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365 Nolley Rd DAVIE COUNTY HEALTH DEPARTMENT I PROV M NTS PERMIT AND CERTIFICATE OF COMPLETION L NOTE: s'hued in Gomp iance Wit Article 11 of G.S.Chapter 130a Sanitary Sewa a Syste s Perm t Number NamebN� ?,. eJ '•,�� C �A��tp Date �y N2 ,76324 Location y 3 C2. •�' ,' Subdivision Name Lot No. Sec. or Block No. Lot Size 2�", X �Y,°° House Mobile Home —T Business -- Industry No. Bedrooms .'—.No. Baths — No. in Family -� — Public Assembly Other Garbage Disposal YES [D NO [g/ Specifications for System: Auto Dish Washer '4, YES'E' N0, ❑ Auto Wash Ma^hine YES 5�/ NO ❑ J O ► c �'( 3 ' X I� Type Water Supply *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. Q . j �P 3 U S s •� �` 3 a h 6 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 ti '1 a t, «►qs, �,r w. . Certificate of Completion ��41 -� Date S _2, *= 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the abovd"regulation,.but shall in NO way be,taken as a guarantee that the system will function satisfactorily for any given period of time. I •' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT \ Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Robin and Beverly McDaniel Mailing Address 343 Godbey Rd. Home Phone 704-492-96n4 Mocksville, NC 27028 Business Phone 704-634-6261 (hers) 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation OtSeptic Tank Installation Permit 4. System to Serve: 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 ? [3Basement/No Plumbing No. of Bedrooms three--1 finished, 2 unfinished KI Washing Machine No. of Bathrooms_2 1/2--1 1/2 finished, 1 unfinished I] Dishwasher Dwelling Dimensions approximately 40x20 ❑ 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 19c Private ❑ Community 8. Property Dimensions 200x200 Sewage Disposal Contractor 7 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes a 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: Go 601 South towards Salisbury, turn right onto Gladstone Rd. Go about 3 or 4 miles and turn right onto Nolley Rd. , just follow the Jockey Signs. The driveway is at the end Iof Nolley Rd. beside a singlewide trailer. This is a temporary driveway. 1+rr� This is to certify that the information provided is corre t to the best of my knowledge, Kid I understa am responsible for all charges incurred from this application. ,o 06-20-94 6 DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: ❑ 1. 1 OWN the property. 29 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 DaviQ County Health Department to nter-upon above described cated in Davie County and owned by Dewey D. Allen and Rosetta M. to all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. DATE SIGNATURE DCHD(193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/`Site Evaluation NAME �y� �- 1��c UAN m 1 DATE EVALUATED -��- T ADDRESS S A ' PROPERTY SIZE PROPOSEDFACIILTY 1'� oyLOCATION OF SITE N Water Supply: On-Site Well Community Public Evaluation By:lkL Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position s s s _.S' Sloe % £s- J314 i l- V__ASGR" 1X-0 HORIZON I DEPTH da" J211, 5." A Texture group C L C Consistence - Structure Mineralogy1' l 11 HORIZON II DEPTH 3L '' Texture group °�. Consistence Structure Mineralogy1 ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5S Sis RESTRICTIVE HORIZON — — — SAPROLITE — — CLASSIFICATION ,S, • S. S - LONG-TERM ACCEPTANCE RATE ,y 1 14 SITE CLASSIFICATION: S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: "0 O REMARKS: AZA I ) kJ 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 3C-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 ■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■■■■..■.■■.■.■■■.■■■■■/..■ .■■...D ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ............■.............. ■■■■■.■.■/■■...■■.■ ■■■.■e.e■.e■..■■.■ ■■......./■...■........■.■■■.■■■■..■...■.�■... ■�..■..■ ■■■e■■N■■ ■..■..■..■■■■■..■.■..■■....■.■.......■.■..■...■..■ ■.■■■■.■■e■e.■ ■..■■.■■./■■■.■.■■■■■■■■■.■.■■■■�■■■■■.■.■�....■/..■■..■....■ ■■■ ■.....■...■■.........■N...■■■■..■■.■.....■■......... ■■■■■■■.EON ................................ ................................ ................................ ............■■........■......■■■ ......................................................... ........ ................................ ....... ........... ■■■...■.eee.■ .................................................................. ■..■...■.■.■..■■..■.■■.■......■....... ...■■. ■ eeee■..■■■e.■■ ■■.....■.■....■.../.■■.■.■■.■■■■ ..■e ..e■ ■■ ■a ■ ■e ■■■■■■■ MEN MOMMEMMEM M MEMO ■■■..■■.....■....N/......■■.....■...■ �■E■ ■ .NH.. ■..■■■ ■ ■.■..■■.■i■.■.■■■■■.■►•��.■■..■■.....■■...■■u ■■■ ■.■■■■■■..■■..■■ ■..■/.........■.....� :e:.■■..■. i...�►■■.Z�:cu� ■ ■ .■ee■■■■e■■■ ■..■/.■.■■■..■■.■■■■.■■■■■■■rZ�.�OREVA%■■91A'Q ■■■■■■■■e■■■■■eWEEMMUM .■ ■■■■e■■ �ii■iiiiiii�iir■.iiii �.��iiiiii ii��rr , ■■■�■■■■e■■i=■■■■� ■■..■■.. ■■■ .■■■......�.-..■r...■..:i..�i■..■1�■ ■■ H■■■■e■.■.■I■. ............................ :■::.......:......5..■■■■C.e■u ... ....//.......................... .■..e■■ee■/1.■N.......e■■■..■.e■ .........................C■...■.■........■..:..■.■....■■■■u■■.MONO ■.■._■.■■■■.■e■■■■■■■■.■■■■.■■■■ ■.■■.e..■...■■/..■.■./.■.■N...■