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761 Baileys Chapel Rd ���� ������ �� ���������� ^~,~~^ ~`~`~^~^ ^ ~~~-''' ~~—' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION °NOTE:Issued inCompliance With Article!|ofd.8.Chapter13Oa -' . Sanitary Sewage Systems Permit Number N2 6992 '="= Location Subdivision Name Lot No. Sec. or Block Lot Size C House Mobile Home Business Speculation No. Bedrooms Ao. Baths No. in Family Garbage Disposal .-- NO ^] Specifications for System: \ Auto Dish Washer YES NO [] Auto Wash yvlo:hine YES NO [] -' Type Water Supply _ *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit iosubject to revocationifsite plans orthe intended use change. ` .� � -- � - ^ _ ` ` } / - � .�< �w���^� Improvements permit by ' ` *Contact o representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. :3O'S:3OA.W1. or 1:00'1:30 P.M. on day of completion. Telephone Number 704'634'5985. � Final Installation Diagram: System Installed by - � ' � � - Certificate ofCompletion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth inthe above regulation, but shall |nNQway be taken enaguarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section Q/j P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone ys 51�6� 1. Permit Requested By. Business Phone 2. Address 0 VIII .2710/0 3. Property Owner if Different t an Above C X'4+ r Address ► _A 7� 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House -"" Mobile Home Business Industry Other b) Number of people 6. ay If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms—Bath Rooms_3 Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions f yd 1/Jere,s xn — w -S S b) Land area designated to building site --j c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? _ What type? This is to certify that the information is correct to the best of my knowledge. 00, Date Owner Signature ---- OWNER IS SOLELY RESPONSIBLE FOR COMPLIAN WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: n. - DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME�Of //© DATE EVALUATED a ADDRESS PROPERTY SIZE PROPOSED FACIILTY �%��' LOCATION OF SITE •'` i/ /9 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut 1 FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH /j' Texture group Si Consistence el!�"_ f 77 Ki Structure Mineralogy HORIZON II DEPTH .� Texture group Consistence �, r Structure Mineralogy 1/1 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 RATE r SITE CLASSIFICATION: , EVALUATED BY: LONG-TERM ACCEPTANCE RATE: - L� 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 zos.� wr.vo 4. 233&.66 52.0 I OAC 2 29`9a o .6 7c' `F 0 29\8 'Ac r 1 \F ba I 4 I cP 9 �1 o s UI .� 12i 1.04 m v �' o ro 11 N N ac _ c x Al 173 =�° 43 -':e m I 142.48 Ac ♦ a� o r- ��R51.� a '3 6.q5 376,86 > ) o X4.67. s r 50 k M 22.' 'A cJ) � ,.. 2 �� x J Vii, y. `a� 0 4- (14Ac ) BAILEYS CHAPEL >:� �50.01��, METHODIST CFf. n rc'4C8A$ �. n 1.77 AC. �Is n 1.211 ' •): . ' 6 \ ,y, b 065 463 `x° 1 •• Davie County NealtI tie artment and Aome AaIK yerrcy 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 February 18, 1991 Alfred Ray Patton J 2950 Beroth Rd. Pfafftown, HC 27040 Re: Site Evaluation Bailey Chapel Road Dear Hr. Patton: On February 15, 1991, this office evaluated parts of an 140 acre tract of land that fronts Bailey Chapel Road in Davie County. Five test holes were bored along the road frontage and near the house. These holes revealed a red clay soil that would be classified provisionally suitable for the installation of septic tanks. If you have any questions, feel free to call. Sincerely, p / Robert B. Hall, Jr., R.S. Environmental Health Section RH/vd Enclosure