447 Pleasant Acre Dr (2) DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name �, ,. , . � 4` �,\�\�.. \ ,, -;rDate 1 V,,
Location
(U)
y
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home_ Business Speculation
No. Bedrooms No: Baths "` i No. in Family _
Garbage Disposal YES :El NO Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES U NO ❑ r y Ir
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i - -
- I
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.
r ` �
Final Installation Diagram: System Installed by `"as �-�e, H
Certificate of Completion f �7 �,. ' i 'r 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
Davie County Health Department
Environmental Health Section
P. O. Box 665 RjEQ7/VE0 JUS
Mocksville, N.C. 27028 2
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 919-965-9744
1. Permit Requested By Pi edmnnt_Health Care Investors Business Phone919-965-9355
2. Address P.O. Box 117, Southern Pines, North Carolina 28387
3. Property Owner if Different than Above N/11
Address N/A
4. Permit To: a) InstallAlter Repair
b) Privy Conventional Other Type
Ground Absorption
nn''or .h 1 �1
c),Sub-DivisionB�L.LPSec. Lot No._. +�_ I �) f! o+` tD 3
5. System used to serve what type facility: HouseX Mobile Home usiness
Industry Other
b) Number of people Five
6. a) If house or mobile home, state sizq of home and number of rooms.
House Dimensions 50' x60' --3nnnSE Approximately--Seven
Bed Rooms_Bath Rooms 9 - 5 Den w/Closet one
b) If Business, Industry or Other, State: Number of persons served N/A
What type business, etc. N/A
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes three urinals None garbage disposal None
lavatory nne showers two washing machine one
dishwasher one sinks three
8. a) Type water supply: Public—Private Community
b) Has the water supply gystem been approved? Yes No
9. a) Property Dimensions See attached map
b) Land area designated to building site See attached map
c) Sewage Disposal Contractor F.E. Stoner, Rt. #12, Salisbury, N.C.
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? No
What type? N/A
This is to certify that the information ' t e of y
C.E. Hester
May 2, 1987 Piedmont Health Care Investors
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: -
601 South from Mocksville. . 5 mile from intersection of 801/601 ,
toward Salisbury, turn left on _Pleasant Acre- Road. Site is on:-!
the left. Site has been visited by Mr. Hall .
DCHD(8-82)
CHARLES
CONSTRUCTION
COMPANY
1 Partners Plaza—P.O.Box 121
203 South Pollock Street • Selma,North Carolina 27576
May 31 , 1987
Mr. Buck Hall
Davie County Health Department
Environmental Health Section
P.O. Box 665
Mocksville , North Carolina 27028
Dear Mr. Hall:
Attached is a copy of a request for site evaluation/improvements
oermit for a site located on Pleasant Acre Road . I assume the
original was misplaced.
Si cerely ,
Charles E. Hester
.CHARLES
CONSTRUCTION
COMPANY
1 Partners Plaza—P.O.Box 121
203 South Pollock Street • Selma,North Carolina 27576 J
Mr. Buck Hall
Davie County Health Department
Environmental Health Section
P.O. Box 665
Mocksville, North Carolina 27028
Dear Mr. Hall:
Enclosed is the Application for Site Evaluation/Improvements Permit
for the site located on Pleasant Acre Road. You have previously
visited this location on April 28 , 1987.
If you need additional information , please do not hesitate to
give me a call . Thank you for your assistance.
