcn GS . '. ,�lccounl No. � �� � � � � Itc��iscclllCIIll (US/03 ��� �j y�? Ln�oiccNo. ��� C'�e 7� � � y ,o,.,,,"�„�... ,�--� �.. Qv�,�...x..�.�.� . �� � w /� ���L,M"�"' � . f ��t � DAVIE COUNTY HEALTH DEPARTMENT • � � � ' Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003748 Tax PIN/EH#: 5789-70-5560 Billed To: Wade Burns Subdivision Info: Reference Name: Location/Address: 434 Peoples CreeJ�Rd:27 06� Proposed Facility: Residence Property Size: 35 acres Date Evaluated: �-j �� `� Water Supply: On-Site Well Community Public ✓ Evaluation By: Auger Boring / Pit Cut FACT'ORS 1 2 3 4 5 6 7 Landsca e sition Slo % /5 ) HORIZON I DEPTH D-3 r ' , Texture rou S S�— .�C Consistence r;► N ��� Structure .S�ic Mineralo 5,� HORIZON II DEPTH r, - � 22 - � Texture rou S� .'�. Consistence F�NS S Structure Mineralo HORIZON III DEPTH ��K L/ Texture rou � lG Consistence Structure �' Mineralo HORI�ON IV DEPTH Texture rou � Consistence Structure Mineralo SOIL WETNESS s/l� cG RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE �. •) .', SITE CLASSIFICATION: P� EVALUATION BY:S 1� LONG-TERM ACCEPTANCE RATE: �'� OTHER(S)PRESENT: Qv1-ti l. ����� xEEivtaxxs: Li tT�� �p.�« ���+p �,.� LEGEND T, na d�pe 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 Tgxturg 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 ON�I�T�.N . �'IQiS� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm �.'e� � NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic , tructur� SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed LIQi� 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-gaUday/ft2 DCHD OS/OS(Revised) ■■■�■����■��■�■■■���■����■■■■■■���■■�■�■■■■������■�■■■■■■���■■■■�■ ■■■�■■■■��■�■■■���■■■������■■■■■�■�■■��■�■����e■�■�■■��■■■■�■■��■ ■�■�■■�■��■■■■■�����■������■■■�■ ■�■■■■■■�������■■�■■��■■■�■�■�■■ ■■■�■■�■��■■■��■����■����■�■�■�■��■■■�■■■�■�����0��■■■���■■■■�■■�■ ■■■�■■��■�■�■��■■■��■�■�■■■■■■����■■■■■■■■�■���■����■■����■�■��■�■ ■�■��■��■�■■��■■■■�■■�■��■���■�■■■�■■��■��■�■■����■��■�■■��■■■�■■■ ■■���■�■■■�����■����■�■■■■�����■��■�■■�■■���■����■■��■����■■���■�■ 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'. . 3t5� � ��' - . � . � n��� 2726 ,.-�i . . . �--..,`__.. :� ,. � . � � . � f18 . . �?� ag J� �z aoa� � g ,� � �3 �2.asn� .� (a.asa) . �a a7A) 3449 � 6398 94d7 � �� � � �` � � i ��i I i'V � o,� � � 4� . t53� tet . � r ' .. . .t�'" � .. "�^"". . . � � (2Ii� � .. . "�,8' PEOp�LES � (�68A} CREEK RD 2001 �B,SA, . . . �p�2 .. . t,9973 � 6965 �127 p2 � PcB2 - �,x$ : ��, �� � .�, ���� � � � . �' 1�ha � iyi:� � _ � : PcB �`� '� �� � 142 � ���.a�n, .. � s13 �: � ��. , �� 3�a (7.51A) 3� PcC2 �s' �z5 . 173 �� � P�c2 � 1 67A �� �y \��� � � V �A\ Ii��?�� ,,°' ����� . � � . q: \ "� r � �� � ��\��� . . ::ii: � ��: . ..., l '. ,, � . : . a'ra �. � . ., � .��:��o,, „ ,, e.w .. �� '. ,.,.,. . ��. �: ,,. ', q", t;.� . .t8g � . l ' -' ` ) „.... �.3�J � .. .. ���,. ... �s { � � ��3 � �,..., ....: �� ., �ry ` "� . . � e.'''`�''s. . . ��, �t I�:.. l . . . 5z+ 1818 ZOO. � �. .. � � 4P93i . . . . . � . . � . Y .. 844} . . . ,�Y.aB G691 �;. . . . ... . �. � .. � � � ! ': 2 s , ��PaQ �. � / ��'3 � �� z t J ' �,; �sz.a�` � � � 0395.. . ` � .. aaa , � � � � a . , .. . � . . .. . . . .. . , . ..� �� . .. � . . .. . � � ( 14.670A . � � ... ... .. ... .' ( � � � 2898 � . �� / ..... ... . � .. . .. . . :. � � i , .. . .. . . ..... . :. . ,iE ,;�...»