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248 Clayton Dr✓ +}.`L;s;-a'i'=1wg°a aftt,sr':,«i'�e'6Yy;� ;�'�S + 't r...:r ,>r-.:' oa_,. .. ... .+.,o(:.:.. .y:}, r _ 1 r.. v 'f - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENV PERMIT **NOTE** This improyement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. AN,AUTHORIZATION FDR 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) NAME S2 C A�(��ePROPERTY ADDRESS I Q Yl t °��d�8 DATE 1-3-7L LOCATION (v Of N 1� Ur • .. R� �aY.tTQJ.1t�L� 1y.�T.ag 1�o~ �an C�DR o- -D..,S.S, SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE lAoy sa # BEDROOMS ,3 # BATHS _ # OCCUPANTS 44 GARBAGE DISPOSAL.: YesA@ { COMMERCIALSPECIFICATION: FACILITY-.TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL. WASTEj.Yes/No LOT SIZE I Mc tTYPE WATER); .Y DESIGN WASTEWATER FLOW (GPD) 346 NEW SITE REPAIR SITE , SYSTEM SPECIFICATIONS"'L TAW SIIE Doo' GAL. PUMP TANK GAL. TRENCH WIDTH 3 ROCK DEPTH Or°rc� LINEAR FT.. OTHER,' s /d r, REQUIRED SITE MODIFICATIONS/CONDITIONS: ;:' ***THIS PERMIT IS i9JECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER,SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE;SYSTEM. i P H d us 42 3'� , IMPROVEMENT PERMIT BY . **CONTACT R REPRESENTATIVE OF THE`DAVIE°CONY HEALTH DEPARTMENT FOR FINAL- INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 R.M. OR 1:00-1:30 P.M. ON THEIDAY OF-INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT M SYSTEM D BYYV Poe, ;x F - AUTHORIZATION N0. �� OPERATION PERMIT BY DATE "7" **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 R GUARANTEE THAT THE SYSTEM.WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. `� DCHD 10/95 .:.�,.. il �4 Davie County',Health Department ENVIRONMENTAL. HEALTH SECTION P.D. Box 665 7�-0. 00 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) j J ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmentaf Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie Cou f�Building Inspections Office when applying for Building Permits.*** DATE NAME �C'e. � i\`i�`(��\` � ,3 :r. AUTHORIZATION NUMBER_._:�=:.� N.. ii 3 4 , NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE*f* THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE`(5) YEARS. .a ENVIRONMENTAL HEALTH SPECIALIST DATE DC RD 10/95 y :Olt , , APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT • �� ' Davie County Health Department Environmental Health Section � P. O. Box 665 Mock ille, NC 27028 1. Application/Permit Requested Byb9�,i Mailing Address Wo Home Phone 9 `?S' 773 9 c9 d t/,4 w 0 e- A.C• 7 O O Cn Business Phone 99S--,�- 33�L _ 2. Name on Permit if Different than Above e "g 1-1.,2 be Ll %l. /0 T A e. 3. Application for: OGeneral Evaluation ❑Septic 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 3 [Z Washing Machine No. of Bathrooms 'LZ J0 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 w Private ❑ Community 8. Property Dimensions /I L/o-7 A(2, Sewage Disposal Contractor ? 