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277 Yadkin Valley Rd Lot 4 - ar Z7 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE Issued in Compliance With Article 11 of G.S.Chapter,130a Syanitary Sewage Systerys . ' Permit„�l rte it � f'•, .:'Fri/ilG � f�//� ,, �.:.1 Name L— Date NO /ilk✓, //. �' (� — G,v �� .J-;/., f` ;; Location — Subdivision Name Lot No. Sec. or Block No. Lot Size House �y. Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES NO ❑ S ecjfications..for-System: Auto Dish Washer YES NO ❑ �G'G�l �•: 'i Auto Wash Ma shine YES NO ❑ Type Water Supply __— *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 intAded a change. f ti Improvements permit by Ila -- *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: Syste Installed by — }r, Do 1 ' Certificate of Completion r 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. si APPLICATION FOR SITE EVALUATION/IMPROVEMENTSP R Davie County Health Department dQ Environmental Health Section SEP ' S lfi; P. O. Box 665 Mocksville, NC 27028 DAVIE COUNTY HEALTH 1. Application/Permit Requested By22 3 iL P � 0-r L t b Lt _—.._ Mailing Address 'L 6 D R C1elm,--' Olh C- /0/--)— Home Phone 9\1 -T X41 L 4 D_1;-_Iq Business Phone ��- 2. Name on Permit if Different than Above 3. Application/Permit for: VGeneral Evaluation ptic Tank Installation fl. System to Serve: louse ❑ Mobile Home ❑ Place of Public Assembly 1 ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Q14 V LV— 1) Fa,V-NZS Section Lot # Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms 14 Er�Wiashing Machine No. of Bathrooms 14 (� 11-dishwasher Dwelling Dimensions 0 r n l i 1-1 350 ra�. t 1 Cq 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: la Public ❑ Private �1 ❑ Community t� 8. Property Dimensions ��-x �� x �g3k "f J 9 Sewage Disposal Contractor Cr I'Q e r1er 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes "o 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: Z- 40 C—( ,t to gOI 1 fit:t _ �-zVt Drt (< V t gD I to UQLIe� �� -QrM RGA-• arti r Cc,� Lit I Ly i-R Lat La CQ-P�� b��r�ee tz <j 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 fro this application. DATE SI ATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: 1. 1 OWN the property. ❑ 2. 1 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 representative of the Davie County HealthDe artment enter ypon abov escribed cated in Davie County and owned by eA4L A all testing procedures as necessary to determine said site's suitability for a ground absorption sewage tment al system. t7h/ DATE SIGNATURE ,- DCHD(12-90) " DAVIE COUNTY HEALTH DEPARTMENT ,a. Environmental Health Section Soil/Site Evaluation /� NAME �1�/?��/` DATE EVALUATED l _JC2 ADDRESS PROPERTY SIZE /V/IG/ PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �/� Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH 5;"t G" Texture group 5_4 Consistence Structure Mineralogy HORIZON II DEPTHS't+- Texturegroup �'_ Gell ConsistenceTell- Structure � , Structure k /„- /' S / Mineralogy /• / HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 773 LONG-TERM ACCEPTANCE RATEI q Io , SITE CLASSIFICATION: /25- 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-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 Mi neralo6ty 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■e■■■■■eee■■■■■■■■■■■■ecce■■eee■■■■■■■■!■■!■./t■t!r .t ■■■! ■eee■e■!■■■■■■.■■■■■■■.■s■■■■■■■e.■■/■■■■■■■■■■■■■■■■■.■■■a.■■■■s■ ■■eeeeeeeeeeee■■■eeeeeeeeeeeeee■ ■■eeeee■■e■eee■ee■■■eee.e■ee■■■■ ■■.■■■■.■■■■■■■■■■ee■■■ecce.■■ee�■■■■eeeeee■■■■e.■ee■■■e■■■■■■ee■ ■ecce■■■.■■■■e■■■■■e■■ee■■■■■.ee■■■■t■■t■■.■■■■■e.■■■■!