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136 Canton Rd Lot 17, Sec 2 7 k/R V DAVIE COUNTY HEALTH DEPARTMENT t ` t - IMPROVEMENTS PERMIT AND 2CERTIFICATE OF COMPLETION 'NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name ,/i �' r��°/Sa�rJ /c�,i %F ./�>k�l�,V. y Date ��" �� '�'� N� - 7800 Location Subdivision Name Clir f,!,�, sv Lot No. Sec. or Block No. Lot Size �� House Mobile Home — Business _— Industry No. Bedrooms r -No. Baths �� No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO Q' Specifications for System: Auto Dish Washer YES NO ❑ � ,. Auto Wash Ma^hine YES NO ❑ �d D '�. ` S 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� Improvements permit by — � f�— *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by y , Q. Gert icat of Completion - Date 'The signing of this certific to qhall indicate hatlie system described above has been installed in compliance with the standards set forth in t e allove regulation, buf shall in NO way be taken as a guarantee that the system will function satisfactorily for any given,period of time. Ro-Y `7 APPLICATION FOR SITE EVALUATIONAM PROVEMENTSPR IT. .� - /��, Davie County Health Department ' ✓ Environmental Health Section i I j�ih' 1 51993 P. O. Box 665 Mocksvilie, NC 27028 1. Application/Permit Requested By D(c&- 4ZVZ2,�,P�p o) a/JS -ZZC. Mailing Address de= b• —&x --&(,7 /,?'O C/L S V"C.�_ dZ.C, Home Phone r7/-!v2- -7,5-7!Z Business Phone 7--) 72 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation E3Septic Tank Installation 4. System to Serve: 90410use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ' > El Other O Unknown 5. If house, mobile home: Subdivision—c1/a/L /is ce-6 CJ Section Lot # O Basement/Plumbing No.of People O Basement/No Plumbing No.of Bedrooms CEWashing Machine No.of Bathrooms 2 T-0 eDishwasher Dwelling Dimensions Cktarbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes a d i= 3 No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers �- /' Water Usage Figures 7. Type of water supply: WPublic NPS �'9 .c ❑ Private ❑ Community 8. Property DimensionsSewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes G}'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: APPLICATION FOR SITE EVALUATIONAMPROVEMENTS P5RMIT. ... / °< Davie County Health Department 3 #01 Environmental Health Section i it4. 1 51993 P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address 4E S CDU x 7 /J'IO C/c'sy,'C i AZ.C. ..2 7o x. Home Phone 4749&2- 7617!Z Business Phone 7-.') 7 5 2, Name on Permit If Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: V1410use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision gaAIL ,f-1bc_&&5c.J Section Lot #J ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms IrWashing Machine No. of Bathrooms a,2 7-0 I21"'Dishwasher Dwelling Dimensions OkGarbage 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: U4ublic ✓V�°�/p�� ,Gmc- ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes QKNo 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: This is to certify that the information provided is correct to the best qLWy knowledge, and I understand I am responsible for all charges incurred from this application. .3 /v - 2r3 6< DATE SIGNATURE CONSENT FOR SITE EVALUATION IQ RE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 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 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE i IL A � _ DAYIE COUNTY HEALTH DEPARTMENT o`r Environmental Health Section Soil/Site Evaluation NAME -� �. ��y,�r- n DATE EVALUATED ADDRESS SA '6 g 3 6_2 PROPERTY SIZE PROPOSED FACIILTY o u s Q LOCATION OF SITE Water Supply: On-Site Well Community Public C�a'-$LA Evaluation By: L Auger Boring Pit ✓ Cut It-j-f FACTORS 1 2 3 4 Landscape position X'S S .Z Sloe %. 2 HORIZON I DEPTH r y Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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 RATE SITE CLASSIFICATION: �.� EVALUATED BY: LONG-TERM AC EPTA C RATE: / OTHER(S) PRESENT: REMARKS: e :�� ✓,m✓ ��v:9'� J6 r f�' 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/ftz DCHD(01-901 ................................ ................................ ■..CMMMM■■■■.■M■■■■M.MM■M■■MMMM■■■■■■.■.■.■n.. ........ .■........ ■■■■■■■■■■■■■■■■■■■......■■■■■■■■■■■■■■■■..t1■.C.i■=..■.i■■■■■■NM■ ■■■...■■■■.■wwwwwww■wwwww■wwwwwwww.■■■MNM��.M.■ ■ .■■■■■...■■..■■ ■■...■■.■■► ■....■■■■■■.■■■.■■■■.....■■■.■■■■■■■■■■■■.■.■■..■■■.■■■ ■...■..■■■■■■.■■■■w■■■■.■■■■■■■■■■■■■■■■■■■.■■■■.■ ■■■■■■ ■■.■■■ ■ ..........N.......C■■.■ . ....C■.■■■■■MMN.C....■...............0 ■■■■.■..■■N■.■\\..■....■N■Ifs■■/�/I....■■....■.■........■■....■■.■ ................►............■■.....C.....i...............C...■■.■■ ■■■.■■■..■■■■■■■■►�■■.■■■.■■■■■■■.■■■■■■■ .M�M■M■■■.MCM■■■■■..MM■■■ ■■■■■...■..■.■.■.\■..■■■..■.■.■■.■...MMMCM■Ni.■■■■■■.M.■■■M■■■■■M■= UMM■MMMUMME■MMUM■EME■ MEM■■■ MMMMM. 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CCCCCCCCCCCCC::CCCCCCCC:C::C•:CCC:C�.:CC�iiCCCiiC=CCCiCCiiiCCiiiii ■■■■■■■■■■■■■■M■■■■■■■■■■■■■a■■■�■■.■■■ ■■■■■MMM MM■M■MM■■■■■■..■ Favre County Nealtfi 7ey artment and Nome .�ealtfi n 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 October 31, 1994 Boger Real Estate 142 North 801 Advance, NC 27006 Re: Quail Hollow/Lot 17 Dear Mr. Boger: Lot 17 in Quail Hollow is now classified provisionally suitable for an oversized—modified septic system. The system will go on the upper right—hand side of the lot. The permit will be issued when the lot is cleared and the house staked off. If you have questions, feel free to call. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd