188 Bobbitt Rd (2) t ,kt. �yq--:.4 � ,�r y y.i9 t;..,� �' t -�.,,,;s �,;; - Y�, s r t .. �� •-•�>., .4 a .-., ..., - >t. ..4':;
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE:Issued in Compllance With Article 11 of G.S.Chapter 130a T d�
Sanitary Sewage Sys ms Permiteidl"9-9;
Name ��k Date /D 1—X;- Np ;s' ' ' /,J$fj
LocationCel?iaacJ?
„S�-r';-1;�� Vii✓r r/� f�/'tc t�,?f" — �Di��cv li�r= .� �P��t�
Subdivision Name Lot No.. Sec. or Block No.
7-
Lot Size r � House Mobile Home —r— Business Speculation
No. Bedrooms No. Baths No. in Family T —
Garbage Disposal YES NO Q S ecifcati ns,for Sy to
Auto Dish Washer YES NO p � ��•114-(/i1 r 1 pt V21w
Auto Wash Ma shine YES NO ❑
Type Water Supply 's __—
*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.
1 �
Q
Improvements permit by —
Ila
"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 RM. on day of completion. Telephone Number 704-634-5-985. --
Final Installation Diagram: System Installed by
/S D
�u )v
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.
Vj(
f .° �ys�/APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
d� Environmental Health Section
P. O. Box 665
P U� 1 Mocksville, NC 27028 4 g
I 192
1. Application/Permit Requested By
Mailing Address `1"►0 ,4�,4 W a ��, - s ts+u Z�(o -
Home Phone Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: D�General Evaluation 2`6eptic Tank Installation
4. System to Serve: Cy7 House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot#
9 Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms 3- Rr Washing Machine
No. of Bathrooms 3 1�Z E;�Dishwasher
Dwelling Dimensions / Pax ZA-2 �� o x 2 IdGarbage 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 X3.33{ '• (see- Sewage Disposal Contractor UAkAV1--\ „k �•.r.�
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes d 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:
C
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
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
Ftaondodisposal
ECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 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 County Health Department to enter upon above described
cated in Davie County and owned by
all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
system.
DATE SIGNATURE
DCHD(12-90)
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CREEK LOCATION It21.552 AC. 'Y
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to 3 50.03'49'W 112.16' -MV/AN JOYCE- 1n �\ \ 11 E]Y•Aq[f --�
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EF 3 53...'.6 W 18.6 _ ;, � --_- f:•a._=_-
F4 N 74.03' 17•W 21.64' _
ON 3 77.09'52'W 01.02' ��
N1 N 75.06'A9'W 81.74' C -- /� .,•1e
Il 3 57.22' 51"W 29.68
09 N ".Ov 17• W 42.30' a 13.636 AC.
NL 3 70.14' 15' IN 44.63' '° 5°2y i ••A
W S 10.10' 32"W 39.62' 1109'2150'
WIN301.11100
N 3 88.21' 48'W ]O.O]' - ,728_AC. ,5
NO 3 05.26' 25'W 21.10' 076 \ 1� 'N 637"
OP .S 27.12' 58'E 76.71' I $q 11.W 661, I -S 609•215D-W 6.7$ --
►0 S 44.09'09"w 31.02' I 3B' I B0e2 6q
OR S 03.20'02"W 103.17' I 1019 6,
R3 3 64.11' SS'E 37.70' _ I •62• f
ST 3 23.11' 57'W 53.31' I
^• 3 q•51S4Y E 36.40' '
DV S 26.33'54"W 78.26'
IRON STAKE FOUND ---- VW 3 02.3r3r W 109.11•
- W2 3 4°•3514• W 244.46 6RF660RY- I
IRON STAKE ➢(ACED ------0 AT 3 23.24'17' E 73.01' - - HAROLD 1 - RUBY MCKN/6N7-
YZ 3 23.33130 W 50.99'
- Z AA 3 IT-45'30"W 214.37'
J
NORTH CAROLINA -DAVIE COUNTY
1.WAYNE HOM74N,BEING DULY SWORN.CER J IFL THAT THIS -
' - YAP46AS MADEIFROM 4 SURVEY Y40E Y 9E.THAT-tNE.
EII0.04 OF CLOSURi AS COMPUTED BY D�A.IS t'j .qg_ (6u1E-1'•200'
TNAT TeSO NOT SURVEYED AR[ SNOWH 15 ' t
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME V7)7L, DATE EVALUATED
ADDRESS PROPERTY SIZE zzi e
PROPOSED FACIILTY �OuSG LOCATION OF SITE
A/ ecc) 7
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 1 2 3 4
Landscape position
Sloe %
HORIZON I DEPTH
Texturegroup_ SL S L
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure > J- '� �A
Mineralogy
HORIZON III DEPTH 71l
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION 1
LONG-TERM ACCEPTANCE RATE ,
SITE CLASSIFICATION: EVALUATED BY: G�
LONG-TERM ACC PTANCE ATE: OTHER(S) PRESENT:
REMARKS: >�/� r'
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(01-901
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Davie County Nealtli Department
It Oen
and .�vme .ilea r y cy
210 HOSPITAL STREET/P.O. BOX 885
MOCKSVILLE,N.C. 27028
PHONE:(704)834.5985
March 4, 1992
Frank Hinman II
470 Avalon Road
Winston-Salem, KC 27104
Rei Site Evaluation
Rainbow Road
Dear Mr. Hinman:
As requested, a representative from this office visited the aforementioned
site on March 3, 1992. The site was found provisionally suitable for the
installation of a ground absorption sewage system with system modifications.
If you have any questions, please feel free to contact this office.
Sincerely,
y'�1���ll•Q�G��j �f
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure