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942 Mr Henry Road Lot 10DAVIE COUNTY HEALTH DEPARTMENT . IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION •NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a —�TSanitary Sewage Syste / Permit Number 7257 Name2QD ate No LocatiofnnVe'/r`C�C� �a s�/Id:e �l�s'r.IriGl�O+✓ VJfi✓rrN �!'r?C� Subdivision Name `� u /IiP� �i91�`r Lot No. �� Sec. or Block No. Lot Size House Mobile Home �^ Business Speculation No. Bedrooms `� No. Baths 2 No. in Family 3 _ Garbage Disposal YES ❑ NO ❑ Specifications)or System: Auto Dish Washer YES ❑ NO El/OOD�- - a 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. D Improvements permit by 'Contact a representative of the Davie County Health Department for final inspection of this system, between 8:30- _30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by )oV) Certificate of Completion _Date _lZT 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.., 17, s DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE l sued in Compliance With Article II of G.S. Chapter 130a anitarvSewage stem�Permit. yp l��ai�prer Dia 7/iQn Name •Date _ y NO i ,....,::,. V P/'r'('/tJ GSC/ �D �/%� < �/'�PII/ i��rA�/^%/ , G. ✓ � .'�J✓F /' 1117- Subdivision Name' of �i S Lot No. �T Sec. or Block No. Lot Size House 2 Mobile Home _ Business _-- Speculation No. Bedrooms .No. Baths No, in Family _ Garbage Disposal YES ❑ NO ❑ Auto Dish Washer YES ❑ NO ❑ Specdf ti s�for,System: Auto Wash Machine YES ❑ NO ❑ /C� Type Water Supply 'This permit Void if sewage system described below is not installed within 5 years from date of This permit is subject to revocation if site plans or the intended use change. 0 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. or 1:00-1:30 P.M. on day of completion. Telephone Number .704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion �y-! _ Datej�/�� '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 Qntiafnntnrily fnr anv nivon ncrinrf of tim> - ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department ®q Environmental Health Section R `EC EI tlr EQ P. O. Box 665 Mocksville, NC 27028 Aus - 2 03 1. Application/Permit Requees/ted By �l1� Mailing Addres-;R4#'f Bu -,s 1tR 6 C I�McJ ► ! lcl �OG O Nw�,'• jy l y) / �d �t�l �C= i� Home Phone �#Z_( Business Phone 2. Name on Permit if Different than Above S�Z✓hD cxs n 10,01 rQ 3. Application/Permit for: ❑ General Evaluation —/ ltd' Septic Tank Installation 4. System to Serve: ❑ House E Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry If ❑! Other (' � 0Z E Agc, ❑ Unknown Lot 5. house, mobile home: Subdivision �l(`U � r1 �Tj j/' Section # ❑ Basement/Plumbing No. of People � El Plumbing No. of Bedrooms /Basement/No LW Washing Machine No. of Bathrooms a ❑ Dishwasher / Dwelling Dimensions 6Loo - 1 El Garbage Disposal 6. If business, industry, place public asse ly, other: Specify type n I /� �of 1 No. of People Served^ t , No. of Sinks ��qq Ar 1613 n No. of CommodesqLy 1� No. of Urinals�l A No. of Lavatories No, of Water Coolers �J n�(�� No. of Showers 'v t l Water Usage Figures 7 t 7. Type of water supply: ❑ Public VPrivate ❑ Community 8. Property Dimensions Sewage Disposal Contractor/CitU ® 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes PKINo 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. Property: 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. cx.- ire .Q IQQ"? DATE SIGNATURE CONSENT FOR SITE EVALUATION M BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: Mel. I OWN the property. g 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 Depa ment to a ter upon above described property located in Davie County and owned by, ; Ge t2t2 .S to conduct all testing procedures as necessary to de mine said site's suitability for a ground absorption sewage treatment and disposal system. DATE a SIGNATURE DCHD (12-90( 'w DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME XY1971119 /( DATE EVALUATED / ¢� ADDRESS PROPERTY. SIZE PROPOSED FACIILTY . LOCATION OF SITE Water, Supply: _On -Site Well Community Public - Evaluation By: Auger Boring Pit- Cut FACTORS 1 2 3 4 Landscape position L Slope R �t 2' HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 6 Ye, Texture rou C- C Consistence -� Structure Mineralogyi �- HORIZON IIle Texture group Consistenc Structure Mineralogy HORIZON IV Texture r Consistenc Structure Mineralog SOIL WETNE RESTRICTIV SAPROLITE CLASSIFICA LONG-TERM ATE RMIATI, i SITE CLASSIFICATION: EVALUATED BY: A' ll LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: -LEGEND -' - - Landscave Position R -Ridge S -Shoulder L -Linear slope FS-Footslope 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 watet 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 Daiie County Nealth 7yenarhnenf and Ylvme NealtFr ey 210 HOSPITAL STREET I P.O. 80% 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 May 11, 1993 Aubrey Realty P. 0. Box 538 Lexington, NC 27293 ` Re: Site Evaluation James R`Mae Edwards South River Farm -is Dear Mr. Aubrey: On May 7,1993, this office conducted a general evaluation on a 65—acre tract located on Mr..Henry Road in Davie County. Based on the soil conditions that exist, this tract is generally developable; however, before any final approval can be given an appropriate application must be filled out for the specific site and that immediate area evaluated. If you have questions, feel free to call. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section N t DAVIE COUNTY HEALTH DEPARTMENT . IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE:'Issued in Compliance With Article 11 of G.S. Chapter 130a --��Sanitary Sewage Syste / Permit Number Name`�`/10mall %liGi��Ck �7�i�J�� Date �ls��T No 7257 Location JP/r`� C� �fI✓•P ��d� O+✓ �YJ9✓rrr` A'f Subdivision Name Upcc /moi vPr /�IrI Lot No. �D Sec. or Block No. Lot Size s�flC No: Bedrooms — Garbage Disposal Auto Dish Washer Auto Wash Ma^hive Type Water Supply House _.No. Baths Z YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ Mobile Home `� Business ___ Speculation No. in Family Specification sfor System: ✓DODJz*e t,a '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. �J F Improvements permit by _ A/G?!/' "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 day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by )OW Certificate of Completion Date L L '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 asra guarantee that the system will function ooficfantnrily fnr am, nivan narinri of fima b.. i Davie County Health Department Environmental Health,Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection Name: Tia-1/tan C' fro c, /t Phone Number CM. 1 ?6- 65 s- y"&ome) Mailing Address: 0141;Z/y2 -/Q Heti (Work) � - Ofl5l/iIl6 IV�.moz) ( Email Address: Property Address: Please Fill In The Following Inf�orma/t/ion About The EXISTING Facility: L3090400l0 Name System Installed Under: �J oN%itYl ANa/�i��f rQ �� Type Of Facility: e-, Date System Installed (Month/Date/Year): D 113 9 Number Of Bedrooms:Number Of People:_ Is The Facility Currently Vacant?es No If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Inforrmatron About The NEW Facility: Type.Of Facility: 791V/�(� /�Q / fdiYi QNumber Of Bedrooms: Is Number of People Pool Size: Garage Size: Other: yltequested By:<21z_� `��',�� ate Requested: /`.---(Signature) For Environmental Health Office Use Only 1 �d ' Appiove Disapproved Iol..St bL rnqd Comments: Su.rry.Ae, g) 2Dll —I Environmental Health *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site ,w,astewater system will function properly for any given period of time. Payme Cash heck Money Order ,,,# '-'=" Amount:$ /V V,yy Date: V- /6 ' / / Paid By: 1 ��;1 I Ion iC : `.:c Received By: `} t! GI YUi'F iz ��Account #: %�� i Invoice #: � I /0