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215 Sugar Creek Rd tv.. TY r. v:.,'=.. .; .w..:x V•,. .;+.. st ?`".4 ( r ' . i 2 V.-r`J.�.r..: .'.y,.:if t 1.., . . ...f t .. {"( .. . e ' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION , *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a S6tar S wagerSystems Permlt„ tlr}] r Name �� / „i R f1 j,n C. __� DateI N D tj y Location 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 ❑ �= �v 'y�'! Auto Wash Ma^hine YES ❑ NO ❑ -; J ,, Type Water Supply *This permit Void if sewage system described below is'�ot inst Iled within 5 years from date of issue. This permit is subject to revocation if site plans or the is ended �e cha ge. J r� b 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 1 0� Environmental Health Section r;1?:;:'mss f ,u,� i 1'I 1/(j• P. O. Box 665 Mocksville, NC 27028 r 1. Application/Permit Requested By rAIZ f X4 4/elizL Mailing Address O - o-5Z t/, Home Phone Business 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation DROleptic Tank Installation 4. System to Serve: P"-House "obile Home 10,stsr.-T ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # R4asement/Plumbing No. of People. ❑ Basement/No Plumbing No. of Bedrooms -3 Ij;-Washing Machine f. No. of Bathrooms Z C;�tS6washer Dwelling Dimensions )goo 2-16arbage 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 9?i6rivate ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? :°-,w- '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: P16EL IVA WiL� yvIGG� I3VGl+ /17Z15 W &4 lf 4-7& /l/n /O/y e. ; f P7L, 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. to/iy/y1Z ) I DATE SIGNAT RE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN thefproperty. E2. I 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 Day)9'�County Health Department to enter upon above described property located in Davie County and owned by `fu�Kor .fir Sr. to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. zop66�� Z DATE SIQWURE DCHD(12-90) _„_\ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �r r��r• � DATE EVALUATED 'A� ay, ADDRESS PROPERTY SIZE .�9�' PROPOSED FACIILTY 4LCE LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe 7. — HORIZON I DEPTH Texture groupL sL f L 1 Consistence Structure Mineralogy HORIZON II DEPTH Texture group . 141 Consistence Structure Mineralogy � - HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION J J LONG-TERM ACCEPTANCE RATE � /J SITE CLASSIFICATION: IT/r!P �w"'E�AL VUATED BY: LONG-TERM ACCEP,TAnNCEATE: �� - OTHER(S) PRESENT: REMARKS: �U l/; �`�[ el u/�• ,✓ 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-Finn 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 Mineralocty 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/f6 DCHD(01-901 ■■■■...■.�.■■■■■■.■..■■.■■■■MOON■/■H.■■./....■......■■.■■ ■MOON■ ■�■■■■■.■■.....■■...■...■..■■■■■■.■H■■...■./■../NOON..■/NOON.■a.■ ■.■.■.....■....■....■■.■.■■■■■■■ ■■■■■.■■......■.■....■■...■/MONO ■N■N■■M.NMMMM■■■N..///■..■O■//■M.■..//..■.....■■■..■■■■■■■■■■■■■■■ iiiiiiiiiiiiiiiiii■■riiiiiiii:iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii ■...■..■....■.■.■..■...■....■..■ ....■.....■■.■...■...../E.i/MONO ■■■■■//■■/.■/■/..■■..■■■■■■■■■■■■■■■■■■■■■■..■■■■■■■■■■■■■■■■■■■■■ ■■..■■■■■■■■■■■■■■■MM■■s■■■■■■■■■■_■■■■■■■■■■u■ MMEMM■■■■EMMME■M■ ■■■...■N..NE■■.■■...■■■..■..■■. ■././.....■■..■....■..../..■ ■■M ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■ice■■■■■■■■■■■■■■■■■■■ ..........................■.............................. ........ ■■■■■.■■■■■■■■■■■.■.//■■��■■■■■■■■■■■■■■■.[ MMM■■■■■■■■■■■■■■■■■■■■■ ■/...■...■■.■...■...■■/./►tel...■■■�■.■MMUN.E.■■■■■. .■■■■....■/■.■ ■■■■■■NN/M■■■■■■MOON■■/MONO■■it/E■■ii:ii■.■./N■ ■■ ■■■■ MONO.■■ .■.............................. 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BOX 885 MOCKSVILLE.N.C. 27028 PHONE:(704)834.5985 October 23, 1992 Earl McLaurine c/o Betty Potts Realty P. 0. Box 2056 Advance, NC 27006 Re: . Site Evaluation Sugar Creek Road Dear Mr. McLaurine: On October 22, 1992, this office evaluated an 8 acre tract of land at the end of Sugar Creek Road. The soil on said tract is very marginal ; however, a permit can be issued for an oversized, modified system. The septic tank system will be designed at 200 linear feet per bedroom. When the mobile home location is staked off, this office will revisit the site and design the system at that time. Sincerely, L Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure