185 Potters Ridge Dr Lot 10 7 DAVIE COUNTY HEALTH DEPARTMENT
*' IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT-PERMIT
/W
**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAS 1 F��C A G 11Q \a \tom s PROPERTY ADDRESS !"O //E r,f!S f--3t. 7�` g DATE / �1
LOCATION (7 - ter o-. •r�c� �(� ` D ���
SUBDIVISION NAME g �`l - LOT NUMBER �C'� SEC./BLOCK NUMBER
V
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS Q- # OCCUPANTS GARBAGE DISPOSAL: Yes No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No,
LOT SIZE ^: o��.c, TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) .} LTJ NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK.SIZE GAL. PUMP TAM( GAL. TRENCH WIDTH 3 ' ROCK DEPTH _l_._ LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR M)ST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
O
?�`4�~
IM ROV�MERMIT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
ffid
OPERATION PERMIT SYSTEM INSTALLED BY /1
a
----------------------------
AUTHORIZATION NO. OPERATION PERMIT BY DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY TOR ANY GIVEN PERIOD OF TIME.
DOHD 10/95
L,-X 0`
Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
P.O. Box 665 '
r , , Mocksville N.C. 27028 J�
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION so O ��
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when,applying for Building Permits.***
T1t I c AUTHORIZATION LVBER
\TV\ Q 0 Q DATE ^T t l . ° 0 2 " ,j
NAME ON IMPROVEMENT PERMIT (If different than above) l
SITE LOCATION V\D N
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
*+*NOTICE*f* THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
y ENVIRONMENTAL HEALTH SPECIALIST DATE
DCHD 10/95
• [EO 15
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM APR 1 61995
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
►
1. Application/Permit Requested y8a-0-VN0J( Ldaerlo C
Mailing Address 55/ \Ymo r—C-) IQC)ck H101 Phone 7S
/
Ile V• Business,Phone
2. Name on Permit if Different than Above
3. Application for: ❑General Evaluation Septic Tank Installation Permit
4. System to Serve: A House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ In stry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision 1 Section Lot # O
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms X Washing Machine
No. of Bathrooms JX Dishwasher
Dwelling Dimensions �S - I V/X a ❑ 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: ❑ P blic 'X Private ❑ Community
8. Property Dimensions CL0,6E,S Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes _ X No
If yes, what type?
'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
PROPERT11 INFORMATION UIRED: n
Directions to Prop%y:W�( e. r� � 11 !_.� � Tax Office PIN:
/0 �` I �Lp PROPERTY ADDRE S, as follows:
S T O��Oo�.� /y3 Road Name: A,� L�Q` e,
j0. ' `/1QiV) OU
pi �d O3
city: J C7
n 1e�4-
U
C %0 ���� 'l�Y 001- y� SU$MZT A PLAT WITH THI PPLICATZON.
Q� \G b(\ 1� �' �.710� � 'v Revisions effective October 1 , 1995.
rd
or 1 e �
This is to certify that the information provided is correct to th best of my knowledge, an nderstand I am responsible for all charges
incurred frgrp this ppl��on. _
((� c
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
Fandd
ECK ONE: 1. I OWN the property. ❑ 2. I DO NOT OWN the property.
ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
ve consent to the authorized represent iv of the D vi ourt y Hea D rtme t to enter u on ab described
cated in Davie County and owned by �� i
all testing procedures as necessary to deter ine id site's s itability fora rand ab�rption s wage treatment
al syste
- - -�&
DATE SI NA U E
DCHD(1/93)
grlvato use as noted. EK. 133, PG. 791
ate OWN:%
S a %P14O EQf,sw' .G ;o �°j :u PO 1147 THAT Is
-
y nuts/ vo eh hb Al N T I'S2'S3'W 1328.14' 'n
,v#S jA'/otOdL/d• y. y� 150 ^o FROM THE CENTERLINE o~o
INTEP,SECTION OF
I hereby sonify that the Davie county t , y ti b SR 1431 AND SR 1410
oa1tA Department hoe •w Iuatod the sub- j 'S Qt•3A'Dr' y d
diet Is •ntlticd POTTER'! RIDGE With JOHN W. BOHANNON JO. I y S 10•SI'9O'M SO.OS'
Cz
res►ee1 t• crll•rle andsenRifle—ni�PNASE 1
•eteblllMd by stet• ler of promutoat•d BK. 120, PG. 076 — _ -4-0 a tc
thereunder end the •ewe le found t•
comply with even •rlterl• en/ eendillons I I O ;
EXCEPT •t found In each evaluatlen. Fer JAMES W. ARNOLD •�,�`- Ir,, �P co
detail of this ovIYetion end ter BK. 133 PG. 199 . i ' lO a • <<<E ROAD O
limitations see the Written report on , , , y•
file at the sold Department.THIS -- -- IN ai i t.
I -----------------=--- ------�-- 1 g e S
NOT OCONSTITUTETANT CA PERMIT ORRAPPROVAL OF TIFICATE S ,A ?yA //O/ O / •�• 4
INSTALLATION OF SEIIAGE FACILITIES. �•
� -sen, �\ u 5.232 ac. 5.010 ac. s 1 g 4 1 S
Date C•Ynty Nealth Official , S` IN 3 �. 1$43 • AC Cr
I W
�•$�, i PROPOPROPOSEDOF
p 2 F AV;/•0BA?
LAWRENCE W. CARROLL �• :M v;: 23' 2
BK. 162, PG. 875 F 20-FT. Raw
1 A•nb/ Hela• th•t. t• the Net of my4$' -- 'st ai $ 7a /!•
ba•rlolpe, the nen-stat• wlnlalnl I AE; YI' m 343 /A SURWYOfEATES A SURD/V/SICW L1v
r•oNs) •lt•r•1 vender Arrtel• Vilest the d°+E/'S 86'24'35'E 50.00' t Z f EA
OF AE couHTr[R MUH/C/PALIIY t
Gavle County art of
lslis Regulations and , 209.09• � , 2 vn O p
whish are a part of thL! RegulaUlon nave Sf O ^ P-9 SE DIMARCT THAT REGULATES PARCELS Of L
Nen designed and IrIII N) aY111 to tn• fr O N l}-J{ M ,
ltanderU o1 ea1O repulafl•n. I •Iso i mo- : V' 'nP ti -\- / Y
hereby declal• that enc• the read*!) le , - Js Oc d' 0
oenetruo♦od to the re4uirod standards. I I G `\� TAT!4rWJgtTH CAROL/AIA. DAY/f CDUNTr
rill no Ienpor be roc Sensible for a -' t.. 5.100 aCt
hrlatcnane• of theme roads. , 5.01 0 ac. m - 4444................................. ..: 1,LAVER
s» !/ALAR. CERT/fY fl61T AL
' tt ISItDER dfr IfNFRYlAltIH IRON AN ACITIAL S
Dat• owner(s) C My S&rWiSlaw THAT TW ADI WAR/ES
.
28705' :t CYEMLr/plCATED AS DRAW FRC1M IA1F1
N 89e18'52'W N 76°54'OD•K, a� cALCmA s iroi00000.inaT rmis PL
h PREPARED WN ACCC11AL$1 WITH O•S. IT-S
.. 293.56' � /•/T7YfSS lC p4/Q/RAL S/BNA7INIE, RFS/iT
—_—�—�— \9.E T52, Z o S 7204 y THIS DAY Of A.D.
0
q$ v ® chord °, � 4/146.3
1 125.15, 23'Wgb en
' fwd
CERTIFICATE Of APPROVAL BY THE PLANNING 5,001 Qr.. \ry.j`Gg. S 4e33'25'W RMI/ATiIltX/NA, DAY/F COG1ITr
I• S 87e55'03'E 302.15' £ pee�a`sy.�go Isy.za to
BOARD: Th• Do Is County Plonnlnp Beard 5 /, AROTBOYPUILlC a TW CLrAMT7MIO
Aorob a proved tha final plot for the / q /O-� 1 C7:RTWiYAMTYIRKR: APPEAR BEFORE
P T g1RQE, PNI�SF�Ly subdlvl.Ien. D PRNp1 /.• l.1 g ``/` :( ►y(>R. PFR:aIucLrAPPFARFo ecscwE
V _ ,/CEibSEOKD TTL EXECDT/CW(Y TTdf f
---- 5.001 ac. $o 0 01' bane U �.y u dtr/WtID�AIs
Irncla iTAd1 air
.D, % . $ 5.995 ac. w E ;d6rRK1Q.
ChiIrmm�.E unTr PlannTns BeardO-% Np
O �,�• Y��� IST 92 CL'�L W V �-f
1 n•r.bl e.rtuy toot the .ubalvltlen �`� 38222 O°355 m Q�
plat shorn hereon hot boon found to 51255 ac.
eerlpty With he County subdlvlllon a. '� "A�AfTN C,MCElNB, DAVIF COtAVTY
R•Sulotions. with the oaceptlon of each ?� �'• m
ver lana•!, tt any, as aro noted In tAI Z o� �0'• OT' %IIaR�FD TO At FCORRIC1.
minutes of the Plonnlnp Beard and toot It �,o/ C,� 289•
has been approved far rocordlnp In the _-
Offtso •f tAe RepUtor e1 Doody. It It _• �+
h•r•1y noted that each apprevel ter 7f, 5.274 CIC• gg09� O
roaerdatlon does net Include apprevel to N N U�
Install and utlilio sanitary faellltlee
her does It Inelud• apprevel ter tn• O - 5
eenelructlen or occupancy •f buildings or
ttr•etur•!. w / - W.W. SPILLMAN, SR.
its Si1 S 89°58'47•W 491.76' N `(v� W.W. SPILLMAN, JR.
Otrecte►,--- —w--w w g 83°4430•W 633.08' RECORD REFEREN
5.098 ac. PAUL M. SPILLMAN
Doul. County Ptennnlns Department p w BK. 099, PG. 459
N TERRY S. SPILLMAN
;o '" m BK. 103, PG. 681
00 o BK. 107, PG. 608
0
0 BK. 103, PG. 681
SECOND TRACT-BK. 99, PG. 459
N W I THIRD TRACT-BK. 99, PG. 459
m
WILLIAM F. BROCK, SR. O 9 °' o \ P/01 of Survey
BK. 100, PG. 250 w ° - \vl
BK. 023, PG. 413 Phase 1
5.132 ac. Potter's Ri
343.54' _ ' Owners: W. W. SP ILLMAN
rpona C4 C5
'• '30°W W
I . W. i P I
471.74' S 83044 L
� � PAUL M.
§PILL
81.?� ' S 83.44'3 — —` /T I TERRY S. SPILL
_�- TEMPORARY MEN
FARMINGTON AVICUL-DE-SAC __— Township County
50-tt. RAW0PP
E
D � _L__--___---�--�- aX Map 8—Tock P
W. W. SPILLMAN, SR. et 01 IU -T�U RE
I _ •
...... .......................... I -----
-._.....
NOTES HOLLAR Q ASSOCIATES,
I P.O. Hmr 656 104 North Ja
LEGEND _____J--- I. INDIVIDUAL SEPTIC TANKS FOR SEWER SYSTEM Yadklnville. NC 27
IPF IRON PIPE FOUND 2. BUILDING SETBACK LINES: _-
lips IRON PIPE SET �__�--� CURVE RADIUS TANGENT LENGTH DELTA CHORD jH.BEARING FRONT - 40-ft. FROM R/W �Ssegn� rarn_y
IRF IRON Rap FOUND 1 SIDE - 15-ft. djc,trb,sps.INch Rich
IRs IRON ROD SET ____--�' O. 19' S8' 153.09' S'45'25' S2'W
Is P. POKR POLE C 1 180.00' 84.57' 158. 13' 5,3.28' 05' 73.21' S 08.31' S 1'W REAR - 30-f t. PROJECT N0. . 1799. IA-63C
Rig RAILROAD SPIKE C2 180.00' 37.39' 734731 2 e 3. ZONED: R-2o <500-t t. OFF SR.1431 )
3 48' 02' 144. I O' S 33°41' S0'W
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section I
' 1 ' Soil/Site Evaluation
p. ` N S R. DATE EVALUATED
ESS S h1 t`1n\ e PROPERTY SIZE
.50
0.2 4�cr 9-a
POSED FACIILTY n sp LOCATION OF SITE -
h bmni� S -9I 1�
Water Supply: On-Site Well S Community Public
Evaluation By:CtL. Auger Boring V Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group C L
Consistence
Structure
Mineralogy
HORIZON II DEPTH LID-" L4Z'
Texture groupC
Consistence
Structure i;
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS Ss SS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION 5 S
LONG-TERM ACCEPTANCE RATE L
SITE CLASSIFICATION: 'S' EVALUATED BY: �1
LONG-TERM ACCEPTANCE RATE: VI OTHER(S) PRESENT:
REMARKS: y
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 r;lay 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
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