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207 Yadkin Valley Rd Lot 2 wJr G(,,: 10 F DAVIE COUNTY HEALTH DEPARTMENT l -'U IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION , NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a - . Sanitary Sewage Systems Permit NumbBr Name .4 \ r :�.. . �;,�,. Date �� ' '(� N2 rr 1 6751' Location __ V" 7. c4' - '�� t Subdivision Name. Lot No, Sec. or Block No. LotaSize �= House Mobile Home _T Business Speculation No`.Bedrooms''�_.No. Baths No. in Family _ 1. Garbage Disposal YES p/ NO ❑ Specifications for System: Auto Dish Washer, YES NO ❑ tr �,` ., X ,`r y C _ n� Auto Wash Ma:hive YES NO ❑ Type Water Supply *This,permit Void-if-se-Wage 4gtem��scribed below is not installed within 5 years from date of issue. This ermit is subject o revpcation if site plans or the intended use change. � !• „� . , i� �. "'•=�'V iso ,---.'.� ' ' F Y. R Ft Improvements pe itltby *Contact a representative2f,the Davie County,'Health Department for final inspection f this! system between 8:30 9:30 A:M. or 1:00-1:3b-P.M., on day�of completion. Telephone Number 704-634-598 . Final Installatio Diagra System Installed ty � J 4 � • N o ,i S _-� 1 Certificateof Completion ~— Date - ^ �J *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. AW APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI1 RECEIVED Davie County Health Department Environmental Health Section 3 b APR 2 4 1992 P.0. Box 665 Mocksville, NC 27028 � '� --------------- 1. Application/Permit Requested By dos&P H Vv \ . M0(�,OISQV t V1At4 H , 1V oIVISOA Mailing Address 2 ( Z 1�,D�C (3�i MockS Vi L.LCS, 4C -?--702-o Home Phone(9 1 C1 C198-2-991 Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: 9 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision VA L—LC`I V I &--W GV yk Section Lot# Z ❑ Basement/Plumbing No. of People 3 9 Basement/No Plumbing No. of Bedrooms 4 ig Washing Machine No.of Bathrooms 315 `6s1 Dishwasher Dwelling Dimensions Q( � X 3-( Q 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: I4 Public , El Private ❑ Community 3AC. 322- X442I tX 3Z1(X 3911 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? K Yes No If yes,what type? I FU L L 1,A-r L1 W( U L ',e&o()117-1-p I n i1= m i A F7(MdQe- "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: O I `TO Y A0 kt n VA Lt,,01 RD. (TUtZn A T S1A L&nj L OT I S On 7-H e l_ �.FT ��Ef.02� Corn I n RsT 400se 6n 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 frorg � this pplication. ya39a DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: DQ 1. 1 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 Sns�r f . VIViAn 14, (Y)OR?iSor1 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal systfm. , 3�9� lna�& DATE SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME c�\ DATE EVALUATED ADDRESS S A`m 9 PROPERTY SIZE 3 � PROPOSED FACIILTY �� LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:CI— Auger Boring V Pit Cut FACTORS 1 2 3 4 Landscape position S S - Slope % p _ o_ CD .Z HORIZON I DEPTH I �5 Texture group S c -C s c -e Consistence F Z I Structure Mineralogy1 l ti i HORIZON II DEPTH Texture group Consistence Structure Q k .Mineralogy1 HORIZON III DEPTH. Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5S SS s RESTRICTIVE HORIZON -� r SAPROLITE _ CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 5 EVALUATED BY: So =>J 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-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 ■■■■■■■■■■■■■e.■■■■■■N■■■■■SSS■SSS■o.■S■■■■e■■■■.■■■■■■■■■■.e■.s■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■.■■■■■■■■■■■■.■■■■■■■■■ ■■■.■■■■.■■■■.SSS■■SSSSS.SN■■■.■�i■■■■.■■■■■■■■■■■■.■■■■■■■■■■■■■■ ■■■■■■■N■■■■EN■■■■■■EE■E■■ENN■■ .■■..■.■..■..■■■■■■■■■■■■■.■�■■■ ■■■■■■■.■■.■■.■■.■■■.e■■N■■S■N■S■■■SSSS■■■e■...■e..S.SSSSSN■■■■■ ■ ■■■■■■■■■■■■■■..■■■■■■■■e■e■SSS■ ■■■e..■■.■■■■■■■.■.■.e■■S■.■..■■ ■..■..�■■■■■.�iGr:!/iNi■■■■■N■■■■■■ ■■■■■■WR■■■e■■ ■ENNEN� ■■■■■■■■■■■■■■%■.■.■.■11■.■■.■.■■■■■■■■■Oil■■■■.■■■.N■■■■■■■■■■■■■■ ■■■.■■■.■■■■!.■■.■...■■■■■■.■.■■�■.■�el,.■.■e■w■ .►■ NONE .NSSS.■ ■■■..■■■■■■�e■■■■e■■./i.■■■■■■.■■ ■■■ moon ■1,■■■■i■■■■■��■■■■■■■e■ e.■■ ■■■■■■■■.■■/t■■.■■ta■■■.■■■■■■■■■■�■■t■Srr1♦.■�t�ilt�l67■t�'i■■■■■■■.■■■■■■■ MOMEM ■■■■.■.■.■■tl■.■�.■.■■■■■■■■■■■■■■■■Jt■■!■►11..t��1�J■iii■■■■■■■■■■■■■■■ iiiiiiiM iii��iiiiiiiiiiiiiiiiiii�u�iiiiiiiiii :i%�i■��■iiiiiiiiiii■�iii ■■■■.■■■■■.t■..■.t�■■■■■■SSS■■e■S■ ■■�■■■i■■N■■ri�S■■■Sri■■■■■■■■■■■ONES ■■■SSSS■■■■�■■■SS■■■SSSSS■■S■■■SSS..■t■■■ie..■■t■■■■■■t■.■.■■■■■■■■■■■■ ■■■/ir:�■SSSS■■■SSSS■■eeSSSNSSSS■■S■■■1,■■/t..1r�■■Nt�e■.■t■■■■■■.■■.■■■.■■ ■■n.Fs■■.■■■i■■:■■.■■..SN.■SSSS■■S■■■raNErIN■��+Ieia��r:N►�SSt■■■e■N■N■SSSS■.S ■■Y!■■...■/I■■i7■.i■■■■■■■■■■■S.■■■■■l■■■11■I�YL�J1►,i■ir■■11■■■■■■n■■■■.■■ ■■■■■■■■.■,1■■r:!■■■.■ ■NOONNNE■■■E■■I.■■I,e��!!�I.■■■■11■■.■.■■■■■.■■■■ ■■■■■■.■■■►�■C.Ii■■■■.■■■.■■SSS■..■ ■.■■Y■■■■■■■■■■■■1■.■■■■■.■■■■■■■ ■■..■.■■■■c■■■S■■r■■■■ecce.■■■■■.se■.■■■■■■■■■■►a■■■■■.■■..■■■■.■■■■■ ■■■■.■■■■it■■■S■■SNSSS■■■■■■■■■■S■■■S■■NNS■■■■.■■■■■■■■■■.■■■■■■■■■ ■■SSS■■■.nSSS■■S■■■■■S■..■■S■SSS�Se..■■.■■.■■.S■.NSS.eS■■■SSS■NS■ r • L'�r;'PLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT a,' 6L Davie County Health Department �s Environmental Health Section S96 1 6, / P. O. Box 665 0" � Mocksville, N.C. 27028 PC f 60'rNSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. / Home Phone A!ermit Requested By 1 � 004L B �� S6L`y Business Phone - g9 Of'. �llU 2. Address 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 L 8AewYSec. Lot No. 5. System used to serve what type facility: House Lot Business IndustryOther b) Number of people 6. ay If house or mobile home, state size ofome and number of rooms. House Dimensi ns O Bed Rooms Bath Rooms L 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 wa er-using fixtures: commodes urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Community— b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 2 4ZD D b) Land area designated to building site T 7- 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 corretTlp the b f my knowledge. 