327 Bridle Lane Lot 700
DAVIE COUNTY HEALTH DEPARTMENT
4 4
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems (?�( ,�C �Jcr� ,1� %`'''` , J'l r Permit Number
N_ 8 06
Name ,kf �L' �,1.,C1� . .� s - � F' � �` --- Date %��1/�.%J� B �
Location' 1% •' %'�_ •f'~ �, mil ZZi)/-/ '
�. �/
Subdivision Name i�'l:! �/t �, f �=`1 Lot No. Sec. or Block No.
Lot Size'` C — House Mobile Home ---- Business -- Industry
No. Bedrooms "i�3 No. Baths -- No. in Family — Public Assembly Other
Garbage Disposal YES NO ❑ Specifications for System:
Auto Dish Washer YES NO ❑ -�
Auto Wash Ma^hine YES NO ❑ /G���%`/ 1
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.
LTi
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 by
i
Certificate of Completion
- --a =�
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/IMPROVEMENTSMR
,• ' �j'G' Davie County Health Department
Environmental Health Section
P. 0.. Box 665 240
Mocksville, NC 27028
0
1. Application/Permit Requested By IJA r re- U 4. Y14 l'✓ Iq trs -014 e--
7), Pre,e. �rllerwl , `
Melling Address �- � ����� �._� �� � /�,� � n� %� � �F
Home Phone ,�`%SCN Business Phone /P; 7D9J
2. Name on Permli if Different than Above
3. Application/Permit for: 0-beneral Evaluation ❑ Septic Tank Installation
4. System to Serve: Ivi mouse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry / ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision F"', Section _ Lot #
❑ Basement/Plumbing
No. of People �[ O Basement/No Plumbing
No. of Bedrooms J G -Washing Machine
No. of Bathrooms ErDishwasher
Dwelling Dimensions 0 -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: O Public E3 -private ? O Community
8. Property Dimensions i E'—`> Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is Intended to serve? ❑ Yes No
If yes, whit 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: L/ E,4�- rrvvl ate✓ /�4 /c i�c }+�t`� l� �
0`d 4-r1i e l �✓ l�S4g! s , /Ye X�' I�'�i� o
This is to certify that the Information provided Is correct tote best of my
Incurred from this application.
DATE /17
understand I am responsible for all charges
SIGNATURE
C0� EO 51M EVALUATION M BE IEE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: O 1. 1 OWN the property. I 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 tqe Davie 9ounW Health Department to enter upon above described
property located in Davie County and owned by TO A r/ ,;!�---
to conduct all testing procedures as necessa o determin said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE tIGNATURE
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` DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME , ,/ S`1 SZlt
ADDRESS
PROPOSED FACIILTY /�►'O u S K
DATE EVALUATED _ nl j
PROPERTY SIZE
LOCATION OF SITE
Water Supply: On -Site Well t/' _ Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1
2
3 4
Landscape position ,4
Slope %
—
—HORIZON
I DEPTH 41,
<,
Texture group
621 -
Consistence
Structure
Mineralogy
HORIZON II DEPTH /-
Texture group
Consistence
i
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: &e1_CZ
LONG-TERM ACCEPTANCE RATE: Z 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- 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
3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineraloey
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 .1iealtlr Department
and Yla ne Nealtk Ayency
210 HOSPITAL STREET I P.O. BOX 665
MoCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
September 7, 1995
Darrell L. Van Arsdale
4372 Creekridge Ln.
Kernersville, KC 27284
Re: Site Evaluation
Rabbit Farm I -Lot 7
Dear Mr. Van Arsdale:
As requested, a representative from this office visited the aforementioned
site on September 5, 1995. Based upon the information provided Qn the
application for site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable for the installation of an on-site
sewage disposal system.
If you have any questions, please feel free to contact this office.
RH/wd
Enclosure(s)
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section