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175 Dreamscape Lane Lot 5acv- 1:0 ' r t D'AVIE COUNTY HEALTH DEPARTMENTC IMPROVEMENTS PERMIT AND CERTIFICATE OF 'COMPLETION' �,� 1 3-9s 'NOTE: Iswedin'Compiiance With .Article I,I of G.S..Chapter 130a sahitarySewage Systems.' Permit Number A/��,.�// s' �} Date 1 o Q 'NameiY� s/y% �N2 8 070 Location1✓_�` ' Subdivision Name U1' Edq� �� ` • Lotto. _ Sec. or 'Block No: - Lot Size �`_� - House Mobile Home _ _ Business Indust No. Bedrooms .i_ No. Baths _ / ! No.;Jn Family __ Public Assembly Other. Garbage Disposal. „' YES p NO. p' Specifications .for System: Auto Dish Washer YESNO - Auto Wash Ma^hine . � YES nQ . NO i�O d� o / f r Type Water Supply" 4,%P/I 'This permit Void if sewage system described below is not' installed within 5 years from date of issue. This permit is subject'Ao 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 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'. on day of completion. Telephone Number: 704-634-5985. 0 J APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT IDavie County Health Department J Q 1 el (rj � Environmental Health Section rI �f P. O. Box 665 �e(') Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address G .i Home Phone l i'U -- 2 z 7 Business Phone no t C 2. Name on Permit if Different than Above 3. Application for: / ❑ General Evaluation El"Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Su64k4sion AL tg 7' t LCS fst c- Section Lot # —56— n�BasemenUPlumbing No. of People �- ❑ Basement/No Plumbing No. of Bedrooms 2- C�Washing Machine / No. of Bathrooms % L'Dishwasher Dwelling Dimensions ❑ 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 Lavatories No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? Mr. ❑ Community '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: 6ot no le "5 CGI'hCrf /1 Le �otira�K �t�liii J'shJ O� �C f� 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. DATE SIGNATLME 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 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. z -k- 9.s - DATE SIGNATUR DCHD (1/93) 0 r / DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME A li ADDRESS PROPOSED FACIILTY DATE EVALUATED E -1/0' v%V PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public L_�— Evaluation By: Auger Boring Pit 1/ Cut FACTORS 1 2 3 4 Landscape position ,L. 4 Slope Z HORIZON I DEPTH Texture groupSL Consistence Structure MineralogX HORIZON II DEPTH _1?O ` Texture groupG Consistence Structure Mineralogy I -t- el 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 SITE CLASSIFICATION: Ue EVALUATED BY: AfY�_� 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 Ilorizon 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 DAVIE COUNTY HEALTH DEPARTMENT y > Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE�� PROPOSED FACIILTY� LOCATION OF SITEi���� ✓l f— Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position C, L Slope % �i c HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH (o Texture group G Consistence r Structure / s i S K J Mineralogya 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: zo_/Z 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- Vl---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 Davie County NealtFr Department and Ake Neala .1yenq 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 HONE: (704) 634-5985 o ;" February 16, 1995 Gregory Keith Leazer P. 0. Pox 633 Mocksville, NC 2708 Re: Site Evaluation Ruby Ratledge Estate -Lot 5 Dear Mr. Leazer: As requested, a representative from this office visited the aforementioned site on February 13, 1995. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system. If you have any questions, please feel free to contact this office. RH/wd Enclosure Sincerely, �. )Os Robert B. Hall, Jr., R.S. Environmental Health Section Davie County Health Department �a -7- ENVIRONMENTAL HEALTH SECTION P.O. Box 665 kyo Mocksville, N.C. 27028 _ AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION AlAelo (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** / AUTHORIZATION NUMBER NAME -44,-;O DATE 4/— _'2 N2 U I I NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ft ***NOTICE*{* THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ) r ENVIRONMENTAL HEALTH SPECIALIST DATE DCHD 10/95 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewat r system. AN AUTHORIZATION.FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) d NAME �?%���'/� ��3 PROPERTY ADDRESS OI 'Yl��>'.� DATE Z--� -� LOCATION ,!/9111- FD 4/ r rt""fi EVA SUBDIVISION NAME '—�!' w LOT NUMBER - SEC./BLOCK NUMBER f c RESIDENTAL SPECIFICATION: BUILDING TYPE ti f # BEDROOMS _.�j # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes UNP COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE Gr Zd TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ,1 ^� NEW SITE /REPAIR SITE SYSTEM SPECIFICATIDNS: TANK SIZE��0 6AL. PUMP TAME( GAL. TRENCH WIDTH �7.1 _ ROCK DEPTH , '' LINEAR FT. � • OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY 06 // **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY AUTHORIZATION NO. 6Q? % OPERATION PERMIT BY ADATE / S **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ti f I Davie County Health Department d d Environmental Health Section P. O. Box 665 Mocksville, NC 27028 v "' 1. Application/Permit Requested By Mailing Address 10,6 I � 'Do �/43 J/7/:k- Home Phone !cam S'U ' 2 Z 7 Business Phone noh 2. Name on Permit if Different than Above 3. Application for: ElGeneral Evaluation ErSeptio Tank Installation Permit d/ 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision /?k i /� f �Y LC- -s- lr-c ft Section Lot # IT"Basement/Plumbing No. of People �- ❑ Basement/No Plumbing No. of Bedrooms Z LT"Washing Machine No. of Bathrooms / Erbishwasher Dwelling Dimensions ❑ 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 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? W. ❑ Community "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: /� / // GO t nonf� n,'S � F �'Gl � Miv,r (= I/A GK /t%W46014( �a�/, �� %SyX o.� i 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. 2—S-- .9.S � ;L� 11� DATE SIGNATLOCE 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 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. z 9s_ DATE DCHD*(1193) . DAVIE COUNTY HEALTH DEPARTMENT 1 Environmental Health Section 1•; Soil/Site Evaluation NAME 12z&1 -y ADDRESS PROPOSED FACIILTY A/ DATE EVALUATED PROPERTY SIZE v �� LOCATION OF SITE Water Supply: On -Site Well _ Community Public_! L64 Evaluation By: Auger Boring 11_� Pit Cut ,- L FACTORS 1 2 3 4 Landscape position L L ,- L Slo e % 41 ok HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence r r 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: /tel/ LDNG-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-•V+--.-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 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