....... i . . .. . " .. . . , DAVIE CO�JN�'Y HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street . Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 September 30, 2005 Wade Burns f 414 Burton Rd. , Advance,NC 27006 � Re: Site Evaluation- 33.37 Acre Tract/Peoples Creek Rd. Tax PIN#: 5789705560 Dear Client(s): As requested, a representative from this office visited the above site September 28, 2005 to perform a site evaluation. Based on the informatiQn 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. House location, size and other design criteria may necessitate the use of an alternative or innovative system. System design will be determined at the time an Improvement Permit/Authorization to Construct is applied for and issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, r� � Jeff G. Beauchamp,R.S. Environmental Health Section Enc(s) � . • , � DAVIE COUNTY HEALTH DEPARTMENT • � Environmental Health Section P.O.Boa 848/210 Hospital Street Mceksville,NC 27028 � (336)751-8760 Account #: 990003748 Tax PIN/EH#: 5789-70-5560 Billed To: Wade Burns Subdivision Info: Reference Name: Location/Address: 434 Peoples Creek Rd.-27006 Proposed Facility Property Size: 35 acres Z/V ATC Number: 4219 as stated in 15A NCAC 18A.198�(5) accepted Systems may also be usca AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **KOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This 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.19_ age eat ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEW N l CTI V PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: 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. � lv � �� � � �=Qo.►9T �� , �N� i�a���� -i.� � Septic System Installed By: W� ' � Environmental Health Specialist's Signature: ' Date: �J DCHD OS/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT � � • Environmental Health Section � � P.O.Boz 848/210 Hospital Street ��� ✓� � ' Mocksville,NC 27028 � I '� � (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003748 Tax PIN/EH#: 5789-70-5560 Biiled To: Wade Burns Subdivision Info: Reference Name: Location/Address: 434 Peoples Creek Rd.-27006 Proposed Facility Property Size: 35 acres ATC Number: 4219 **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 #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type ��K►� #People � #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�1� Design Wastewater Flow(GPD) Z� _ Site: New�Repair❑ �i n � System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width �� Rock Depth �Z Linear Ft.2� As stated in 15A NCAC 18A.19S9(5) Other: � ,�iSl��l�T�br� 1�bX- accept.ed Svstems may also be useci Required Site Modifications/Conditions: �NS'rAu. c�J Gt�.�ic�c,'1�, �� 5��`� gq� �� (,o�� p��.�,ss Il�'[PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF C►" BEL ► FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final insp o � 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►)7� * *� . � ���� � P� l j2�/o� -C��;,�v�� Goc�-r�c� fl✓� � ?-� -_ �/-�� �'�r +v�,�c � " � �r-(Z�r� . , , i �� , � . , � 6.J Sr�.,.� s�,z►�S 1 ��r�S �"�Ti�C�T �Qf,.�•J LI n5�`� � Z- 1� Ac� F� � �p ����S cy � LtX.J�- F2c9dv�.. !-��4J� 1�4�1C,— / � �O {`�.��t?J� �11.�P ��E �-1J'�A�S AP�,.��� °o� � � S�-1'17S ��1 �i'p�J K �'jQ����Filc—l..l� �. Environmental Health Specialist's Signa e: , y Date• DCHD OS/99(Revised) � ;/��apl� �� b �! . ���� ��'�'� ���L 3��1� . • � . � �, ) /� ,��s- F�a � � � � 't C�1'!(UN FOR SITC EVALUATION/Ih1PII0VC6i[NT PCR�1117&ATC � � {;�, � Davie County Healtf� Department � � Q � ��� Fnvironmenta/Hea/th Section P.O. Hox 04II/210 Fiospital Straot L�--� . � � 9 ��:�fi+�� MOCkBville� NC 27028 � � J;0 ��'� S� (336)751-8760 ** ! �`��'�.� '�'tIi�$ ICATION CIWNOT I?E PROCESSED UNL�SS ALL THE RLQUIR�D INFOI • �TI�' OVIDLD. Refer to tha INFORhIATION BULLETIN for ina�ruc�ionn. � 1. Nama Co bc Dilled �Vf�U i _ �• �`�'V'��J Contact Pcrnon �/�l� tdailing 1lddre�a ��7 ���`r���� n�� ' Iiomo Phone CiL•y/Stata/ZZP /�lJl�/��C�', �� rjGO � IIu�innaa rhono ���'— ��G Z--� 2. Nama on Permit/I►TC 1E Diifaront than Abova ,:Y����� �`� Z— 14� 5� Mailing Addroaa City/5tate/Zip 3. Application For: � SiLe �valuation � Improvement PermiL/ATC Doth ��,� I � � 4. sya�em to servico: l!l�Iiouae � 14obile Home ❑ Du3ine3� � Indua�ry �f'Othcr _ i���/t� 5. Typa a}•ntam requc�tad: ❑ Convontional ❑ convantional modificd ❑ innovaL-ivo pac�epte �z / � G. IL• •Renidenco: 11 People �_� fl IIedroom3 � 3 il DaLhr ma r^ �—�'/�/�'�� ❑Di�hwanhar ❑Garba�o Diaposal ❑Washing t3achino ❑Da�ement/P1unS�ing ❑Uanement/tdo Plumbing J �'�� 7. If IIuainean/InduaL-ry /Otktor: verify type II Peopla IE Sink� � �+,�-I q Commodon � 1! Showora � 11 Urinals --�"" It WaLor Coolora •-- IF F'OOD��RVIC�: �� Seatu Ea�imated Water Uuage (galion� per day) 0. Typo of wator uuppiy: 19�Coun�y/City ❑ Well O CommuniCy 9. no you anticipata addition� or c�pansions of tlic facility t$is system is intcnciccl to scrvc? Cl 1'cs u.r[vo If}�cs,titi•Itat typc? ***IAIPOItT�IN7'"**CLILN7'S AlUST COdiPLGTt'I'IIL RL•QUIRED PROPCR'1'1'INI�ORA�IATION I21:QU�S'T[;D I3I;L01Y. ritl�cr a PI.AT or SI1'C PLAI�'dIU.ST IIE.SWIAflT77iD bv thc clicnt �vlt6'I'I I1S APPLICATION. 1'ropCi't}'llitucusions: �� ����5� 1VI21TC DIRGCT101S(frut�i 11�Iucltsti�illc)tu I'IZOPLK'I'1':� •r:�.orr��i'IN: iE .���� 7�S.S C�C) �-'',�.CT �' <<�r d f�v�,� ��t�I �"�ue�1 I'roperly Address: Road Nainc T.�� �i��PL€S ��c"Ec� /�1). � �Z �/,L�S ?�/a = ,¢ LE.~/ d�% City/zi�� AvJ/�uC�, /�lC z�Gv4� � �''��JI'�L�s C�'�,c,r/ �� L� �Gb'/��/`�� I � Ca/��12C� — �/c'U�'�'f'i 1`� //1lS/d r' � �. If in a Subditi�isiai �roti idc iiiforrnatioii,as follotivs: � C�D/��t,�i� Namc: i�� '�U�1-O�y � , Scccion: Blocic: Lot: Datc l�omc corlicr•s ll:�ggcd: / ` Os 'I'his is to ccrtil}�tlial tlic inCormatian providcd is corrcct to tl�c bcst of my�kaotivlcdgc. I uncicrstaiid tliat any permil(s) issucd I�crcaftcr are subjcct to suspcnsion or rcvocation,if tl�c sitc plans or iutcndcd usc cl�augc,ur if tLc informalion submil�ecl iu lhis applicalion is f;ilsiCed or et�anged. I,nlso, rurdersl�urrl!l�at I anr res1�o�rsiLle f�r n!!chrrrges i�rerrrrcdJronr lhis applicnliu�r. I,l�crcby,�;ivc conscnt t� tI�c Autl�orizccl Rcprescntativc of tl�c Da��ic Couuly IIcaltl►llcpartuunt to cntcr upon abovc dcscribcd propci•ty�locatcd in Davic County a►�d otiti�t�ccl �y to conduct all t� liug proccdures as i�cccssary to dctcc•ininc tl�c silc suitabilily. / Dr1'I'I? �� �� .��� SIGNrV'I'URI: � i ���' ��� ' TIIIS ARI;A A�AY B�US�D rOR DI�11VIlYG YOUTL SITI:PLAN(Includc al!of t1�c fopo�rir�g: L�istiug and proposcd proper(y lines and dimensio»s, structures, setbzcics, and septic Iocztions). � �` � ' ' Sitc Rcvisit Char�c � � L (.�� D:►tc(s): ..�< < ► fi� • ��,� � �� Clicut NotiGcatiai Datc: �� o�"" O �I�IS: '�'L`h �u;, L�- ������ �r"�" ' • —? Sign�ivcn GS r '. ,�lccount No. � � � � � � � Q� Rc��iscd llCIIll(U5/03 ��� ' , � y�?y Iin�oicc No. �`��v ��� 7� �_ ,�-�, �. a��.:�,..e-2� ��� �� � . _ ..-� ;�� '�� C. � .R, .�.--�REA= 2 A ,--,' --�✓'`3�_-=�-----�6so R/w . � .-�'"� INCW��� S.R. 1646 & S':R. � . .,j' • . . ���_ �� i , f .-.- n y , � `"'' ( � l,./' !`���� �' _. 1 '� J� ' ��! s �j \� , � t � � a � � � � o � � �� , � • Z � � ��� ti S 84 SpZ P' , � BEN`\RON �LIFToN , �,,,-- � D.B.. .�..-.s.�,� ro . . o : �1 jw�a� � - � ,,,, � �=.a�2 �n ,,,, I 0 . �l s�' _ � � . � � � r :.,,:>�:. � `' ..:�v F:. .p��.`1 � O � �017.15 . �N N 5 g2.�3� v . � Z LLC. . '�TD �HaS,566 f • • ►�; DAVIE COUNTY HEALTH DEPARTMENT r � . Environmental Health Section � Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003748 Tax PIN/EH #: 5789-70-5560 Billed To: Wade Burns Subdivision Info: Reference Name: Location/Address: 434 Peoples Cre�l Rd.- 70� Proposed Facility: Barn Property Size: 35 acres Date Evaluated: �e 2� �� Water Supply: On-Site Well Community Public '� Evaluation By: Auger Boring � Pit � l� Cut FACTORS 1 2 � 4 5 6 7 Landsca e sition Slo % � HORIZON I DEPTH .- �p p- Texture rou CL G� Consistence Js 5 Structure Mineralo HORIZON II DEPTH /O- �d-G� �'!- 3 Texture rou Consistence ' � Structure S Mineralo HORIZON III DEPTH -° -LD Texture rou SL� S�-k5 Consistence r 5 Structure S Mineralo g.. 5�, HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS b RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION •S LONG-TERM ACCEPTANCE RATE a• a. SITE CLASSIFICATION: � EVALUATION BY: � �'�"'7 LONG-TERM ACCEPTANCE RATE: d�� OTHER(S)PRESENT: �`' �'��� REMARKS: LEGEND j,andsca,pe Position � R-Ridge S -Shoulder L-Lineaz slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace FP-Flood plain H-Head slope �� 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 S'ON4IST�.N . . ��415� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � � NS-Non sticky SS-Slightly sticky S-Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic S r> >r SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK -Subangular blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed lYntcs 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 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. ^ � •r � DAVIE COIJN�Y HEALT�-� DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street . Mocksville, NC 27028 � Phone: (336)751-8760 / Fax: (336)751-8786 September 30, 2005 Wade Bums : 414 Burton Rd. � � Advance,NC 27006 � � Re: Site Evaluation- 33.37 Acre Tract/Peoples Creek Rd. Tax PIN#: 5789705560 Dear Client(s): As requested, a representative from this office visited the above site September 28, 2005 to perform a site evaluation. Based on the informatiQn provided on the Application for Site Evaltration and after the evaluation was campleted,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. House location, size and other desi;n criteria may necessitate the use of an alternative or innovative system. System design�vill be determined at the.time an Improvement Permit/Authorization to Construct is applied for and issued. Before a representative of this office will revisit the site to issue an Improvement PermidAuthorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, �'� � Jeff G. Beauchamp,R.S. Environmental Health Section Enc(s)