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270 Oakland Avenue Lot 46-48, 119DAVIE COUNTY ,HEALTH DEPARTMENT' IMPROVEMENTS PERMIT :AND CERTIFICATE .OF. COMPLETION NOTE: Issued in Compliaiice..wtla G.S. of North. Carolina Chapter, 130 'Article 13c Sewage Treatment and •Disposal Rules (10 NCAC 10A .1934-.1968) Permit. Number Named Date R' t: -BAF 3666 Location C�'u w- Ock V I a:(l 1•le �h� s _ Subdivision Name (fin t_ L r,i Ae', OAS - Lot No.' Sec. or Block No. : Lot Size /4-T w2i2y3V_ House Mobile Home _ Business Speculation No. Bedrooms _3�_:No. `Baths No.' in Family ' Garbage Disposal YES ;1] NO p• "" Specifications' for System: )poo C& -TA ri �t Auto Dish Washer YES'©NO fl 'x3 ,X,2., _ Auto Wash Machine "YES [' NO .❑ � / 3v �P�Uaa�� gam: Type Water Supply, cru ►.i �, A10 C/PPPGD ..*This permit Void if sewage system described below is not installed within 36 months from date of issue. . • _ n � • - - � / o — Z. b .-�sr- eras Ga�•� T , - . Improvements permit by *Contact a representative of the Davie. County Health Department for final inspection of this system between, 8:30- - 9130 :A.M. ,or- 1:00-1:30 P.M. on day of completion. Telephone Number.y704-634-5985. Final` Installation Diagram: System Installed by Up1 • - Ali ` ' j ? �' �o t Certificate of Completion O-`(�rMar.�a Date 10 — 3 0�;i #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 betaken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - °90TE:-sauad in Compliance with G.S. of North Carolina Chapter 130 Article 13o �Sewage Treatment and Disposal Rules (10 NCAC 10A .1934`1868) Permit Number ' . NDate Location Subdivision Name ` [ \ � Lot No. Sec. orBlock No. Lot Sizo-��Houae Mobile Home —_—____--Business __-_—_—_�Speculation —_____-- No. Bedrooms No. �� Batha—__=----_ No. in Fami|y---y.—___ ' Garbage Disposal YES D NOSpecifications for System: i ' Auto Dish Washer YES E]' NO [� Auto Wash Machine YES E] NO -E] Type Water Supply *This permit penndVoid if sewage system douohbod below in not installed within 30 months from date of issue. Z6-�y'` J'.//�''���/ ' / | ' ' / | � Improvements permit by__�' °Contaota 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: 704'034'59Ub. � Final Installation Diagram: . System Installed by .� (! \� � � ` i `n-���^�/ Co��oa��cfCompletion ```«~-~~ 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 ragu|a1ion, but uho|| in NO way be taken an a guarantee that the system will function JY APPLICATION FOF, SITE EVALLI,knowIMPROVEIVIENTS PERMIT Davie County Health Doapartment Environmental Health Section R O. E30X 865 ►� 3 Mocksville. N.C. 270213 CONSTRUCTION SHALL. NOT BEGIN UNTIL IKIPROVEMENYS PERMIT HAS BEEN ISSUED. 1. Permit Req sted ay — L- • I/ -� I?h tfa Ud _� 2. Addres. 3. Property Owner if Different than Above Address� : /9�s�.Tl�_ 4. Permit To: a) Install... Alter__ Rep? r b) Privy_. Conventional Other Typo—_.. Ground Absorption 2 c) Sub -Division. `� —_ ___ Sec._--.-- Lo; No. �`/ fq 5r? 5. System used to serve what type facility: House _�-f7Mobila Horne.—_ Industry____ Other___ b) Number of people _--, 6. a) If house or mobile home, state size of home and nurnber of rooms. House Dimensions 3�— Bed Rooms 3 — Bath Rooms_. Z Den w/Closet _ b) If Business, Industry or Other, State: Number of persons served —r What type business, etc. - Estimate amouni-of waste daily (24 hours)_-__—_.. ' - - 7. Number and type of water -using fixtures: comma1bes �- urinals--__�_ garbage disposal lavatory _2=-- __ showers _ _ _ ; waahing machine_ dishwasher _ sinks 8. a) Type water supply: Public__..____ F'riv4e_`___._ Cornmunity b) Has the water supply system been approved? Yes -±f:-No___ g. a) Property Dimensions b) Land area designated to building site -- c) Sewage Disposal Contractor -- 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serer?What typo? x This is to certify that the information is, correct to the oest of my knowledge. Date ( ner Sign re OWNER I:i SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALLSTATE AN LOCAL LAWS Allow :i clays for processing DCHU (6-82) 4 �'�. � � �� �� � C�� � � ! if �'. i•:f 11 ., � � �' G;� a , 14 w IK to I Name_ Address �Ar rnae DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION ARCA I APPA 7 Date 4 �) 43 Lot Size AREA A APPA A Topography/ Landscape