195 Buckeye Trail (2) a �.�lei' _ p �t er t'1 b '� 1�Y1.•`�`f
t DAVIE COUNTY HEALTH DEPARTMENT N
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a H
�Sanitary SeN Systems f _ Permit Number 6K
Name`"�II>�I l� Date ~-� '�S N2
Location
Subdivision Name Lot No. Sec. or Block No.
Lot SizeHouse j'� Mobile Home Business _— Speculation
No. Bedrooms Lf� No. Baths No. in Family y
Garbage Disposal YES ❑ NO Specifi"cations..for,System:
Auto Dish Washer YES NO ❑
Auto Wash Ma:hive YES �j 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. 4
SQ
fes,: a
I y7
'
Improvements permit by __/ /ice
P P
*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: 3y tem
2S"4 E
Certificate of Completion _! Date._
v
"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 PERMI
Davie County Health Department
Environmental Health Section
P. O. Box 665 [ ���3
Mocksville, NC 27028
1. Application/Permit Requested By Alt,
�)/�
Mailing Address �✓ J r_s /ZF �"� ' -2—
Home Phone 912 9 ZI-5-5~w 73 Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation 2-1reptic Tank Installation
4. System to Serve: P'I-louse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision SectionLot#
es
L7 Isasement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms 2� B Vashing Machine
No. of Bathroomsa 7 dishwasher
_315-) X
Dwelling Dimensions �!� 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 Private ❑ Community
8. Property Dimensions 45�44 �� 7S Sewage Disposal Contractor Coote
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes @'I o
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:
eYL
cc4a - Crete
1 � 0..croSs ro 0.d
/2 '5�_ Go r n
This is to certify that the information provided is correct to the best of my knowledge,and I understand I am responsible for all charges
incurre from this application.
� f �'ee C
DATE SIGMADBRE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. Er2 I DO NOT OWN the property.
If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representativq of the Davie Co ty ealth ep rtment to enter upon abov des ribed
property located in Davie County and owned by. .1A���-G F.r,C AAQ . ! =�7E
to conduct all testing procedures as necessary to determine said site suitability fora ground abs rption sewage treatment
and disposal system1"//
.
Z' V4�DATE S TUBE
DCHD(12-90)
DB. 162 PG. 764-766 DB. 56 PG. 420
S 82'55'47" E t \
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eip at 19.W.2 eiP \ 50' EASEMENT
fence DB. 154 PG. 391
corner N 02'18'05 W
DB. 163 PG. 908-909
25.34
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GEORGE H. LEAGANS AREA = 5..001 ACRES o
PG. 474
617.89 26.09 \
nip N 82. 55' 47" W 643.98 TOTAL nip
N 09.33'06- W \ /
96.77
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I C
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section V. .-k
P. O. Box 665
Mocksville, NC 27028
--------------- -
1. Application/Permit Requested By. 5o 9 c t, 5/ �
Mailing Address ��• ��b X �S��� �c7 il�+w�e /v C• 2_760 (_o
Home Phone Business Phone - - — "k3 3 Qf
2. Name on Permit if Different than Above n Xtee
3. Application/Permit for: NrGeneral Evaluation ❑ Septic Tank Installation
4. System to Serve: Erriouse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
E'Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms 3 ❑ Washing Machine
No.of Bathrooms ❑ Dishwasher
Dwelling Dimensions a ❑ 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 A Private ❑ Community
8. Property Dimensions Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem 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.
Directions to Property:
�vdd; ,�f �'��ge �d• � cab ss -��o,.� C'l�-y-l�,� �ti��e
(� + env d /V /�'�� S 2 e
This is to certify that the information provided is correct to the b of my knowledge, and I understand I am responsible for all charges
incurred from this application.
l -- / 2�
DATE SIGN RE
CONSENT FOR SITE EVALUATION TO BE DQNE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 9 2. 1 DO NOT OWN the property.
If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by f �r/cl-i
to conduct all testing procedures as necessary to determine aid site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD(12.90)
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• DAVIE COUNTY, HEALTH'DEPARTMENT
•=' - Environmental Health Section
Soil/Site Evaluation
NAME UE °tom l� DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY ,//�s�' LOCATION 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 Z
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture groupC
Consistence
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 RATEI 41 1
SITE CLASSIFICATION: EVALUATED BY: 116l.�
LONG-TERM ACCEPTANCE RATE: y 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/('t2
DCHD(01-901
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rDavie County Nealtif De artment
• \y I
• and Nome Jlealtl yency
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634.5985
November 13, 199E
James Clayton Peele
c/o Boger Realty
Rt. 1, Box 569A
Advance, NC 27005
Re: Site Evaluation
Pudding Ridge Road/5 acres
Dear Mr. Peele:
As requested, a representative from this office visited the aforementioned
site on November 12, 1992. 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