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251 Potter's Ridge Dr Lot 11 -.-�- .. ..�- �v.�----- - 2, --.- DAVIE COUNTY HEALTH DEPARTMENT n„ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION * ''NOTE:issu l iii Compliance With Article 11 of G.S.Chapter 130a f S/a�niittary Sew ge Systems. ' Permit'Number Name. II —c _A�Date ` 5� �5N2 8171 Location Subdivision Name �f' . No. // - Sec. or Block No. y I Lot 'Size II House _✓ Mobile Home ____:Business __ Industry No. Bedrooms —_:No. Baths _ No. in Family __ Public Assembly Other Garbage Disposal YES NO p Specifications for. System: Auto Dish Washer YES u NO Q ,� ;,D' •� Auto Wash Ma^hine YES 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 ATTENTION. 'YOUR SEPTIC SYSTEM CONTRACTOR'MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLIING THIS y SYSTEM. Improvements permit by 4 I • `_Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.K, 1:00.1:30 P.M::or.4.30-5:00 P.M.on day-of completion.Telephone Number: 704-634-5985.o Final Installation Diagram: System Installed r � .' Certificate of Completion V� Date The signing of this.certificate shall' indicate. that-the•system'described above, has:been installed in compliance'with 4A the standard's set forth in tfi'e abov6.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 P ' �a ' r,' ' ��avie County Health Department v r} S Environmental Health Section P. O. Box 665 2 2 Mocksville, NC 27028 1. Application/Permit Requested Byhon lE Mailing Address 263 - 1A (9uo� �- r l n-J ( A)ill-4 Home Phone q)lJ - 774 -t r?4 I W i ma6n- Salem I_ Ne- 2M64 Business Phone��0 - r7q g"4?66 2. Name on Permit if Different than Above Vn ber-�- 02 . b3r11eV 3. Application for: ❑General Evaluation ❑Septic Tank Installation Permit 4. System to Serve: C97 House ❑ Mobile Home ❑ Place of Public Assembly }\ ❑ Business ❑ Industry (� Q ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision �� Tf �f'S Pl�C�t✓ Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms VWashing Machine No. of Bathrooms .2 �2/Dishwasher Dwelling Dimensions ' ud 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 x Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes La'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: II h2oQ� i n epi (�� Rood . R -s4- YOCtC� C�rynl n tO� --o This is to certify that the information provided is correct t st of my kn ledge, and I understand I am responsible for all charges incurredf m this applicat,�_�ion. v 0. /� DATE SIG ATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: 2/1. 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 d site's suitability for a ground absorption sewage treatment al system. DATE TURE DCHD(1/93) �l Al 11 77'3Z•53'7V 13264 11 Ve. y e , WTERS�fRznl� • I� f E g + SR 1a31 AND SP• Wo 41, W-Irmrp 30,W ev •. ' • 7'J-s!'2.r•s`/QgI#,E, '.I \Z 3 �aPro ' `'� a_ ♦je a`p wl•>lI1 rAa xr � At 5.232 5.010 OC. 4 fD; V, � n 30 8 rp: r- 68- C OLD PROPOSED j D r 06eti - X J_2gM4 50.01, 10 R • 4 : i V ' A 5.010 C1C. ra, = $OLD •................... o 5.100 26T05• ac ` AO!A - -,i-„• �,,� � $30,090 . 090 . �' r - Tr a4 89"Is � +J�ot�arri � S . aFwe[ • `j z� o 04 * m o S)tis ah �. N\SOLD D !rC el M v P A 4/ o qv'E e / \ Ifs Z 30Lt5' /� In.�!• F es..�- �, C J Arta J p ir;J � � 1k'aY tear � -j a 5.001 ac. g t.,, a ' og $29,500. e�,s Lai � 'Q Jax'r "G 5.995 cc. W 5.255 OC. r 3„2"�' ;5.31O� ` ` $35, 37o. ,. 1000_ S ,ar• v m �� s � CD .� Q SOLD � 5.274 ac, N = 131,116. t S 89"'.NY71Y �gOt7E �a, 110,11 Ill ry S 83'' •"C-K 633.08- SOLD b $30,078. . 