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209 Merry Lane Lot 2 7.7• ^.-v.VET7 v - o...�--.-.saa-.r-•r, i1p• -�•wr.• mer.-.�•� - //�� - .• '. .; «-tib DAVIE COUNTY HEALTH DEPARTMENT - a IMPROVEMENTS PERMIT AND. CERTIFICATE,. O.F COMPLETION, , *NOTE:Issued in Compliance With.Article'Jl'of'G.S.,Chapter 130a ' San�ita� Sewao Systems :�. , Permit Ntu ber A Date Name___ �' "``%f� -- N_ 80 •7 Location , 0 : ' d -� �1�W.�.t .d t V% . ,Subdivision Name Lot No. Sec. or Block No. Lot eize _ _- House._ Mobile iFiome Business'` Industryj -No.-Bedrooms ('}_:No, Baths ? No. in Family Pubflc Assembly Other �. Garbage Disposal YES p N0 m Speciticatioris for System: ' Auto Dish Washer YES �•,NO 'p b.c; e� -� 'Auto Wash Ma^hine YES p�.NO [j _ Type Water Supply .•_ -- --- �. �. ,�( 3 v �� . 'This permit Void if sewage system described beib.w is.not installed within 5 years from date of issue: This permit is subject.to revocation.ff.site plans or-the.intended use change ATTENTION: YOUV SEPTIC•SYSTEM CONTRACTOR MUST`SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS Improvements permit by *Contact a representative of the Dayle 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.'5n day of completloh.'Telephone Number:704-634,-5985: J Ficial Installation Di ram: ., -- System Installed by �. , ••A , N/• • ti V� d Ce ificate of m talion `*= �•� 9 P Date The signing of this certificate shall.indi at that the ystem described above has been installed in compliance with 'the standards set forth in the above regulat' n, but sh II in NO way be taken as a guarantee that the system will function sAdsfactorily for any given period of.time. Q�j r�p�• t , 'r. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI1 RE �QVE® 6� Davie County Health Department �1 Environmental Health Section ,U f� 1 0 f 93 t/ P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By L44�j ©.5 e /L Mailing Address / O /V- Home Phone Business Phone 2. Name on Permit if Different than Above �� 3. Application/Permit for: — T General Evaluation ❑ Septic Tank Installation 4. System to Serve: L3r/ Eouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # 0"'Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms T EMashing Machine No. of Bathrooms 3 0-Dishwasher Dwelling Dimensions p.-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: 10 Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ® 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: &5 4 ea 1�m I e 0 %N 7a Alin rdi F �o-- ho--S b?� ,,��- l /�2rB 5 5 `-rant 1Vtkk'Zo- e��h- �rou r 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. Of DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE 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 D partment to enter upon above described property located in Davie County and owned by IF—,d,4 5 $ T/�41-1 e-e to conduct all testing procedures as necessary to determine said site's suitabi' r a ground absorption sewage treatment and disposal system. J V'--/x ^ J DA 3ESIGNATUREJ DCHD(12.90) 30 Sr1.96, -1 Oared or I � I N v 26.80' i 506-36'E 8 � 9 { 10 I I 12 13 o"d _ 5.775 AC MO,K1pnd a I Dov1d L Dooy W . I 1 0.8159-438 ' ., a f' N8l8-20"E N7620e�p0• . I a�Son W 7.000 AC 6.730 AC ; m 6.703 AC ; A 6.389 AC. - 1.356 AG. 4 I ¢ p••nr`" .