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes [Y 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: Tv rr•► I• 1-v,T O /11 y o�� ✓• u ��o e e✓4(1 DSV Yi'9 I-/ i r This is to certify that the information provided is correct to the be f my knowledge, and I understand I am responsible for all charges incurred from this application. DATE SIGNA URE 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 Davie Cou9ty Health pepartfnent to enter upon above described cated in Davie County and owned by_ � ee C"/+.Aa1--Je all testing procedures as necessary to determin aid site's suita lity for a ground absorption sewage treatment system. / - /s— 9L/ 'J DATE IGNATURE DCHD(193) •: �` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED O _ 9H ADDRESS P PROPERTY SIZE -2. LA O.u� PROPOSED FACIILTY �O�J� LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By(Q'�_L Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S _�S_ Sloe R -6' ISS $- HORIZON I DEPTH (o'' Texture group (Z'L_ L Consistence Structure G� Q Mineralogy HORIZON II DEPTH �' 2 'Alk. Texture group C Q- Consistence F Ta FM Structure $ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 5 S SS RESTRICTIVE HORIZON — — SAPROLITE CLASSIFICATION . S. •S .5 _S LONG-TERM ACCEPTANCE RATE %kA LA ,L SITE CLASSIFICATION: �� EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: \noIQ¢ REMARKS: t� \� ��tuz� .- 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 Mi neraloiry 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 ■■■■...■■■■.■.■■■■■...■.■...■....■...■■■.■■.■■■■■■■■■■■.■■ ■■e■■■■ ■■■..■■■■■■.■■■■■.■■■.■■.■.■■■■■■■■■■■■.■.■.■■■.■■.■..■■■■.■■■■■■ ■■■.■....■■■...■■.......■....■.■....■■■.■■■■.■■.■■■■.■■■■■■■■■■O■■ ........................... ...................................... ■■■.■■■.■..■.■■■■■■■■■■■.■■.■.■■■■■■■...�■..■ ■■■M■■■■ ■■■■■■H■■ ■■.■■■■■■..e■■■.■.■■■■■■■■.■■■■■■.■t■■.■■■■■.s■■e■=■...Mee..■.■■.■ ■■.■■..■■■■■.■■■■..■.■.Mee.■.■■■■■■■.■■■■■..■■.■■.■■ ■■■■.■■■■_■■■ ■■■■■■.■■■■.■■■■■■■■■■■■■■■■.....■■■...■.■■■.■...■.■■ ■■■■■■■.MUM ■■■.■■■■.t■■..■■■■■..■■■■■■■■■■..■■■■■■.■■■as■e.t■.■=.■■■ ■■ERRE■ NMEMMEUCCCCCC 6366R iiiCiiiiiiC CCCC■�CCCCCCCC ii'i■:��iiMENEM .................1111\��11■■■.■■■■■■■■■■■■H■CO■■■■. u■M■O■ ■M■EMME■ ...■..■■..■■.■■■..►.._/..■■...■...■.■..CCCCCCC■i�iC C�■��CC��CCCCCC� ■■■■■..■■..■.■He.■a■■■■■■■■...■.■...■ ■....■■..■..■.■.......■■■.■■..■.�.■.�■■■■ ■ll'ER ■■ M■■■■■ ■.■■■■■■.■■■■■■■■.■■■■■t■■.■■■.■ ■.■ ■..■..■. ■►.N■■■■■.■■ ■■■■ w ■s■■■■.■..■■.■■■■...■■■■.■■s■■.■■.■.■■■=s■■■-■.■_Ci��i■ ■■■e■■■■C■■■■ ■■■.■■■■.■.■■■...................■.■... ..■■�.'■ -MIKE HMUMMEM.■M■ ■.■■■■..■■■■■■■■■.■■■■.■■.■.■.■..■■ ■.■■■■.■ ■ ■ ■.-a-N■.■ ■■■■■■ ■ ■■■...■■.■■t■■■■..■..■■.■.■■■■..■■.C■.■■■■u.■■e ■.■■1/■■■■■■■■.■ .......................ROOM■■R■■RMC■■■uC.■H■ �/.71A ........ ................................� ■■u■ u.■■ C::. ............ ■■.■■..■■■■■■■■.■■.■..■■■■■■.■■■ EME■EH■■■■ ■Ill■■.t■■■..■■■■■■ ■.■■■.■ MEMO.■■..I%r�R■■..■.■.■.■■. .H■■■■ .■■■■■■■■VEMNE■■■■ ■..e■■■ ■■■ ■■..■llf/l1t/11■e■■■■■■.■■■■■.■■■■�� ■■ .■■■■/%■I,\u■■ ■■M.■■. ■■■.m_ A■■. ■■RC1,\►111.■■. 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N.C. 27028 PHONE:(704)634.5985 November 21, 1994 Boger Real Estate Attn: Gilbert Boger 142 Hwy. 801 North Advance, NC 27006 Re: Site Evaluation/Lee Campbell Clayton Drive/12. 407 Acres Dear Mr. Boger: As requested, a representative from this office visited the aforementioned site on November 18, 1994. Based upon the information provided on the application for a 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