Sincerely,
Charles E. Hester
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
PS PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) PS PS
U U U U
3) Soil Structure (12-36 in.) S S
Clayey Soils PS PS PS
U U U
4) Soil Depth (inches) S S
PS PS PS
U U U
5) Soil Drainage: Internal � S S
( PS) PS PS
U U U
External S S
pS
M PS PS
U L( U U
6) Restrictive Horizons
7) Available Space S S
PS PS PS
U U U U
8) Other (Specify) S S S S
g PS PS PS
U U
9) Site Classification S S
U—UNSUITABLE S—SUITABLE PS— rovisionally Suitable
Recommendations/Comments:
Described by c Title Date
SITE DIAGRAM
--fT
l
9'
DCHD(6-82)
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665 ECEIVED MAy
Mocksville, N.C. 27028 12 W7
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 919-965-9744
1. Permit Requested By Pi edmont Heal th Care Investors Business Phone919-965-9355
2. Address P.0. Box 117, Southern Pines , North Carolina 28387
3. Property Owner if Different than Above N.1 A
Address N/A
4. Permit To: a) Install X Alter Repair
b) Privy Conventional X Other Type
Ground Absorption
c).Sub-Divisiona�ufi' �"�' Sec. Lot No.q-
5. System used to serve what type facility: House X Mobile Home Business
Industry Other
b) Number of people Five
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 5n ' X60 ' --3000SF Approximately--Seven
Bed Rooms_Bath Rooms 9 - 5 Den w/Closet_ nne
b) If Business, Industry or Other, State: Number of persons served N/A
What type business, etc. N/A
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes three urinals None garbage disposal None
lavatory onp showers two washing machine one
dishwasher one sinks three
8. a) Type water supply: Public_X—Private Community
b) Has the water supply system been approved? Yes X No
9. a) Property Dimensions See attached map
b) Land area designated to building site See attached map
c) Sewage Disposal Contractor F .E. Stoner, Rt. #12, Salisbury, N .C .
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? No
What type? N/A
This is to certify that the informatiLisCorr to,.Ve f owled e.
C .E . Hester
May 2. 1987 Piedmont Health Care Investors
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
601 South from Mocksville. .5 mile from intersection of 801/601 ,
toward Salisbury, turn left on Pleasant Acre Road. Site is on::-,
the left. Site has been visited by Mr . Hall .
DCHD(6-82)
CHARLES
CONSTRUCTION
COMPANY
1 Partners Plaza—P.O.Box 121
203 South Pollock Street • Selma,North Carolina 27576
Mr. Buck Hall
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville , North Carolina 27028
Dear Mr. Hall :
Enclosed is the Application for Site Evaluation/Improvements Permit
for the site located on Pleasant Acre Road. You have previously
visited this location on April 28 , 1987 .
If you need additional information , please do not hesitate to
give me a call. Thank you for your assistance.
Sincerely ,
Charles E. Hester
1,Richard G current,Registered Land Surveyor:(L-756)Certlfy Wiliam G. Johnson Jr e/ux. I
that this map was drawn from an actual field survey perforrrred I I
under my direction and supervision.that said Survajr conforms I I I
to the standards of practice of turd Surveyors of NC and the stiff
laws of NG I
Witness my hand and seal Mls/ =00"E /SJR' + .i►e - l
Ricl ►0 G Gn►r/Drim ,
e
e` `v°°° RFG/sl`•��/eeM O Lot 9d Lot 29 I
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Lot/O 1.0 30 a
C GUUR1C1'
Loi 3/ Cil
Cb
r Gro Lot/2 Lot 32
sae- - Op
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I 209' , dna►/a I I
R/W I I Cb�
Plot of Survey for I
Richord R. Foster
Piedmont` He olfh Core InI Lydio Frye I
yesfor� R/W 131-491 I 77-339 I
Jerusalem Township, Dovie Co., NC 106-28/ I I
April 14, 1987 Scale /"=60'
so ao o so MoI Vicin/1 Sketch
Legend _ ea
Current Surveying 8 Mopping, P.A. /.90 Acres Boxwood Acres
Brushy Mountain Road • Existing Iron Mop 2
Rt 4 Box /342 o Ca/cu/algid Point �►� �+�ss Iron set
Lots 9-12 64
Wilkesboro, N.C. 28697 29-32
Richard C. Current, Reg. No. L-756 Mop Book 4, P. 49 _ IM7
Tax Map M6-1/ eo,►
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�tti�ie (I�nixn#g �ett�#� �epttr#men#
Unb Pante Pealth �genq
P. O. BOX 665
f arksiui(Ie, North ( arn[itta 27028
CONNIE L.STAFFORD.8A,MPH TELEPHONE
Health Director August 21, 1987 (704)634.5985
(704)634.5881
Charles Construction Co.
P. 0. Box 121
Selma, NC 27576
Dear Sir:
This letter is regarding the group home under construction on
Pleasant Acre Drive in Davie County.
It was brought to our attention by a neighbor that there are
two wells cut off underground in the vicinity of the newly installed
septic tank.
Please contact this office as soon as possible regarding this
matter.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health
RH/wd