Pudding Ridge Clubhouse - ��,, r�y,� y"-, " - --.—� — .ems. ..e.r Yty +.s.+'V""' "•..n.,.:,,--...�y/Vic.v�.�; +'L:ate y....-yv..,e•_ sr�—
' DAVIE COUNTY HEALTH DEPARTMENT.' 4
IMPROVEMENTS PERMIT AND ZERTIFICATE -OF COMPLETION
*NOTE:Issued in Compliance With Article Il of G.S.Chapter 130a,
Sanitary ySewa Systemsy;,t, ;� , Peimit Number .
Name. 1/... /� �. f�isf _ r%. -. ��'Date l N2 7 �l
Location
�
Subdivision Name Lot No. Sec. or Block No,
Chb W
Lot Size =L E_ _'House Mobile Home _ , Business _ Industry
No. Bedrooms ,ezl._CT.No: Baths __ No. in Family _ Public Assembly. Other
' Ga'rbage-Disposal YES p NO p Specifications for 'System:
�..
Auto Dish Washer YES p. NO p
Auto Wash Ma^hine YES Q 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 INSTALLING THIS
SYSTEM.
Improvements permit b
'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: 704-6345985.
Final Installation Diagram: System Installed by
Certificate,of Completion T� __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 6 NO way be taken as a g' "'''e:that the system will function
satisfactorily for any.given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE
Davie County Health Department
Environmental Health Section NNft 191994
1. Application/Permit Requested By
P. 0. Box 665
Apt I �4 Mocksvilie, NC 27028
d d l2 i-cF —cam ( o CD ✓ 14 t-,)" 0 ✓S -c
r
Mailing Address Z— Home Phone 9 Y + Q= '�
r� 6ie,Kr dr.l �-'� N C Business Phone 9 9 977 4F/
2. Name on Permit if Different than AbovejEA21 G 2U z0
3. Application for: O General Evaluation Septic Tank Installation Permit
4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry eOther C l vb o Of-t--❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
❑ Basement/Plumbing
No. of People " ❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business, Industry, place of public assembly, other: Specify type Gy 1'F 4yry,,
3_SWonK4Lrr t> 1v =D i/4 mm.tvNI �^ G/.,� 8. nwo�•
No. of People Served ,�oo,4 �� ,., �_;_� o '// No. of Sinks
No. of Commodes S -7'6 /4/ No. of Urinals 3 -1D J
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: G'Public ❑ Private ❑ Community
8. Property Dimensions A.elg n a K 7 t r c f Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 12"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),i IR �' �Z i., �-✓ l�-t� (,v,,.i 2►.j t J n ///~c -z
n , ✓ J ✓ tt q i�^ l 'C r J c�Lv L�.vP e ✓r�
-- -Ve X 112 = �i s'o
t
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.
Z/- /00,. 9V
DATE SIGNATURE
FtaonCONSENT EQB 5= EVALUATION IQ @F DONE QN ABOVE DESCRIBED PROPERTY
d
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
If
al system.
DATE SIGNATURE
DCHD(1193)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
J
AME �G DATE EVALUATED _L
ADDRESS / PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE iZ
Water Supply: On-Site Well Community Public 1/
Evaluation By: Auger Boring Pit b ,i Cut
FACTORS 1 2 3 4
Landscape position
Slope % �-
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
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 RATE � /
SITE CLASSIFICATION: _ _ EVALUATED BY: J
T a l /
LONG-TERM ACCEPTANCE RATE: r �� 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-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
1
Structure
.3C•-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogy
I
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(0 1-901