Position S S 4P S <1!i�) S PS P U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S PS S TS -P S ® S PS U U 1) Soil Structure (12-36 in.) Clayey Soils S erip �SS � S ) Soil Depth (inches) S S � S 9:1 Soil Drainage: Internal S P S PS U Uj External S S S U U �) Restrictive Horizons 3 Available Space S S S PS U U 1) Other (Specify) S PS S PS S PS S PS U U U U !) Site Classification i Xf U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: Cc '`I - r dc,, -Q 3a`` r d �i�C r • `t d� Described by Title SITE DIAGRAM #-1 DCHD (6-82) 0� Kro�� �3 '4"2 Date �- " / U S • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 C 0 -M /J 1. Application/Permit Requested By 1 n r,) ( / i S Mailing Address. r 2X 3f* Home Phone 00 q) S -q& - a 7 L z 2- - 7 U,', (e Business Phone 3 - 7 z 6e / 2. Name on Permit if Different than Above N 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: ❑ House X Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown L 5. If house, mobile home: Subdivision �-� �1 1 othc� r H i c, f S Section 6 V Lot # ❑ Basement/Plumbing No. of People ' ❑ Basement/No Plumbing No. of Bedrooms kI Washing Machine No. of Bathrooms K 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 Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ PrivateC Community 8. Property Dimensions 9 ',k 'a,I V X I & 0 j 150 ' Sewage Disposal Contractor l T�� � n � �^ i he t r1 Qun n 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No 6q` l 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: C; q liwy +o Do, v+(— R C & 6 t m Tu r\ + +o ,/ o j n c) 0 cAK1I1h� Ave, -F��n �r;5 )\A-�c ' �cwc\ Pc,s i,e �;e v� YJ U,- h is k 4 t-- o i I I cj i S fh ti, K e- d�---- Q p A Jd �c r n d rs (4 hwy s F, -K rn i K e v- ) s J c, s civx t 1 0 p-� Mei�hbo 11ou��� titJX. , 1 �rory� ecjSe 0-C fie he\5Ahc1^s 'Dt-'.ue- This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges incurred from this application. }� e /l 3 hx / cl 3 (S?� . � rt�2.c�G1 , DATE r% " 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 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 (12.90) CO 9'- S /9 � ro 16.0 S ' \,1 Q \,, 0, / / (o .7. *it Q) t0 .-4.0 U /r �� • .� ',\ N. .d�, h •1 •, \ � � � 5. O v j✓ .4 A o . v ,,, .v }, � v 1 m ctit O/ -7, d) o )vh n 16 x r h J� ° Q�; 5�.3` 0 69 O l9 a S N ,OS �, ° 'gyp Be r Q ON. C, v 85` ,55.0,4� . 35� _ � 0 P 0 0 o s` '�y j P.` ' `' o Z u. 6 a a,a ti f k Q o� 0 0'£. N r o Q. z 9 77 9,29 _ ar 5Z C) �" ,�, a P b r e , 9_ i e , DAYIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section \ (� Soil/Site Evaluation NAME 0 '�" DATE EVALUATED ADDRESS S P PROPERTY SIZE �G k ���- I �(,' r b PROPOSED FACIILTY \`\� LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation Byt�'_�-- Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position S -S -.Cl- s Sloe % - IS` - (7° - ° ) HORIZON I DEPTH V, lam`') D Texture group('_. Consistence %-;k:z VA � drllzaVT ya_ Structure Mineralogy1 •.1 1':� �� \ 1 HORIZON II DEPTH 4 U Texture group C, Consistence ;-G V FZ VFT Structure l`c. Mineralogy Z-) 1 ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S s S RESTRICTIVE HORIZON -- SAPROLITE— CLASSIFICATIONv S S LONG-TERM ACCEPTANCE RATE'77�2734 Q SITE CLASSIFICATION: _ -) ) , S. EVALUATED BY:� LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: N o N ¢ REMARKS: `��" - "'� ` \ - Q� LEGEND �l 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 Moiat 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 ■mo■■■■ ■■■EME■ ■E■EEM■ Davie County Yfealtfn rDe aatment and Mame Yfealtfn Men a y cy 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 March 29, 1993 Randy Combs Rt. 1, Box 7F Harmony, IVC 28634 Re: Site Evaluation Oakland Heights/Sec. 4—Lot 119 Dear Mr. Combs: As requested, a representative from this office visited the aforementioned site on March 25, 1993, to determine the soil/site suitability for the installation of a ground absorption sewage system. Unfortunately, due to the reasons noted below, we must classify this site unsuitable: 1) Topography. 2) Heavy 2:1 clay. 3) Saprolite under weathered clay. 4) Gray mottling in clay. We sincerely regret this classification and are more than willing to discuss this matter further, upon your request. Sincerely, Charles E. Little, R.S. Environmental Health Section CL/wd Enclosure