176 Sonora Drive Lot 11r-
U
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I 'of G.S. Chapter 130a
Sanitary Sewage Systems -n Permit_ Number
Name ,� el �, �`� : �> _ i` %r Date N0 6997
r
Location
Subdivision Name %ii. r f/��' �'�� Lot No. Sec. or Block No.
Lot Size House Mobile Home_ f-�'�Business Speculation
No. Bedrooms t No. Baths No. in Family
Garbage Disposal YES ❑ NO, 4HJSpecifications for System:
Auto Dish Washer YES NO -'p -tF=
Auto Wash Ma :hive YES �j NO ❑ p�
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.
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
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/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section 1
S P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requested By 9A.49AQ Business Phone 9l -
2. Address
3. Property Owner if Different than Above
S
Address 309- S xlez- r e (
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorpti n „ Jd04V&_L6_6�
c) Sub -Division Sec.— Lot No. � / ry Nf 6- 7-
5. System used to serve what type facility: House Mobile Home Busines
Industry Other
A -S/
b) Number of people
6. a1 If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms— Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours) f
7. Number and type of water -using fixtures:
commodes urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water_ supply system been approved? Yes -::"No
9. 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 serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
zit
Date wner Signatur �U
OWNER IS SOLELY RESPONSIBLE FOR COMPLIA/cessing WITH ALLSTATE AND LOCAL LAWS
Allow 5 days for pr
Directions to property:
h/ COy/1/6a �Z mak—. Fe/
DCHD (6-82)
b V o(e � � �or✓p�-�9- ��' �l�
Y
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation '
NAME '
ADDRESS
PROPOSED FACIILTY -004?!:�"
DATE EVALUATED'
PROPERTY SIZE
LOCATION OF SITE
oNO��{ �jz SSC•
Water Supply: On -Site Well Community Public Poo'
Evaluation By: Auger Boring_ /' Pit Cut
FACTORS 1 2 3 4
Landscape position
Slope X
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH li
Texture group
Consistence
Structure / I
Mineralogy1
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: P_�
LONG-TERM ACCEPTANCE RATE:
REMARKS: /J . II. _
DCHD (01-901
EVALUATED BY: -112-14 &__
OTHER(S) PRESENT:
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
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
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Davie County .�lealtFr De
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and .7�vme .�lealtfrcy
210 HOSPITAL STREET I P.O. BOX 885
MOCKSVILLE• N.C. 27028
PHONES (704) 834.5985
July 31, 1992
Betty Potts Realty
P. 0. Box 2056
Advance, NC 27006
Re: Site Evaluation
Woodvally/Sec. 1—Lot 11
Dear Realtor:
As requested, a representative from this office visited the aforementioned
site on July 31, 1992. The site was found provisionally suitable for the
installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section