9113 9i �,��/n Date Owner Signat e OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: V �T �t o �- S''nn 3 �TLam, y�) d� (6-82) `hoe U i "A ' • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED `��f) / ADDRESS PROPERTY SIZE Z"C PROPOSED FACIILTY 061age& LOCATION OF SITE /11,41 � Water Supply: On-Site Well Community Public 8_� Evaluation By: Auger Boring i� Pit Cut FACTORS 1 2 3 4 Landscape position t- L L Sloe Z HORIZON I DEPTH • */�• Texture group SL s L Consistence Structure Mineralogy HORIZON II DEPTH i /Il Y Texture group Consistence ;-- Structure r Mineralo /:/ HORIZON III DEPTH Texture group Consistence Structure ' Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION r LONG-TERM ACCEPTANCE RATE l SITE CLASSIFICATION: ) EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Footslope 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 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 ■...■■■■■■■■■■■..■■.■■■■■.■i■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■ ..■ s■■■....■..■...■........■.......■...test.■..■.■...■■■■...■....■..■ ■■■■■■■■■.................■.......tit....■..■■...■t�....■�e...■..■ ■.■.■....■....■■■■■■■■■■.■■■■■■■■►%■.......►.....ii.■tt■■.fid!■.■.■■■ ■■■■■.■.■........■.....■■■..■stele.■.■.■.■.t......s..t....■...■.■.■ ■............■................■%..ill■.../71.■■■.%.........■.■.■■■.■ ■.....■■■.■tt..■■.■■■■■■.■■.■t%..not..■.■■t.■�■..■■■.■...■......■■ iiiMiiiiiiiiiiiiiiiiii ■......■.■■.■■■■...■■..■�%■rpt■�===t:::�.■■■.■.ri.....■�r�■.■■.......■ :::CCC:::CCC:CCCCCCCCCC: ::::C�CCiCCCCCCCCCCC��:::::.:�::::':::. .............................��.....■■■.....■..11.■......■.....�.... ■........■..■■.....■ %■■■....Ic:iii■■...��■e►■■ ■■....■ ■■.■.■ ■ ■.............■■■■■■■■■■■■■..■.■..■..IBJ'■.■■....■..■....■ ■...■... CCCCCCC''CCC'CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC'.CCCC'■CCCCCCCCCCC'CC ■■■..■.■�iimom�i......■■■..■.■...........■.■.......■.............■e�.■ ................................ ■..■■.. ......■.■............... .................................................................. ■.■■■■■■■■■■■■■■■■■.C........... ■............................... 4 • • DAVIE COUNTY HEALTH DEPARTMENT2, Environmental Health Section L�7 U 1 60 P. O. Box 665 v o t F A Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name /?tl4)r»R10 rY1:i/I- eev m://j- e.7-0-4m �Tw- ,-rnrw'd Date 2 - /o Address -?.<)' -Ar 70T Lot Size a•e a //lila ,?c 2-71-)Z, FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position ® S S S PS (i!�:> PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) r (OnD PS PS U U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils1<-=-M> PS PS �U U U U 4) Soil Depth (inches) <Tj <� S S f" PS PS PS PS U �p U U U 5) Soil Drainage: Internal S S S S ® <i!R> PS PS U U U U External4 S S S PS dft> PS PS U U U U 6) Restrictive Horizons /--, Nom,,.- J., 7) Available Space G:9 S S PS PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification j�.� .� U—UNSUITABLE S—SUITABLE —Provisionally Suitable Recommendations/Comments: afQL r- .� - - tea•+ �4,v' �,o ..e;� /� Described by Title Grw• W eA Date 2-/n SITE DIAGRAM Li A�Kt.- v ra►�c1�m�� 3a�.4•c.' Ark c r i 3aas3 DCHD(6-62) Davie County Nealtk De artment and .dome NealtFr Myency 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE,N.C. 27028 PHONE:(704)634.5985 August 26, 1991 Mike Morrison c/o Potts Realty P. 0. Box 11 Advance, KC 27006 Re: Site Evaluation Valley View Farms/Sec. 1-Lot 2 Dear Realtor: As requested, a representative from this office visited the aforementioned site on August 26, 1991. The site was found provisionally suitable for the installation of a ground absorption sewage system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure