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118 Cora Jolly Ln 140 DAVIE COUNTY HEALTH DEPARTMENT . IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION A • *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems /Jj; Permit Number Name •r i, �� / /,1. ?t , rte: Date No - - 3639 Location' Subdivision Name Lot No. Sec. or Block No. Lot Size fir House Mobile Home Business Speculation No. Bedrooms �Q No. Baths No. in Family Garbage Disposal YES ❑ NO 2-"' Specifications for System: Auto Dish Washer YES ❑ NO [2''^ Auto Wash Ma.hine YES EKNO ❑ /DO�/' f•'. > �y - Type Water Supply �.! _ �V/GGj.�:1',�%.� �� :r� *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. l f�i;e F 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�1n. talled by- - i Certificate of Completion �t 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. tel— APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE"t � Davie County Health DepartmentEnvironmental Health Section I l�6 I P. O. Box 665 Mocksville, NC 27028 _ 1. Application/Permit Requested By Jc / Mailing Address ��3 �oX .5d0- 9m2o u illks /'! -d . 02 72)2,9 Home Phone �� � Business Phone d3 3S� /�•9�,r- 2. Name on Permit if Different than Above _SAm,C 3. Application/Permit for: ❑ General Evaluation 4Septic Tank Installation 4. System to Serve: 9§"Alouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing No. of People ❑❑ Basement/No Plumbing No. of Bedrooms 111/Washing Machine No. of Bathrooms ?❑ 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: Liz Public 447 7 I El Private ❑ Community 8. Property Dimensions ARFwE 300 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No 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: �E ,��o4�c 1�✓o`'S This is to certify that the information provided is correct to the best of my knowledge, and I nderstand I am responsible for all charges incurred from this application. DATE S GNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: �1. I 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) r � r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �J ® Soil/Site Evaluation NAME !�1< <,e �I!/i`G DATE EVALUATED ADDRESS PROPERTY SIZE 1,1;rX?00 PROPOSED FACIILTY �, ��ll Q LOCATION OF SITE' Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .0 L A_ Sloe Z ell HORIZON I DEPTH V ri Texture group rz- Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence Structure d vq-st-s- Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE / — - I SITE CLASSIFICATION: (/- EVALUATED BY: /Gt%J/ LONG-TERM AP4PEPTANCE RATE: OTHER?il�)�,Oeo ) PRESENT: REMARKS: rol - _'`� , � vE°/ LEGEND P_e✓�,��/ �,�- AS .' a Landscape Position �I�P / 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 ■■■■■..n■■.....■.■■■■■■■■e.■■■■ ■■■■■■■■■■■■■■■■■■■■■■.■■■■■ ■■■ ■■■■■■■■■■■■.....■■...■■. .....■..........■.■....■.■■■■.■■■■..■■■■ MEMNON MiiiiiiiiiiiMEMNONMEMNONRii■■iM"EMEiii ■■......■t■■■■■........■.■..■■.■ ■■■�......■..■.■..■■��...■■�.■.■ ■■■■■■■■■■■■■..■■■■■■■■■■s■■■.■��■■■..■■■.■..■■■■■ .W■■■a■■■■■■■■■■ Davie County Neakf De aitment and ,, l e Xealtt yency 210 HOSPITAL STREET/P.O.BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 January 16, 1992 George Randall McDaniel Rt. 3, Box 502 Mockeville, HC 27028 Re: Site Evaluation Bowens Road Dear Mr. McDaniel: As requested, a representative from this office visited the aforementioned site on January 15, 1992, 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) Shallow soil to rock. 2) 2:1 clay. We sincerely regret this classification and are more than willing to discuss this matter further upon your request. Sincerely. Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure