1181 Baltimore Rdllri'7.p i.ht,., y 'r
'•sem k1.>e, x �,.Y
o
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION 4'
* DOTE>,Issued in Compliance With Article I I of G.S. Chapter 130a
Sanitary Sewage rS `stems_ r Permit6996, Number
Name i r� �. Date n N2 U 9 9 6.
Location 5s Q. u vvy�, U S V) C �Y O l Z_
r6 �' � , j� �� fir: r� n � � ,'.�. � �.,..�•,,_
Subdivision Nameof No, Sec. or Block No.
Lot Sizey
1 i� a t
House Mobile Home Business Speculation
No. Bedrooms ,.No. Baths No. in Family _
Garbage Disposal YES ❑ NO [i,/ .., Specifications." for System:
Auto Dish Washer YES ❑ NO p'
0° {,
Auto Wash Ma.hive. YES NO' ❑ �`� �' x�
c,o`'
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.'
it
V !_
S
7.'T •'6 � 11.
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t' 15 (Y
{. 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:
y:
System Installed by
! � t
Certificate of Completion �J"� / Date e< � Y
"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.
' vv APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Lp;� Environmental Health Section
0 P. 0. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By 9294Y &OA425--
Mailing Address ,� �� 0�/i(/��1� �,� . �L /V1 /yl DNS. Al v2 w1z
Home Phone Business Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation S/Tank Installation
S. System to Serve:House U Mobile Home 0 Business
L Industry u Other Q Unknown
6. If house, mobile home:
No. of People 2 -
No. of Bedrooms 3
No l of Bathrooms
Washing Machine
Subdivision
Dwelling Dimensions
Sec. Lott
Basement/Plumbing
Basement/No Plumbing
J Dishwasher Garbage Disposa.i
7. If business, industry, 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
8. Type
of
water supply: &-fublic
Private 0 Community
9. Property
Dimensionsy
�/10
10. Sewage Disposal Contractor
11. Do you anticipate additions/ex nsions of the facility this system is
intended to serve? o Yes ;To
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.
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.
,2-077-f /
-2daAel -_-_ 6!IW-A-
Date Signature
Directions to Property:
DCHD (10-89)
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section 6
• ���� `-� P. 0. Box 665 �V03 d
Mockaville, NC 27028 RE,Ci�'
1. Application/Permit Requested By
Mailing Address �7�.s �yfl�T�J 764-Aa34'// e�d✓A71C,,:: 11IC A f044
Home Phone Business Phone
2. Name on Permit if Different than A �ve t�
3. Property Owner if Different than Above v 06 r 4
4. Application/Permit For: neral Evaluation 0 S/Tank Installation
7. If business, industry, other:
No.
of
People Served
No.
5. System to Serves
House
0
Mobile Home
0 Business
Lavatories -Z
L Industry
u
Other
0 Unknown
6. If house, mobile
home: Subdivision
of
water supply:
Sec. Lot#
No. of People
z7z
Dwelling
Dimensions
/ s7- 0 d All
No. of Bedrooms
3
Basement/Plumbing
No,elof Bathrooms �_
�asement/No
Plumbing
po'Washing Machine
&-Yishwasher
0 Garbage Disposal
7. If business, industry, other:
No.
of
People Served
No.
of
Commodes
No.
of
Lavatories -Z
No.
of
Showers �.
8. Type
of
water supply:
Public
Specify type
9. Property Dimensions /<�70 X 3 0
10. Sewage Disposal Contractor
No. of Sinks
No. of Urinals
No. of Water Coolers
0 Private 0 Community
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 Yes 3 ""
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.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges7.�
urred fr m this applicat n
9v
Date Signature
Directions to Property:
DCHD (1
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
r Soil/Site Evaluation
NAME �•° R P y A W •Q iR DATE EVALUATED I r - �[ d
ADDRESS `S� PROPERTY SIZEC�,1
PROPOSED FACIILTY V v c 9 LOCATION OF SITE
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring ✓
Pit
Cut
FACTORS
1
2
3
4
Landscape position
R
Sll
Slope %
U
HORIZON I DEPTH
Texture group
L
C �-
Consistence
F 1
F -T-
Structure
C
C
C
Mineralo
7
1'
I- 1
HORIZON II DEPTH
LM'
v"
Texture group
0-
L°
Consistence
T
--L
Structure
13'r`
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
—
SAPROLITE"—
CLASSIFICATION
S51c
LONG-TERM ACCEPTANCE
RATE k�- - tl. d
5 y.0
3•S L)
L
SITE CLASSIFICATION: L EVALUATED BY: - C-
3 S y •� OTHER(S) PRESENT: _ ' O P
LANG -TERM ACCEPTANCE RATE:
REMARKS: �� ��-�- (Za� - ��
L GEND
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
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
Daae County Nealtfr D artment
and .dome Nealtl yency
210 HOSPITAL STREET P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634.5985
November 7, 1990
Potts Realty
P. 0. Box 11
Advance, HC 27006
Ret 2 Site Evaluations
Guy Cornatzer - Owner
Garfy Boner - Buyer/l Lot
Baltimore Road
Dear Realtor:
As requested, a representative from this office visited the aforementioned
sites on November 6, 1990. Both sites were found provisionally suitable for
the installation of a ground absorption sewage system on each site.
If you have any questions, please feel free to contact this office.
Sincerely,
Charles E. Little, R.S.
Environmental Health Section.
CL/vd
Enclosure