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137 Daye Ln .. P° DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '9K *NOTE: *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a d a�s� Sa itary Sewage Systems Permit,,l �or Name `-.ia . A. Date N2 , Location ./.S i Subdivision Name Lot No. Sec. or Block No. Lot Size /'' House Mobile Home Business Speculation No. Bedrooms ..No, Baths No. in Family _ Garbage Disposal YES ❑ NO Specifications for, System: Auto Dish Washer YES ❑ NO [�` �f Auto Wash Ma shine YES p'ANO E] Type Water Supply 1 __— 'This permit Void if sewage system described below is not installed within 5 years from date of issue. r. This permit is subject to revocation if site plans or the intended use change. ' .fir-.....+. j��.•� I r Improvements permit by 'Contact a representative of the Davie Cauy Health Depa merit for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of co le ion. Telephone Nu ber 704-634-5985. r r.ari �l Final Installation Diagram: Fa stem Installed by 1 Certificate of Completion - Date t� :L ^� *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. VD � : • . 7 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Q G Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Reques d By Business Phone _!�75?7'Zlbl 2. Address L 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home_t�'_Busines s / Industry Other b) Number of people Z 6. ap 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) 7. Number and type of water-using fixtures: commodes 3 urinals garbage disposal lavatory Y showers washing machine_ , dishwasher / sinks 8. a) Type water supply: Public !f Private Corpmunity b) Has the water supply System been approved? Yes 1 No 9. a) Property Dimension / 1740 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 corr o the b f- y knowledge. /q/ Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: IAJ TOT ^�T� DCHD(6-62) Y` DAVIE COUNTY HEALTH DEPARTMENT ' > Environmental Health Section Soil/Site Evaluation 'may NAME pr DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE � 1 Water Supply: On-Site Well Community Public f Evaluation By: Auger Boring ��_ Pit Cut FACTORS 1 2 3 4 Landscape position L L- L— .L Sloe % -1/0 Y .HORIZON I DEPTH Y Texture group f'L Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence ,e a 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 �f , SITE CLASSIFICATION: _ (f! EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 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 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-Nonplastic 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 ■.■■■■■.■■..■■.■■.■■■■.■■■■...■....■......■■...■..■■■.■■.■■.■..■■■ ■...■■■■■■..■■■■.■.■■....■.■.■■.■■..■■■■�.■■■■■.■■■■■..■■■■.■■ ■■■ ................................ ................................ ■....■ ■.■■■■ ■■■■■.1 ■■■■■■ ' ■■■■■■ EMMMEMSEEMMEME ■■■■■■ ............................................�■............C■■■■■■■■ ■■...■■■■■.■..■■■■.■■■■► ■■...ii■■.........�■��■■■.■■�■■■■■■.■■■■■■■ ■■....■■■■■...■■■■...■■��■..■.!!��%��������!\■N■ .■ ■■■■ ■■■■■■■ ................................i�....,fit..................... .■.. ............................................... ................ ■■■■■.. ■■■■■■■■■�i■■■�■■■■■■■ ■■■■■■■■■■■■■■■■■...■■■■■■.■.■■■■■■■■■ ■■�■■ ■■■ ■■■■.■■■■■.■.■■■■■■.■■..■■■..■■■■■■■■ ■■■■■■.■.■■. ■■ ........................................... ..................... ................................ ................................ .........■........................................................ ■■■■..■e.■.■■■■eeeeeee■■ecce.■■■■eee■.e.eeeee..eee■....■.■■.■ee.■■ s4^ >w w ... �,.rn +:'1 _.,,...« � ' "1]�rr°r1'tAt'~'..I.._,'. 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 August 27, 1991 Potts Realty Attn: Roy Potts P. 0. Box 11 Advance, HC 27006 Re: 3 Site Evaluations Redland Road at I-40 Dear Realtor: As requested, a representative from this office visited the aforementioned sites on August 22, 1991. The sites were found provisionally suitable for the installation of a ground absorption sewage system on each tract. The location of each house must be staked before permits can be issued. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosures