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181 Mocks Church Rd DAVIE COUNTY HEALTH DEPARTMENT J IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name cif'� "f :%, r l r' ir, �yf J1, Date �� N2 7849 Location Subdivision Name Lot No. Sec. or Block No. Lot Size 2/7 r — House —� Mobile Home —_—_ Business -- Industry No. Bedrooms �!Z _.No. Baths — — No. in Family — Public Assembly Other Garbage Disposal YES NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ , ,�� rj Auto Wash Ma,:hine YES NO ❑ �`�� ;�` f Type Water Supply , r ; ----- --- y�� C, '- .,�./.. '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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. ) Improvements permit by r *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 &Z,14 , r= Certificate of Completion ,-/�l 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENT Davie County Health Department L2 5 V n/7 152 Environmental Health Section P. O. Box 665 SEP Y6 iso Mocksville, NC 27028 LJ 1. Application/Permit Requested By Mocks United Methodist Church by Da Mailing Address P. 0. Box -4,v Id a/ Home Phone (910)998-5518(Church) Advance, NC 27006 Business Phone(910)998-2140(Dayid) 2. Name on Permit if Different than Above 3. Application for: Q9 General Evaluation ❑Septic Tank Installation Permit 4. System to Serve: [3 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 2 — 6 ❑ Basement/No Plumbing No. of Bedrooms 3-4 ® Washing Machine No. of Bathrooms 2 ® Dishwasher Dwelling Dimensions approx. 42' x 58' ® 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: ® Public ❑ Private ❑ Community 8. Property Dimensions 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: Corner lot at Hillcrest Drive and Mocks Church Road off NC Hwy 801 S b� This is to certify that the information provided is correct to the best of my knowled wd I understa�d I am responsible for all charges incurred from is application. !�S e DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: ❑ 1. 1 OWN the property. R] 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: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by MnekG uni f-Pd Methodist Church all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. 9/21/94 DATE SIGNATURE WHO(1193) it - 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ��U � DATE EVALUATED - 22 ADDRESS S p'�g PROPERTY SIZE �2� PROPOSED FACIILTY LOCATION OF SITE Q-7� Water Supply: On-Site Well Community Public Evaluation By:'--/�. Auger Boring V Pit Cut FACTORS 1 2 3 4 Landscape position 1-.. L Sloe 9. C3 - O—%° CU-$ HORIZON I DEPTH } � �► 2 ' Texture group Consistence Structure Mineralogy HORIZON II DEPTH 6" 3 3 G" b Texture group tal Consistence ?T Z Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: liza EVALUATED BY: LONG-TERM ACCEPTANCE RATE: I 1 OTHER(S) PRESENT: REMARKS: �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 5C-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 ■■..