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141 Byerlys Chapel Rd 1 4I- -- oo A r DAVIE COUNTY HEALTH DEPARTMENT - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION , 'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary /Sewage Systems ;,.,.,; ;� r � "' ' Permit Number Name L �,< 7r r ^ hT/� iw, S; -Date _ i ... ND 8 0 7 1 Location Subdivision Name / Lot No. Sec. or Block No. Lot Size T fJ --- House — y Mobile Home __—_ Business _— Industry No. Bedrooms — Z—.No Baths --L— No. in Family_L_— Public Assembly Other Garbage Disposal YES p NO Specifications for System: Auto Dish Washer YES p NO / Auto Wash Ma^hine YES p NO ��/ � %" ' J`�6X�'� 1 r {� Type Water Supply ------- '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 �L— 'Contact a representative of the Davie County Health Department for final inspection 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 Number:704-634.5985. o �t Final Installation Diagram: System Installed by Q I r. \ 1 �_ " 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM tea• Davie County Health Department 7 Environmental Health Section P. O. Box 665 1i�E1�TAl NfAk1H Mocksville, NC 27028 Uf 1. Application/Permit Renu tedBy AIL � Aed LAqe ' f 6 --� Mailing Address to Home Phone 5 J U AZC Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation W'9—eptic Tank Installation Permit 4. System to Serve: 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 ❑ Washing Machine No. of Bathrooms ❑ 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: ❑ Public nvate ❑ Community 8. Property Dimensions / !Z ACl Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes CYNo 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: 18r� P, (Ykof ez O . This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurrfrom this application. C d (G� t .k ,0 &4� A J i r�rx� DA S G ATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ! I OWN the property. ❑ 2. I 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 representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1193) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department l/ Environmental Health Section roJ P. O. Box 665 FEB 1 01993 Mocksville, NC 27028 --------------- Application/Permit Reque ed By e- ' Mailing Address 'o Ae 42, SZG 33 - .5c2- r5c., '7yl oC Home Phone Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: ❑ House Je�9S/,P5lVe—❑ Mobile Home [3 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 ❑ Washing Machine No. of Bathrooms ❑ 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: ❑ Public /�Private ❑ Community 8. Property Dimensions /S.1176 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ 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: Ale' -TEW rx This is to certify that the information provided is correct to the best of nowle , and understand am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: ❑ 1. 1 OWN the property. �$ 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the D 'e CountyHealt Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine sad site's a 'i fora un absorptions age t atment system. DATE SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE /SV,rC PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L Sloe % — — HORIZON I DEPTH Texture group S-L- y 4 <'Z- Consistence Structure MineralogX HORIZON II DEPTH .2f- G r- Texture group e ' Consistence i Structure Mineralogy .•/ /- /: l 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 RATEY SITE CLASSIFICATION: EVALUATED BY: �� LONG-TERM ACCEPTANCE RATE: - 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 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 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 ■■■■■■■w■ww■■■ww■w■■■■■■■■■■e■■■ ■■w■■ww■■ww■.w.wwwwt■ww.wcw.www■ ■■.■■■■■■■w■■.■■ww■■w■w■■ww.■■■w■■■.■www■■..■■■ww■■■w■■■.w■■■■■■.■ ■■www■www■■.■■w■■■■■■.www..■.■■■■■■■■■■■■■■.■■■..■■■■■..■■■■■■■.■ ■■wwww■■w■■■■■■wwwww■www■.■■■■■■�■■■■www■■■■■■■■■■■■■.■■.■■■■■■■■ ■■■ww.■■w■■■www■■■.■■■■■■■■■■.■■ ■■ww■w.ww.ww■■■■ww■■■ww■■w■■ww.■ ■■.■■■■■■■■■■■.■w■■w■■■ww■■.w■■ww■.■www■■ww■■www■■■.■■■■s.■■w■■■■■ ■■...■■wwww.e.www.■■■.■■■■■ww■■■ ■■■■.rww■■w■■r�w■■■w■■■www■■ww■■■ ■■■■wwww.■.■■ww■■■ww.■■■www■w■■■■wwww■■w■ww.■■■■www■w■■ww■■■w■ ■■■ ■■■w■■■n■■..■.■■■w■■■w■.w.■■w■■ ..■■■■■■■■■■■■..■■■■■■■■■■.■G■■■ ■■www.■■■■wwww■■■wwwwe■www■■■ww■ .w■■w�.�wwww■w■ww■ww■■■wwww■wwww■■ ■■■www■■■■■■■www■■■wwwe■■■w■■■■ww■■■www■■.■■■.w■■■■■■■■■■■■■w■■■ ■ ■■■■ww■■■■n■■w.ww■.■ww.wwwwwww■ ■wwww■■■■.w.w■■■s■■.■ww■■■■ww■■■ ......................................................... 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BOX 666 MOCKSVILLE,N.C. 27028 PHONE:(704)634.6988 February 22; 1993 Michael L. Harwood c/o Howard Realty Attn: Red Foust 330 S. Salisbury St. Mocksville, NC 27028 Re: Site Evaluation Byerly Chapel Road/15+ Acres Dear Mr. Harwood: As requested, a representative from this office visited the aforementioned site on February 15, 1993. The site was found provisionally suitable for the installation of a ground absorption sewage 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