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Pudding Ridge Foodservice r, . DAVIE COUNTY HEALTH DEPARTMENT - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewa a Systems 7 �sl<r. Permit Number �; Name s' 1� u� ffr' = Date N2 7 7 2 9 Location ..: f "�e/Ila Subdivision Name �JJ� fit. !�o�� ��IT ('Ou+�Lot No. Sec. or Block No. Lot Size '`/ House Mobile Hpme _ Business —�^'"'� Industry No. Bedrooms—4&k? .No. Baths — No. in Fam�ly �: Public Assembly Other Garbage Disposal YES ❑ NO [}r f Specifications for System: Auto Dish Washer YES a NO ❑ /vOG�'uf'� �.�r Tr%< 0 �'� Auto Wash Ma^hine YES ❑ NO <0c / Type Water Supply _-- ��� / G '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. Sf de C�l G - i s47 S Improvements permit by *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,Oi )I p'A a Rte � SX n r L�. t S All d r 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE ` ED �� Davie County Health Department ` Environmental Health Section ON 1 91994 P. O. Box 665 ,Ia�y V Mocksville, NC 27028 ' --------------- 1. Application/Permit Requested By Mailing Address iR Z 3 o K / Home Phone 9 Y z'�O 3 yVl 6zr-K—X </r,� � N • C• Business Phone 9 9 7 7 9/ 2. Name on Permit if Different than Above FA 3. Application for: d General Evaluation A.Septic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry eOther C l L)b k o cv f--t—❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 3 ❑ 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 .F C-0 3-5Wo,,,K t>'to 3D iry immty'-I '`/ � No. of People Served r-00 � , ;, �T, , '// No. of Sinks (� ' No. of Commodes -S '7'0 A/ No. of Urinals 3 Yo 244 No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: l4'Public ❑ Private ❑ Community 8. Property Dimensions P 0 r a c 7/3 c-r c f Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2 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: o iJ12 I Y2' � L w�-J 60 t?�,J LJ 11 /IA-z 1s = ��$o 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 a plication. /00 9 0 DATE 7 SIGNATURE CONSENT FOR SITE EVALUATION TO BED NE_ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: I� 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 DCHD(1/93) ' DAVIE COUNTY HEALTH DEPARTMENT x Environmental Health Section Soil/Site Evaluation NAME D f ! �� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY y 6l/S LOCATION OF SITE >Z Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit b,/ Cut FACTORS 1 2 3 4 Landscape position Tr— Slope %. a- HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH •, 72 .15el Texture groupef Consistence Structure /� T 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 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-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 3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralouy 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 ■■.■.■■■■.■■..■..■.■■■■.■■.■■.■....■■■.■■■■■■.■■■■■■■■■■■■■■.■■■■ �CCCCCCC�C�C\CCCCCC�������lC����CCCC��CCC■����CC■CCC����M����CNCC ■■■■■■■■■.■wIJ■■■..■■■E■.w.M.■..■■■■■■w■■■■■■■■.■..■. .■11■■■.■ MEN .�... ■.■■■■■■■■■■■■■■■....N.M■■O.■.■■■.N■■■■■■■■■■■■■■■I.=■I■■■■■■.■■■I �iiiCCi�ieiiiiil�iiii■■■il�iiiiiC:i�' ICCiiiC�CCCCCC�i=iiiiu�CCCCiC� IN MIMMENIM No mom C::CCMM MOMMMU�EN EMO N�C mol'CCC'IM MEM ME ■.......■■..M..I■■■■...■.■..■■.. 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 May 3, 1994 Earl Groce Pudding Ridge Golf Course & Clubhouse Rt. 2, Box 128 Mocksville, NC 27028 Re: Site Evaluation Pudding Ridge Golf Course & Clubhouse Pudding Ridge Road/b+ Acres Dear Mr. Groce: This letter is to confirm our conversations of April 27 and May 2, 1994, regarding the sewage systems to serve the clubhouse at Pudding Ridge Golf Course. The building will be served by two sewage disposal systems. One will serve the meeting room, which will have two bathrooms. The other will serve the restaurant, which will have 12 seats and 5 employees. The system that will serve the meeting area will consist of one 1000 gallon tank, D—box and 400 linear feet of nitrification line. The system that serves the restaurant will consist of one 1000 gallon grease trap with riser,, one 1500 gallon septic tank with riser, one 1500 gallon pump tank with riser (should topography dictate the need), splash box, and 4-6 D—boxes and 800 linear feet of nitrification line. Any part of the nitrification field that is crossed by a cart path or other pavement shall use solid schedule 40 pipe- for the width of the path. It would be better to redirect any cart paths and/or any payment away from the drain field area. When the clubhouse floor level is determined this office can reassess the need for any effluent pump for the restaurant sewage system. It should be noted that all commodes. shall be ultra—low flush and lavatories be spring loaded. Contact this office before construction begins. If you have any questions feel free to call this office. Sincerely, A�l Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure