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452 Merrells Lake Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION a0-9q, *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number, �, cn, C�V v��e� 7 o Name_�—� _ ate N- 7542 O K Location `3 U S u ,Wa 114 IF– Subdivision Name ' Lot No. Sec. or Block No. Lot Size�_" - ` � �' House Mobile Home Business,. Industry No. Bedrooms ..No. Baths No. in Family — Public Assembly Other Garbage Disposal k . YES .Q NO Q Specifications for System: Auto Dish Washer YES p . NO Q `/t�c� ca C�`z� 'fir,•. - - Auto Wash Ma Nne YES g? NO Q Type Water Supply *This permit Void if sewage system described below isnot installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use'change. 1-3 .,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.; 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by R a � _'vFN Certificate..of Completion ` • Date �r *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.,PERMIT l Davie County Health Department Environmental Health Section P. O. Box 665 1� Mocksville, NC 27028 1. Application/Permit Requested ByVT� 0kn K i AA_ l2 row(e.y Mailing Address S09 &ods U��1�- py�' a7o2-Y /�� Home Phone % 1�, Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: M 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 2 Yz ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type J 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: 02,Public ❑ Private ❑ Community 8. Property Dimensions —7 4� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facilit 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: w �e �{ fo J'�(e r r 1 Lo-k-e— �OoJ . �L e f f) J � r �wV4,1 as s , This is to certify that the information provided i correct to t e best of my knowled a nd I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 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 ealth Department to enter upon above described property located in Davie County and owned by r to conduct all testing procedures as necessary to determin s id site's uitability for a ground absorption sewage treatment and disposal system. DATE SIGN DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME � -� DATE EVALUATED l �' '93 ADDRESS S P e PROPERTY SIZE PROPOSED FACULTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation Bytom- - Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position 57 57 -5 Sloe %. - � �' -O 1S HORIZON I DEPTH Texture group L C L Consistence 1- Structure C. P Mineralogy HORIZON II DEPTH Texture groupC c Consistence - Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS Ss 5S S RESTRICTIVE HORIZON SAPROLITE — CLASSIFICATION p s �• LONG-TERM ACCEPTANCE RATE L1 .y SITE CLASSIFICATION: 5 EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: 0 REMARKS: �� 11_1 � 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 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 ■■■■■■■■■■■■■■■..■■■■■■■■■■.■■■■■■■■■■■■■■■.■■■■■NOON.■■/■ ■ ■■l1.� NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNmom NMEMO NNNNNNNiiN ■■■■■..■■.■■■■■■■■■■■■/.■■■■■■■./■■■■/.■.■■.■.■■■■/■■■■.■■■■■■■■■■ ■■■■■■■■■■■■■■■■.■■■■■.■■■■■■■■■■■_■■.■■■■■■■■■■■■..■■..■■■■■.■mom NNNNNNNNNNNNNNNNNNNNN■i�NNNNNNNN�NNaN■iiiiNNNNNNNNNNNNNNNNNNNN=iii ■.■■/■.■■■.■.■■■.■■■/N/■/■/■■//■NONE/■■■■■■■.■.■■■■■ ■.■■■■■■■■■ .................................................. ............... ■■■■O.■■.■..■.O■moi!.■■..■NOON■■■ u■■■.■■■■■■■.■.■.■.■.■■■.■■■■■■■ ■.■.■..t..■...■.■■ .nl..■.■■■/■...■:..1■■O..■.N.■O/O■■.■■.■�.■■.■.■ ■.■■.■.■/NEON■t■■.r■■N■N■/.��.�■I..■■II��tEe■■if.■.■_ ■■■■■.■.■■e■■ ■■NOON NOON■■ ■.i\..■ \iiCii�l.�/moi/■/►�i�rN�■■... .■■/.1. ■■//■■ ■■■.■■■■.■..■■■■■■■■`■.■■■■.�■■/■.■■■■■1ii%NOON■■■ .■■■..I■■.■■.■■■■■ ■■■.■.■t■■■■.■Nt■.■■.►`\.■■■Er:f■...■..■..■■■NONE■■■■.■■I■■N■■■■.■■■ ■.■./.■■■■/■/O■■■.■.■■/i�\/■/■.ri■...OE■��■ ■.N■■.■ .NN■/I■■■■■■/■■■■ :NNNNNNNNNNNNNNNNNNNNNNNN:::::NCNCN:N`:NNNN:�.C� .■:.�:��::�_:::::� ■...■■■E.N/■....■...■./I/.■.//■.. ...�■�■■ ■ 1■t ■/■/E. ■/■//■■/■■O■■■O■■.■■■■■I■.■.■■■■/ ■.■ N'■■E■■/ NONE/It/■NOON ■■.■ ■■■..■■■■■■..■■■N■■■.■/I■■■.i■iO:�\i ■■■■ ■■■■■■■�� ■■■■I.■.■■■■NN■■■ ■■.■■■■.■■■■■■■■■■■■■■.I..■■■i.■■■■■.■■■ ■.EE ■ E■.■'/.■ NEON■. ■ ■.■■■■■■■■■.■■.■■..■■■...■■E■E■..■■=■■■t■■..NNNEN ■■■■t■. ■■MEMO ■ ■.■.■....■...E■■■■■.■.■,■....>•■t.■/._.11 •amEE. ■■■//■.■■■■■■O■■■ NNNNNNNNNNNNNNN■■NNNNN■iiiiiiii■■NNN� ■■N■....E■■...■Ot■■....t/N...■■O NNNNNNNN EN NNNNNNWINNNENNNONE. ■/■ XNNNN / ■■N.■.■.■■■■■■■.■ ■■.■.■.■.■■■■.�i.Et■e■Ott■r.■.�I�E■�.r�N......■..■■■ ■.N.■N■■■.■..■.■N...E■■■■...■>•■_t..l.■iEI�iN.■�- ,�t�t■■■..■.■■...■ ME MENNNN�N�NNNNN�iliiNiiiN��NNNNNNiiiiiNE. i t�NNNNNNNNNNNNN -MMEME mom CNON: .�::::D. ■■....■■. ■■■■■■■■■■■'.■■■■■■■■■■■G\.■■t■■ ■1�/a1�Olw ■.E■■///N■■■■■■E■■ NONE ■/E/■.■■■■■■■■■.■NN■■.��■■■■/■■■■''�i/�v�■■■r�Cr;;�■■■■/./■.■.■■/■■■/■■/■ ..■.......�/■...........1./ ■1.■I..►...►...INI►..N■I►1■.N'i1■.■■.N.t. .■N...mom. ■■■.■■.■.0l.■............►1...MEMO ��.......•......■►................. ■■/■■.■■.■.NO■■.■.N.■.■■1\IN■■.BOE/■►1■.�i.�N■■.■■ON■■//./N.//N.■.//.. ■/■■■■/■.■I■N.�■O■■f■.....■■./■■■■■NEON/t■■■/NEON■■.N■■■/■■.N/■/■/ ■E■ NOON■■■t■■■■■■■■■■■■■■■■■■■ ■■■■t■■■.■■■■t/.//E■.■/■.■N■/■■ ■■■■■■■■■■► ■■■■■■■■■■■■■■■.■■■■■■E/■■O■■■■■/E.■■■tNOON■.■/■■■NOON■ Davie (aLqnty .Va1Pf .Dyar1xen1 and .Moine NealtI yency 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 April 71 1993 John & Kim Crowley Rt. 31 Box 309 Mocksville, NC 2709 Re: Site Evaluation Merrells Lake Rd.-7 1/2 Acres Dear M/M Crowley: As requested, a representative from this office visited the aforementioned site on April b, 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, Charles E. Little, R.S. Environmental Health Section CL/wd Enclosure