137 Daye Ln ..
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'9K
*NOTE:
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a d a�s�
Sa itary Sewage Systems Permit,,l �or
Name `-.ia . A. Date N2 ,
Location ./.S
i
Subdivision Name Lot No. Sec. or Block No.
Lot Size /'' House Mobile Home Business Speculation
No. Bedrooms ..No, Baths No. in Family _
Garbage Disposal YES ❑ NO Specifications for, System:
Auto Dish Washer YES ❑ NO [�` �f
Auto Wash Ma shine YES p'ANO E]
Type Water Supply 1 __—
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
r. This permit is subject to revocation if site plans or the intended use change.
' .fir-.....+. j��.•�
I
r
Improvements permit by
'Contact a representative of the Davie Cauy Health Depa merit for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of co le ion. Telephone Nu ber 704-634-5985. r
r.ari �l
Final Installation Diagram: Fa stem Installed by
1
Certificate of Completion - Date t� :L ^�
*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.
VD
� : • . 7 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Q G Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Reques d By Business Phone _!�75?7'Zlbl
2. Address L
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home_t�'_Busines
s
/ Industry Other
b) Number of people Z
6. ap If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes 3 urinals garbage disposal
lavatory Y showers washing machine_ ,
dishwasher / sinks
8. a) Type water supply: Public !f Private Corpmunity
b) Has the water supply System been approved? Yes 1 No
9. a) Property Dimension / 1740
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is corr o the b f- y knowledge.
/q/
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
IAJ
TOT ^�T�
DCHD(6-62)
Y` DAVIE COUNTY HEALTH DEPARTMENT
' > Environmental Health Section
Soil/Site Evaluation 'may
NAME pr DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE � 1
Water Supply: On-Site Well Community Public f
Evaluation By: Auger Boring ��_ Pit Cut
FACTORS 1 2 3 4
Landscape position L L- L— .L
Sloe % -1/0 Y
.HORIZON I DEPTH Y
Texture group f'L
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC
Consistence ,e a
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE �f ,
SITE CLASSIFICATION: _ (f! EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
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-Nonplastic 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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BEST MAPPING SERVICE A
ROUTE 4, BOX 409 ��
ASTER, SOUTH CAROLINA 29720 DATE 0i
RON
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s Davie County Yfeaki 7yaie'my
rtment
e Nealtli
and .1�nm
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634-5985
August 27, 1991
Potts Realty
Attn: Roy Potts
P. 0. Box 11
Advance, HC 27006
Re: 3 Site Evaluations
Redland Road at I-40
Dear Realtor:
As requested, a representative from this office visited the aforementioned
sites on August 22, 1991. The sites were found provisionally suitable for the
installation of a ground absorption sewage system on each tract. The location
of each house must be staked before permits can be issued.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health Section
RH/wd
Enclosures