821 Bobbitt Rd f `r-'.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
anitary S wage y � nn ';Y� ' V Permit er
Name � �/ 9 ".T ate NO
Location —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home ` _ Business __ Speculation
No. Bedrooms .No. Baths `'� No. in Family _
Garbage Disposal YES 4 NO C) �.
Sp i cations or ,SystejnOCX �-
Auto Dish Washer YES NO ❑
Auto Wash Ma;hine YES NO ❑ f�jcS / /� '°i% /" 'E`er" �� �
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.
'1
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,t r
rt•
Improvemehrmitbyv
'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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by
�o
t�
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.
. L.1J �, t v , 00
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT '
e (� Davie County Health Department
Environmental Health Section
�I G P. O. Box 665
P 1 d Mocksville, NC 27028
5 MAY 2 8199,
1. Application/Permit Requested By Fred M. & Theres`a R. Bond
Mailing Address 372 Weatherford Drive, King, N.C. 27021 (.
Home Phone ( 919 )983-4418 Business Phone ( 919 ) 768-5073
2. Name on Permit if Different than Above
3. Application/Permit for: General Evaluation ® Septic Tank Installation
4. System to Serve: N House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
❑ Basement/Plumbing
No. of People Three ❑ Basement/No Plumbing
No. of Bedrooms Four M Washing Machine
No. of Bathrooms Three and one-half Zl Dishwasher
Dwelling Dimensions 1500 - 1800 sq. ft. 29 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: IN Public ❑ Private ❑ Community
8. Property Dimensions Approx 5 acres Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes KJ 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: NOTE - PLEASE CALL MR. BOND AT ABOVE NUMBER TO MEET YOU AT
INSPECTION SITE.
Farmington Road to Bobbitt Road. Travel South on Bobbitt Road
approximately 2/10 mi to Robert Pride driveway. Mr. Bond will
meet you at that spot.
This is to certify that the information provided is correct to the best of my knowledge, and I derstand I am responsible for all charges
incurred from this application.
/C)
DA
plication.
DA SIGNATURE o
E
ONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
CK 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:
e consent to the authorized representative of the Davie County Health Department to enter upon above described
ated in Davie County and owned by RobertPrice / Marianne M Bondall testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
al system.
43 ,
DATE `I- IGNATURE
0o
DCHD(12.90) /wit
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �� DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY �orrrP LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position L4 L 'k- L
Slope —0-
HORIZON I DEPTH 6 .1 "
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence l°
Structure /
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION S tJS
LONG-TERM ACCEPTANCE RATE
,7 1
/
SITE CLASSIFICATION: EVALUATED BY:
LONG-TERM ACCEPTANCE/RATE: OTHER(S) PRESENT:
REMARKS: '44 O,/Br �'.`L� r./S fie/!/ tT'/✓
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
Mineraloey
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 watef 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 Nealtfi Department
and Naive Aealfi A' errcy
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE,N.C. 27028
PHONE:(704)634-5985
June. 11, 199.
Fred & Theresa Bond
372 Weatherford Dr.
King, NC 27021
Re: Site Evaluation
Bobbitt Road
Dear M/M Bond:
As requested, a representative from this office visited the aforementioned
site on June 9, 1993. The site was found provisionally suitable for the
installation of a modified-oversized, 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