979 Pudding Ridge RdDAVIE COUNTY HEALTH DEPARTMENT//- 7
Environmental Health Section /✓ /
• ,� P. O. Boz 848/210 Hospital Street
{ Mocksville, NC 27028
` (336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 990001790 Tax PIN/EH M 5831-46-9687
Billed To: Edward Leagans Subdivision Info:
Reference Name: Location/Address: Pudding Ridge Road -27028
Proposed Facility: Residence Property Size: 90+ acres
ATC Number: 2979
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type H Nr�5r— #People 2— #Bedrooms �—�; #Baths —2—
Dishwasher:
Dishwasher: 0" Garbage Disposal: M"'— Washing Machine: 0� Basement w/Plumbing: 13"— Basement/No Plumbing: 13
Commercial Specification: Facility Type #People #People/Shift #Seats Industriall Waste: 13
Lot Size 4-53 A4—L"5 Type Water Supply Est— Design Wastewater Flow (GPD) 436`0 Site: New E' Repair El
System Specifications: Tank SizeLULOGAL. Pump Tank GAL. Trench Width Rock Depth Z Linear Ft.
Other: q '01SrO (&)TI0r-3 0 ) Nnir&I-L. L.t►-9�S g� O .0 . r,., Ia .
Required Site Modifications/Conditions:
-ALL a �1 co t" -o p -
LA
0
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)7 1-8760.*A**
13
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Environmental Health Specialist's
DCHD 05/99 (Revised)
Date: 10
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
P. O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001790 Tax PIN/EH #: 5831-46-9687
Billed To: Edward Leagans Subdivision Info:
Reference Name: Location/Address: Pudding Ridge Road -27028
Facility: Residence
ATC Number: 2979
a¢e- aut acres
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE STR IO VAL D FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature ate: v Of
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be taken as a guar lee he system will function satisfactorily for any
given period of time. II l
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Septic System Installed By:.
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
O
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Soi
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE6MIT & ATC
• Davie County Health Department
Fnci
En
virwmetdaiHeai i Secdw
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 JUN } 3 2U01
(336) 751-8760
i
i !rc
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AI -T THE UIRFII)I;Y _
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for "irictpi/o�n—sem.
M
1. Name to be Billed C/C2'( & T (( 44 Contact Person g-lOp'- gr&c-
-
Mailing Address % (�ucdc�•i�t�i �Lf ii ���./ Home Phone ���
City/state/ZIP '�(pG�l.?(/liBusiness Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For:�'>./Site Evaluation ❑ Improvement Permit/ATC ❑ Both
4. System to Service: House ❑ Mobile,Home ❑ Business ❑ Industry ❑ Other
s. Iff Residence: - / # People
2 #Bedrooms ---�� �13athrooms '�.
IST Dishwasher F/ Garbage Disposal L Washing Machine /Basement/Plumbing fl Basement/No Plumbing
6. If Business/Industry/Other:-.Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: ElCounty/City W Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes VNO
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: y�b 'rum • /p WRITE DIRECTIONS from Mocksville) to PROPERTY:
Tax Office PIN: "c # "�O 3 r —�t/b `7 �,O L NO//;A-
Property Address: Road Name �� ��C!�h' f �/��c/ 2T• �Q- �T �"�
City/zip �illc . IUB' �7oZ.P' �udd,yL.t 64e_ az�-
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
Date Property Flagged: _ �3 D /
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. 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 j ��d H. lmw&: &;Ae'X t Ona#aza Jae,
to conduct all testing procedures as necessary to determine the site su ility. P Cezy je- /eit14A-c.'
