118 Cora Jolly Ln 140
DAVIE COUNTY HEALTH DEPARTMENT .
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
A •
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems /Jj; Permit Number
Name •r i, �� / /,1. ?t , rte: Date No
- - 3639
Location'
Subdivision Name Lot No. Sec. or Block No.
Lot Size fir House Mobile Home Business Speculation
No. Bedrooms �Q No. Baths No. in Family
Garbage Disposal YES ❑ NO 2-"' Specifications for System:
Auto Dish Washer YES ❑ NO [2''^
Auto Wash Ma.hine YES EKNO ❑ /DO�/' f•'. > �y -
Type Water Supply �.! _ �V/GGj.�:1',�%.� �� :r�
*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.
l f�i;e
F
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�1n. talled by-
-
i
Certificate of Completion �t 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.
tel—
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE"t �
Davie County Health DepartmentEnvironmental Health Section
I l�6 I P. O. Box 665
Mocksville, NC 27028 _
1. Application/Permit Requested By Jc /
Mailing Address ��3 �oX .5d0- 9m2o u illks /'! -d . 02 72)2,9
Home Phone �� � Business Phone d3 3S� /�•9�,r-
2. Name on Permit if Different than Above _SAm,C
3. Application/Permit for: ❑ General Evaluation 4Septic Tank Installation
4. System to Serve: 9§"Alouse ❑ 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 111/Washing Machine
No. of Bathrooms ?❑ 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: Liz Public 447
7 I El Private ❑ Community
8. Property Dimensions ARFwE 300 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility 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:
�E ,��o4�c 1�✓o`'S
This is to certify that the information provided is correct to the best of my knowledge, and I nderstand I am responsible for all charges
incurred from this application.
DATE S GNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: �1. I 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 Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD(12-90)
r �
r DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
�J ® Soil/Site Evaluation
NAME !�1< <,e �I!/i`G DATE EVALUATED
ADDRESS PROPERTY SIZE 1,1;rX?00
PROPOSED FACIILTY �, ��ll Q LOCATION OF SITE'
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position .0 L A_
Sloe Z ell
HORIZON I DEPTH V ri
Texture group rz-
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture group
Consistence
Structure d vq-st-s-
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION S
LONG-TERM ACCEPTANCE RATE / — - I SITE CLASSIFICATION: (/- EVALUATED BY: /Gt%J/
LONG-TERM AP4PEPTANCE RATE: OTHER?il�)�,Oeo
) PRESENT:
REMARKS: rol - _'`� , � vE°/
LEGEND P_e✓�,��/ �,�- AS
.' a
Landscape Position �I�P /
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
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Davie County Neakf De aitment
and ,, l e Xealtt yency
210 HOSPITAL STREET/P.O.BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634-5985
January 16, 1992
George Randall McDaniel
Rt. 3, Box 502
Mockeville, HC 27028
Re: Site Evaluation
Bowens Road
Dear Mr. McDaniel:
As requested, a representative from this office visited the aforementioned
site on January 15, 1992, to determine the soil/site suitability for the
installation of a ground absorption sewage system. Unfortunately, due to the
reasons noted below, we must classify this site unsuitable:
1) Shallow soil to rock.
2) 2:1 clay.
We sincerely regret this classification and are more than willing to
discuss this matter further upon your request.
Sincerely.
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure