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1171 Baltimore Rd DAVIE COUNTY HEALTH .DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION �, a *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems 1 Permit Number Name LI IA3`� Date . 1— � N2 54019! - Location /<.. �, `l rf ltriti Subdivision Name Lot No. Sec. or Block No. k' Lot Size House Mobile.Home _� Business Speculation No. Bedrooms ? No. Baths t� No. in Family Garbage Disposal YES'❑ NO ❑/ Specifications for System: # Auto Dish Washer. YES ❑ NO D,. c1 ' Auto Wash Ma thine YES ®' NO ❑ r° QO 3 ' moi y Type Water Suppl "� •� "', _ *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. Improvements permit by *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 ��4�= l r 1Q` �rif cate of Completion - Date • *The signing of this certificate sha)l 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 PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mockaville, NC 27028 1 . Application/Permit Requested By rnaAjp-( Q OAI-A N. 611 -) 0 Mailing Address Dai Rdr � Home Phone �i9'IIDL -2W(l1 Business Phone 2. Name on Permit if Different than Above ` (-4'LLQ 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation 8 S/Tank Installation S. System to Serve: 0 House Mobile Home 0 Business 0 Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People 1 Dwelling Dimensions No. of Bedrooms Basement/plumbing No. of Bathrooms L Basement/No Plumbing T Washing Machine J Dishwasher 0 Garbage Disposai 7. If business, industry, 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 8. Type of water supply: @/,public 0 Private 0 Community 9. Property Dimensions / 5 QL 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes 0 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. 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 incurred from this application. M24 3 /11/ Date Signature Directions to Property : , / / c/o SBS IT I 9"�- -'ka lQ -�s tq C /� cp172 see T Q C/eq{ DCHD (10-89) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department .Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 RECiG`r�� S -C� ? 1 . Application/Permit Requested By NNW Mailing Address /a S �-T �Q.Ba �� ✓A�iC� /j✓� 70Q10 ��a�� Home Phone Busi ess Phone 45R0p�— '�L X 00 secp 1413 Bu_LS(,P- rod. 2. Name on Permit if Different than A vel 3. Property Owner if Different than Above u r' v Z 4. Application/Permit For: neral Evaluation 0 S/Tank Installation S. System to Serve: House u Mobile Home Business 0 Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Z71 Dwelling Dimensions / — 0 0 No. of Bedrooms 3 Basement/Plumbing No,/of Bathroomssement/No Plumbing @/Washing Machine Zi7lishwasher 0 Garbage Disposal 7. If business, industry, other: Specify type No. of People Served y No. of Sinks No. of Commodes 2 No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers 2. S. Type of water supply: Public 0 Private 0 Community 9. Property Dimensions _lam X O 10. Sewage Disposal Contractor- 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes 3Ti 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. This is to certify that the information provided is correct to thc! best of my knowledge, and I understand I am responsible for all charges in urred fr m this applicat n � 913 Date Signature Directions to Property : -n X—" a DCHD (10-89) �'¢L' •�`�M`' l� rDavie County Jlealt De arhnent and .dome Nealtlr Myency 210 HOSPITAL STREET I P.O. Box 885 MOCKSVILLE.N.C. 27028 PHONE:(704)834-5985 November 7, 1990 Potts Realty P. 0. Box 11 Advance, HC 27006 Re: 2 Site Evaluations Guy Cornatzer - Ovner Gary Boner - Buyer/1 Lot Baltimore Road Dear Realtor: As requested, a representative from this office visited the aforementioned sites on November 6, 1990. Both sites vere found provisionally suitable for the installation of a ground absorption sevage system on each site. If you have any questions, please feel free to contact this office. Sincerely, Charles E. Little, R.S. Environmental Health Section CL/vd Enclosure DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation G� NAME ' DATE EVALUATED ADDRESS S t`c�P PROPERTY SIZEC2� PROPOSED FACIILTY �-I s -9 LOCATION OF SITE _ Water Supply: On-Site Well Community Public // Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position Slope % O Z `�° G-�` 4 -g " HORIZON I DEPTH l% Texture group C L C L- Consistence Structure G Z C C Mineralo '. 1 HORIZON II DEPTH 4011 Texture group Consistence _ -Z F Z Structure k B,t_— 1_ A Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 S 5 5 _5S S —S RESTRICTIVE HORIZON SAPROLITE — — CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE 0 5 9, 3•S 4p 3.5--4,0 SITE CLASSIFICATION: S EVALUATED BY: __ l.- LONG-TERM ACCEPTANCE RATE: 3's - y OTHER(S)'yPRESENT: ow REMARKS: ' �- �� " LVIGEND 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