138 Poplar Hill Ln N I-V-`,krmp
DAVIE COUNTY HEALTH DEPARTMENT f
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE!Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �� ;�.: %/ %,.r` Date 's C2_ f NO �5 ._
..,✓ - � 6.J
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size / W) House Mobile Home -Le� Business Speculation
No. Bedrooms -- No. Baths — No. in Family— —
Garbage Disposal YES ❑ NO Q-' Specifications for System:`'-
Auto Dish Washer YES NO ❑
Auto Wash Ma.hine YES NO ❑ � � ``'' /*
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.
t.
� r
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 Installed by
'M Certificate of Completion �`-'� 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/IMPROVEMENTS PERMIT
j Davie County Health Department
" `� Environmental Health Section
P. .O. Sox 665
Mocksville, NC, 27028
��E1VEC1 MAR' 1
B
1 . Application/Permit R e u Requested t e d� y
Mailing Address J/C :271oJ
Home Phone IZ, 70 0 Business Phone
2. Name on Permit if Different than Above
3. Property 'Owner if Different than Above
4. Application/Permit For : C) General Evaluation S/Tank Installation
5. System to Serve: O House
I.Industry
Home 0 Business
L Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms 3 Basement/Plumbing
No. of Bathrooms -7 Basement/No Plumbing
Washing Machine Dishwasher Garbage Disposal
7. If business, industry, 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
8. Type of water supply: Public D Private Community
9. Property Dimensions z 4.,
10. Sewage Disposal Contractor
11 . Do you anticipate additions/expansions of the facility this system 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.
This is to certify tnat the information provided is correct to trig
best of my knowledge, and I and tand I am responsible for all
charges incurred from this ap lica ion.
Date Signature
Directions to Property :
DCHD (10-89)
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department 1
Environmental Health Section
'• 1� P. 0. Box 665
.`I Mockoville, NC 27028
1 . Application/Permit Requested By i
'
Mailing Addressa!
Home Phone s- Business Phone
2. Name on Permit if Different than Above (/ '�zYf'�=�� dz2 •
3. Property Owner if Different than AboveU/2,Y9^—// �rn
4. Application/Permit For : 0 General Evaluation 0 S/Tank Installation
5. System to Serve: House Mobile Home [r& 0 Business
0 Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions �ux Z.6
No. of Bedrooms - Basement/plumbing
No. of Bathrooms Basement/No Plumbing
Washing Machine Dishwasher 0 Garbage Disposai
7. If business, industry, 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
S. Type of water supply: W Public 0 Private 0 Community
9. Property Dimensions
10. Sewage Disposal, Contractor
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 Yes XNo
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.
This is to certify that the information provided is correcltlitb0401
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
Date Signature
r-"a-q t— /A 0-21Z V J
Directions to Property : -t-
GJ 0 vg qt" ("d/1-.e� �� 31 U I'2- .2 n 2� ry Y 1� f' /�y
P4
WA,
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME ��•�// .��'�?� Y DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY -i'0P LOCATION OF SITE I ��/ -
Water Supply: On-Site Well Community Public 2/
Evaluation By: Auger Boring 6/ Pit Cut
FACTORS 1 2 3 4
Landscape position G C L G
Slope % 62-
HORIZON I DEPTH G
Texture group
Consistence
Structure re-
MineralogX
HORIZON II DEPTH -z/11 L HIJ
Texture group 14-
Consistence . '
Structure J P mat>r
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION S S
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: �-S_ 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-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(01-90)
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Davie County Jfealtl De artrnent
and Xome Nealtk Ayency
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE,N.C. 27028
PHONE:(704)634-5985
February 5, 1991
W. V. & Darrell Smith
Rt. 1, Box 316
Advance, NC 27006
Re: Site Evaluation
Redland Road
Dear Mr. Smith:
As requested, a representative from this office visited the aforementioned
site on February 4, 1991. The site was found provisionally suitable for the
installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health Section
RH/wd
Enclosure