•4. o o q H 't No '23'25"E- 0, Z W 316.32' o o I N 41:06-30-E ��r s�cgal J Cn ]6.62' q+ JyFR E o n 1.436 AC. R I 46 N81•_OS'E--... 588^56'.[;3•E R w N76•-!M'-40"E- . a� 508.73 a Z'- . " c 15 45•,l,D. o 403:35'-OS"W�••''Q ,,N�B.'S6�03'M63SSH\5 Id ui�InY wsemr+_ yd�l . %� Cn. 56.88' I J �I IHH 28• •• -56,r9„ o To101 673'22• N 1.433 AC. 55�� 1 a 4 5 ;p 3 5S•04'.1q•.w N _ •ibjq .E N89elj_•_g4- N77•_23'.47"E i OI•gp_ O"E 50.7g. ?H. •'sr P E 1 _.34I4.__. +•o 50.92' n M. SH_r 5.�" C14185.56' _ 77.26.40,0 ZT7..2@•...... _ _ /I •m n-• 9'•W _ 5 -- ..2 '5726 10 q1�1 ws4meM m� A E 1 ' �_�� •)NN1n \ 7O1d ~_'1 155 4d• - O ' W 7 1 "4 n u 2• r0urnn SSB.? 't --- --^ _........ ... ..333.b'f'yr _ O m u %Q 0 6.665 ACRES ' I q r 0p+4 H js H9•_13_qq.,w 0 0 oq:was r,ta 663.26' n b o a N m m0^r ! Cn 206 O I 577-23.47"±_ vc q r l 6' l 8 lrl�m 6.244 ACRES6.408 AC n W •2o'drgno9r•os� 5355 AC. {13�3SI -+a~ 3II n ..On found O ; N aO� 4463 AC. " > o 6 3 14 ci o N el•os'E-- I f 7 �y65G o o ro9° N 3 -yvd, O -I 0 549.36 �� : ' o �~ SpO. /Z,v re t S2• ''� oN r w 01 " SHH•-53_q JI'I p 493.37'5"E .m, ��r _�_�sYro�.aj� °°.K ,•-{.20� AO ai 6 ' n O p i I o . ti b 5.010 ACRES " \ 2• $ I n 4 / \s 'o• sy•y,\ O�y� 1rw round H �SS. 1O n I 5.759 ACRES N77•_57'_16"E 555.55' NJ3i3- �ii1 2� o•0.0.\ I OWN '0 � ss3° • 6': ~Ov \ 7.003 ACRES ' m q �`� K d9 00 \ Fultz m ;o -}O/�\3 \ 4s 9�a. d SCC'1E oN• h � 1t \ '96%55., \ 2DC II \ K \ y t" n \ �� S6 89•,) \\ SC=-- S e 3�2'' CURVE N0 R 6 Ort. bb/rye Gpe S K \\ I 502.46 23••39-55 207.56 6_Z2. b.p 6S�y. 228 2 542.38 19••59'-27" 189.24 75°- 35 , 2•'S \ 3 25.00' 4H'_II'-23•' 21 03' N� 1364 d v� K �� 4 50.00' 68'-52'-03" 60.10' �E6?j72e_15.56•'�' \ 5 50.00 69•-19'-55" 60.50' / BAS 6 5000' 100'-01'-25" 87.29' �Oory Ann BOrnho'df \ �.\ 7 50.00' 38'-09'-30" 33.30' . 574°-23'S6"w D B 72-494 8 25.00' 48•n'-OI" 21.02' 17416' ;40•, 9 592 38' 19•-59'-27" 206.68' ?ORT iOkS 0• 60JNO4RY w45 7-�•�`='•1 FROM M.:?S 9Y 07n E3$ 1� c52 46' 21•-39'-55" P6-88, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 1/` �S' rfi,�i!. DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY /-- /��1�r LOCATION OF SITE Water Supply: On-Site Well Community Public c/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Lands cape positionSlope % — `— HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r r Structure SJ/k 6.0 s"f-E s 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 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■...■e.■■eee.■■■....../■■ ■■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■../.■eee■■tees■■■■t■t■■■m■■■■■E■ ■...■.E.e.■tee.......■.■.■■..■■■■....■■■■■■!■■■..■■■........■...■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■....../■.■teat■■■tM/■■tet.■ ........................... ..................................■.■. 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 June 17, 1993 Hubbard Realty Att: Gray Potts Rt. 1, Box 2-B-200 Advance, N.C. 27006 Re: Sita Evaluation Merry Brook Acres Lot 2 Dear Mr. Potts: As requested, a representative from ,this office visited the aforementioned site on June 17, 1993. The site was found provisionally suitable for the installation of a ground absorption sewage system. I£ you have any qupstions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. ,R.S. Environmental Health Section Enclosure(s)