■■■■il.i.■■■...■.■.■.l■■■■■.l.i■■ilii■■■/■■■ilii■.■■■■ ■ /. ■. ■./.■■.■.■..■./..■■.■MMES..■■....../E■■ill■iMi.iilitl...■■l.li'%.0■ ■l.l■■■■ill■■■■t■■■■.■.i■■■■..■■�i.l■■i■■...i■■..e..iii..illMi■■■ ■■■■■.■tE■■....■...■■■.■.■......■....■...■ilii■.■till■ilil.it■iii■ ■...■S■iE■■■■i..■■■....■■l■.../.■ii■■.i.■■t■■.■e■■■li■Mil■■■.i..l■ ■illEli■■■l.■■.■■i.■.l.l.l.11...li■■SEMI■■■eM■.ill■■ll.■■i■..■■i.■ ■■■■t■t■■■.l■■■■■l.il■■.l.l.il...■ilii■i..ei■...i■■.....■..e.e■■.■ ■E■■.■■■■■!■Ilii■.■■■■Ili■■..■■■■■■ill.■■■■M■■■e■■■■il■it■t■■ll■■ ■l..■...■■il.i■ii■■■il■■■l■■.■t■■■ie■l..ile..ee■..e■■..e.e.e...li■ ■■ill■■■■e.i■■...ISE..I■■S..■■/. ■ll..i.■■■■tl...liiiililMi.Mii■■ ■■ii.■ei.l....ieeii■.Iii.■t/eli�i■■i.ili■ii■l■iiiei■ii.eii■.i.i■ ■■M.t■ii■i■.li.l■■t■■i■.■■■Mei■ ■■il.■..■.■..eie..i..ietee.■.i.■ ■Iii.■■■■■ii..■.E■...■■.■S■/..■■t■■■■.i■lM.■E■■■l.l■ll■iii■e...11■ ■.....Mee■....eee■..■eiaeeei■i.■■e■eeiee.e■e..i.e■C.i.i...Mlle.ele ■■■■■■■■■■l..M■■E■■■it■l■■ii.lEit■il.l.■l.ti■.i■e■ ■■!■■leE.leOmni ■.■■ei......e.e■..e....t.teiii.e.. ■.i..e..e.u■..■.C..e...ee■.■.. ■iii.lelSi.teM.i■lel■i.SMI..■... i.i.Ml.Mi ■S.i/i.l■ie.i■i■.iii■i ■■■ill.■i.■■■Mi.■■.il■..il■.■li.■..■.l■■.■■i.i■e..■.■ MEN C ■...i.SS.e/ll/S.■1..Si..■ii■.i.tiiie■ii.iiei.eee.e H■eee■..ei.eC■ ■.■e.■.....e■e.■..e.■.e...i■■ii■■■■■ii■li.l■■etii.Cl■.■M■l■■llleil ■ii■e■.1.......■e■dell.■■i■e■■■■■■i.l■.t..iee..ee..■.e...■..■■■EM ■lil■lei.......lee.■■e■e..■■.ie.■■et■e.e..e....ie.■e.e.ie...■....i ■ele■el.■■ieeiie■■■■■.■■■ie..e■■�i■.e■.e.M....u...e.■e■...■e.i..■ ■l.i.e..e■ie..tlni.■i■...Eei■lie.ie■..■■.i..i.ei...ee.■s■.e..ee■ ■eeeeee..ei...■e■...■..■■...■e.se■.e.e■e.eee...■■.e.■■..e�..i..i■ CCCCCCCCCCCCCCCCCCCCCCCCCCCCCC�i CetC■t■C�CC■.CCCCCCCCCCCCC.tmom ■CCC ■.■.ee....i.ee.e■...e.i..e.eeei.Cee..i■eC...e.■H■.....■e..e...ie■ ■e.e�ee�■ecce....ee..■...ee..■e.■■e■■...■■.e.e■e.■....e■�e..e.eee.■ �iGiil■�`heel■■i-iiMiiiiG:wr��:ti�iCl=i: �!eiliiC'�-��_:�r.i1��%■�r� ■e■■■.titi■i.i■eel........ee.■e.■e.■.e■e■■e...■.�i.■■.e..■..e....■ ■e.e.ee..e■ee..■e.il.Mlt.■■..l.i■■■.S■.i.ie■ill■e.■■■■■■■C■■S■■ie■ ■i...ee■.eii.e.......M..e.e...e...e..en. e..e.e. 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MEN.MM■MMMMMMMMMMMM■■■..■.■.....■■....i■S.Mi■i■■S.i.■■li■■.■i■.l■ rDatne County .dealt§ De artment and .761me Nealtfr� yency 210 HOSPITAL STREET P.O.BOX 645 MOCKSVILLE,N.C. 27028 . PHONE:(704)634.5985 September 23, 1994 Mocks United Methodist Church P. 0. Box 2122 Advance, NC 27006 Re: Site. Evaluation/House Hillcrest Dr. & Mocks Church Rd. Dear Client: As requested, a representative fro■ this office visited the aforementioned site on September 22, 1994. Based upon the information provided on the application for a site evaluation and after the evaluation was, completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal 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