128 Buckeye Trail - . .. 'Y':f. Y.zi' Y i,r t".vM,_.t�e .. 'y_ l-^•} c 1. . " A4s.'`� �1. - F- ..1 - .
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
aq ti ��. � � f, y ` Date � � - � ? j� N2 6 9.4 9
o ki
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business —_ Speculation
No.Bedrooms, 3 No. Baths No. in Family —
Garbage Disposal, YES [] NO Specifications for System:
Auto Dish Washer YES e NO p
Auto Wash Ma shine YES Q NO p
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.
f
IS" G V S O
i
(J
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
DER7 L-
_ F
Certificate of Completion C - r Date E� "A- 9c:�
'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.
P" ripIPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI
14 Davie County Health Department
Environmental Health Section MAY 1992
P. O. Box 665
n ' I Mocksville, NC 27028
rs
1. Application/Permit Requested By
Mailing Address 1Q1 /Jox S`6'?4 04 d IZIA/C C N- ('- —21-7,o o b
Home Phone 9 9Z -7 7 3 19— Business Phone
2. Name on Permit if Different than Above �� / P1411 Z
3. Application/Permit for: I4 General Evaluation Z4-!5—, ❑ Septic Tank Installation
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 ❑ Basement/No Plumbing
No. of Bedrooms 3 "Washing Machine
No. of Bathrooms 2-- r I-Dishwasher
Dwelling Dimensions d o cS2, + ❑ 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 2�Private ❑ Community
8. Property Dimensions l �' Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No 2
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:
,. ►.� C��y-l�W tom. v e. G, - .�-�{ /--(V+„lee d o N
This is to certify that the information provided is correct to the st of my knowledge, and I understand I am responsible for all charges
incurred from this application.
S-67-- -7 `
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
Fandd
ECK ONE: ❑ 1. I OWN the property. 2. I 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 Co y Health q�partment to enter upon above described
cated in Davie County and owned by d C c -�_
all testing procedures as necessary to determin aid site's suitability or a ground absorption sewage treatment
al system.
C� zll�w
DATE SIGNA3WRE
DCHD(12-90)
• 190
NIP \
QI \
N tp
N S 63�
o AREA =10.000 ACRES ��
z � •
TO BE CONVEYED TO
CHARLES R. BOGER 2X334,/3 —
'
PrP /3
N sso X42 w
� r
PIP p
N
' AREA =; 50.701' `APRVS
TAKEN FROM
N O DB. 97 PG. 474 �r (INCWDES EASEMENT)
m o
o �
AREA =.4.583 ACRES. "'
N
O
cn _
427.62 S 820 55' 47'0
ONE N 193-12 tD NIP . •�
X47" ►y NIP ,Q,, 425.67
(on prbperty EIP 380.17
N
205-5 471
line) W
573.29 TOTAL
50 1
EASEMENT
to
to
2 NIP :
LEAGANS TO BE CONVEYED TO ;
JULIAN H. ' RYLE &
W/ PEGGY M. RYLE x
O
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-OD N
+to
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un
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F
.,NIP
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ti
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+"r"��- G St74° 23' 59° W
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME Z DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTYLOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring, Pit Cut
FACTORS 1 2 3 4
Landscape position L L L
Sloe % 2
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group '
Consistence r
Structure
Mineralogy / J
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
SITE CLASSIFICATION: Y EVALUATED BY: 46 l
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
Mi neralo6ty
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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j Davie County .lfealthr Department
and Noifle Health' Ayency
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704) 634.5985
may 20, 1992
Patti Paul
c/o Gilbert Boger
Rt. 1, Box 569—F1
Advance, NC 27006
Re: Site Evaluation
Pudding Ridge Road
Dear Realtor:
As requested, a representative from this office visited the aforementioned
site on May 19, 1992. The site was found provisionally suitable for the
installation of a ground absorption sewage system. When the house is location
is determined, -the septic system will be designed by this office.
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
cc: Patti Paul