5.132 cc_ $30, 278. .Don°•! aT i.Ta• Ca CS +•,y3„ys• - - _._._ _ .,- - ---��I \ P Q 1 S D3'44'30'W Co PC i Owners: 3 0 1 Cu7E1a�� 1 � 777 • _ .. is !' i [� �^^ _ j -A 1-+ • I esnr. �© DAVIE COUNTY HEALTH DEPARTMENTnJJ1�� Environmental Health Section Soil/Site Evaluation C c NAME S DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY �o v 5 e L ATION OF SITE N U1,`� D S 04 - - Water Supply: 7 On-Site Well Community Public Evaluation By:C11. Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .S Slope % 1.9 HORIZON I DEPTH Texture group Consistence :T F__L Structure Mineralogy1',l HORIZON II DEPTH Texture group Q_ C Consistence - _jP Structure R --Fu 7 Mineralogy ' i HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S 5 LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: ��� S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHERS) PRESENT: N b N 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 r:lay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vc.*y 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 ,3C-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 .......................................... ...................... .................................................................. ................................ ................................ ........................... ................... .................. ■■.....■■■.■.■...■■■■■..■..■■.■E...■.....N■■EN■■EM■■ OMEN■.■■M=NNE ■.....■■...■..■■■■/.../.../■■■..�....■... .N..N..N....O...■ on ■■../.■..../.../..■/.■■/..■..... ■..■■..■ /■u■■■■■■■■■■.■■.■■■■ ■...■■■■.■■■.■■..■.......■..■■■■ ■■■.■..■.■■.■_■■■■■■■■■.■■■■■■■■ ■...u..N■■■NE■.N■..■■..■.......■■.■■■....... ■■■.■■■E■E■■■■■■■■ ■■■■■■■..s.■EMM■MM■E.M.■MMM.MM■MM■■■■.■■■■■■■■■■■■■■■■■..�■..■■.■ CCCCCCCCCCCCCCCCCCCC�■CCCC�.CCCCCiiiC'■.'�CCCCCCCCCC"' """"""' ■■._■■■■■ ■■■/.■..■■■■■■■■■_._■■_■_■_■_�■■■■. ■■■■■■■MMM■■■■■■■MERN ■■■.■ www■� ..■... 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OXEN ■■■■■■HO../...■........■.■ ...■■.....0■...../■...■./.0/..■ CC�CCCCCCCCCCCCCCCCCCCCCCCC�CC..CCCC'C'CCCCCCCCCCCCCCCCCCCCCCCCC DAVIE COUNTY HEALTH DEPARTMENT R Environmental Health Section Soil/Site Evaluation 'NAME DATE EVALUATED _ r ADDRESS PROPERTY SIZE Q � PROPOSED FACIILTYLOCATION OF SITE /iJUrdi�/ � Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring Ll---- Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group14.4 Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence Structure 1- Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 1 / SITE CLASSIFICATION: _ EVALUATED BY: 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 :lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V12-y 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 3C--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/fU DCHD(01-901 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■ ■■■E■■■■ so■■ ■ .................................................................. ................................s■■■s■■■■■C■■■s■■■■ ■■■■■E■■■■■E■ Nmommom�Mom0 MEM��MM�■MMENE :::::::::::::::::::::::::::C■■■■■■■■■..■.■■■■■■IMEN■ ■�=n■o■=■■■o■no■ ■/EEE■■E■EENE■SSS■ ■ ■ENE ONEE" ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ mom M IMEN MONSON" ME iiiiiiiiiiiiiiii ■/■■■/■■■■///■■■■■■■///////■/■■MINI■EN■■■■N■■■■■/■/■■■■■■■■/■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■n■■�■=■■■■■■u■■■■■■■■ ■/■■■■■■///■/■■/////■///■/■■■/////■■■/■/■/■/■/■ ■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�u■■■=■■■■■■ ■■■■■_■■■■■■■■� ■■■■■■■■ SSSS...NNE/EENN■EENE■/EN/FEN■EE�SSN■OSEN��E■NNNEESN■■■■■N�■■■ .........................■...... ■ u■E■O■■■■■■■S■■■■ "No M MMNMIIN:�� MEN SSSS.. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ i■■n■�■■■■n�hl ■■ Elm MEMO_�■■■■■■■ ::::�.::C::.'C EMS ms NONE ME ■iii ■Niiiiiiii'■i '::::::■�■ ■. _■.soon .■■■■■■■■■■■■■■S■■■■■■■■■■■■S■■u . 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