DATE Z/ �� ( SIGNATURE � �ti
�f
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
C,'
Revised DCHD (07/99)
(1-7 0)
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No. / b
Invoice No. `�
�. -PUDDING RIDGE ROAD,
(1274) I Oh 1065
(1081) (995)
808 IL�AI
j"j ('p((il1 %1AVSv
U +ribc��lacGd w,�'n j.JVinc� �tu4�'�•
E400000041
(91.62 A)
9687
N
277 ,
?77
(1206)
SR 1435
9
cn
N
to
o'
(667)
(6.27 A)
5735
(30.34A)
13.39A 9725
3637
V
V
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #: 990001790
Billed To: Edward Leagans
Reference Name:
Proposed Facility: Residence
Water Supply:
Evaluation By:
PROPERTY INFORMATION
Tax PIN/EH #: 6831-46-9687
Subdivision Info:
Location/Address: Pudding Ridge Road 02
Property Size: 90+ acres Date Evaluated: �i 01
On -Site Well Community
Auger Boring ' Pit
Public
Cut
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE- OTHER(S) PRESENT: �4
AA f# ncZr�G
REMARKS: 4� �>vd✓ [c�4�%�Z- S 1 FDL11Fa +^' gZ ,, &-fe,
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 05/99 (Revised)
rM
groupHORIZON
Texture
r�•�s����•a��r
�:sM10MViEWE=_
M
_Consistence
HORIZON 11 DEPTH
Consistence
ineralogy
MMineralogy
Texture group
1001, OF E WA WIM
Consistence
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
SOIL WETNESS
SAPROLITE
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE- OTHER(S) PRESENT: �4
AA f# ncZr�G
REMARKS: 4� �>vd✓ [c�4�%�Z- S 1 FDL11Fa +^' gZ ,, &-fe,
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 05/99 (Revised)
i
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Davie County Wealth Department
Environmental Nealth Section
PO Box 848 / 210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
June 21, 2001
Mr. Edward Leagans
979 Pudding Ridge Road
Mocksville, NC 27028
Re: Site Evaluation -
90 Acre Tract/Pudding Ridge Road
Tax PIN #: 5831-46-9687
Dear Mr. Leagans:
As requested, a representative from this office visited the above site on June 20,
2001. Based on the information provided on the Application for Site Evaluation and after
the evaluation was completed, the site was found to be provisionally suitable for the
installation of an on-site sewage disposal system.
Based on the evaluation, a three-bedroom residence would require approximately
500 linear feet of septic drain line. This is subject to change as actual dimensions of the
septic drain field will be determined at the time an improvement permit is issued.
Before a representative of this office will revisit the site to issue an Improvement
Permit/Authorization to Construct the appropriate application must be completed in full
and submitted to this office. The location of the facility the system is to serve must be
staked off.
If you have any questions, feel free to contact this office at (336)751-8760.
Sincerely,
CJ
eeauchamp, R.S.
Environmental Health Section
enc(s)
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ED WARD H. LEAGANS , ET AL i \'
D.B. 198 , PG. 864 � �.
D.B. 97 , PG. 474 � s'T�
� PINEVIEW ACRES
� r�oT TO SCALE
� P.B. 6 , PG. >23
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EDWARD H. LEAGANS , ET AL � °
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D. B. 198 , PG. 864 .
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„ ED WARD H. LEA GANS , ET AL
AREA = 4.581 ACRES D.B. � 98 , PG. 864
AREA INCLUDES S.R.1435 R/lY
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% TU'I"I'EROW SURVEYING COMPANY
� /' 124 S�UTH SALISBURY ST,
� ;' M❑CKSV I LLE, N, C. 27028
�eW ' (336) 751-5616
�y 300.34 � ��ro� �
�,e�, ��--S g4•29'31'
�on
100 50 0 100 200 300
SCALE IN FEET
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,����N CA�O�,,�� • PLAT OF SURVEY FpR+
;�o�`•oFEss;oti�!ti9 B ED WARD H. LEA GANS
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= SEAL I, GRADY L. TUTTEROY, CERTIFY THAT UNDER REVISIONS , 1" = 100� �ppRpym yy, Y, RHO
= ' MY DIRECTIDd AND SUPERVISION, THIS MAP GRADY L. TUTTEROW FILE tW[�
� : L-Zr'J`L7 � ` MAS DRAMN F AN CTUAL FIELD SURVEY 06�28�01 LEAG—ELL
%�";� Q'�: MADE TUT ROY S EY I OMPANT.
BEING 4.5813 ACRES TAKEN FROM
:�,9-�tio suR�E`:'Q,O:
,�� °•.,, �`� THE C. ELLIS LEAGANS , ET AL PROPERTY (D.B. 198 , PG. 864)
� YC TU��•`� LYING IN THE FARMINGTON TOWNSHIP , DAVIE COUNTY , NORTH CAROLINA
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: PROFE SIDNAL L sua EroR �-2s2� TAX MAP REF: E -4 , P/0 PARCELS 40&41 �I"� �'�pi_3
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