■■■■■■■■■■■ ■■■■■■■■■■■■■■■e■■■■e■■■■■■■tee■■■■■■■■■e■■■■■■eeeee■■■■■et.!■■■■■ ■■■eeeeee■eet■■ecce■■■■■■■■■e■■■ee■■■■!■!■■■■■■■/■■■■■■■■■■.■■■■.■ ■.■■■tt■■■■!■tt!!■t■e■■■e■■■■eee■■■!■■t■eeeet■■■■■tee.■.■■ee■■■■■ ■■■■eee■■■e■■e■■■■.■■■■■!■■!■■■!■■■.■■■■■■.■■■■■■■■■■■.■■■■■.■■■■■ ■■■■■■■■■■■■■■eeee.e■eeeeee■eeee ■■e■eee■eeeee■e■■■■■■eet■■■■e■■■ ■eee■■■■■■■■■■■.eeeeeeeee■tee■eee■■■■.■ee■e■■■■■■■■..■/■■■■■■■tt.■ ■.■■■■■eee■■■eeeeeee■■eeeeeG■■■■ ■eee■..■■tt■/■■■■■te■t■..■■■�■■■ ■■■■■■■■■■ttet■■..t.■/.■tl�■■■.■.�i■..■■.■■ee■■ecce■eee■■e■■■.■eee■ OEM ■e■■■eee■eeeee■eee■■■et■G■e■■■■■■!■■e■■t.G.�i�I'■■■■.t■■■.■■...■■■■■■■ ■■■■■■■■■■■■■■Ii.■■.■■tteeeeeee■■■■eee■Ge■e■eeeteeeeteeeteeeeeee■ ■ ■/■■■.■■■■■t.t�.■■t.■eeeee■e■��ee ■t.■..■■.■e■■■■tt■t■■■■■■■/t.■.■ EMMONSEM■MENMEMMEM MENNENMENNENMEN■E■ MENNEN ■■■■■■■tt��n..tri■■■■■■■t■■■■.■■■.t.■■■■■■■■■■■■.......■■■■■■■■■■■■■ ■■■■■■.■■■a■■ei■■■■■■■teteeeee■■■■■c�c.■■■t■■t■/■.■■ .tt■t■■■■■■■.■ ■■!■■■■■■■■tt/1■■ttt■■■■/...■tt■■■■■■■■■■.■■■■■■■■■■.■.■.tt■■�■■■■ ::_::::::C:::NON M .............C....■.■■■■■■■■■■.■■■■■■■■■■■■...■■■ ...........!■!.. ..............►,...............■....■.......■...■.............■.■.. ■..■■■t ■■. 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Clemmons, NC 27012 Re: Site Evaluation Valley View Farms/Sec. 1—Lot 4 Dear MIM Isenhour: As requested, a representative from this office visited the aforementioned site on September 22, 1992. 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, 461"12 Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure DAVIE COUNTY HEALTH DEPARTMENT Lo1 � Environmental Health Section A�) � 0j R O. Box 665 LJ A Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name Ade"I41/y:/IJ- ,lit-,w W;I/J- G•T P.4v:/ XA- Date Z-/D Address Lot Size 3-046 'Fcrler FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position SPS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) C3�9> em> PS PS U U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils G efn> PS PS U U U U 4) Soil Depth (inches) -M S S 'r PS 41 PS PS PS U �P U U U 5) Soil Drainage: Internal SS S S ef!s> PS PS U U U U External S S PS PS PS PS U U U U 6) Restrictive Horizons i /V*,,d-n 7) Available Space 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 S 1 ;PS U—UNSUITABLE S—SUITABLE —Provisionali Suitable Recommendations/Comments: �� :/�-�! o � 4- uz ;Z Described by Q- a"� Title /2-- Date SITE DIAGRAM �RaY1w Va1�t1 415 qqq.53 ag3. a?2. 4S DCHD(6-82) 'e j Davie County Nealt§ Department and .dome Jlealtli� Ayency 210 HOSPITAL STREET/P.O. BOX 668 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5988 December 11, 1991 Mr. Robert Bradley 160 Queensberry Road Winston-Salem, N.C. 27104 Re: Lot #4, Valley View Farms 3 Acres Mr. Bradley:. On February 10, 1984 the aforementioned site was evaluated by this office for the purpose of determining its suitability for development. At the time of evaluation this site was classified provisionally suitable for the installation of an on-site sewage disposal system. Provisionally suitable means that there were areas on the site that were better suited for a sewage systems than others. In general, the site should not have many problems concerning the placement of a sewage system. As this evaluation (2-10-84), was a general evaluation for determining the classification of the site, before a permit could be issued to install a sewage system on the site, this office would need to review the site again based on specific information concerning the size of home to be built, number of bedrooms, number of bathrooms, etc. Enclosed please find an application to be completed by the prospective homeowner and returned to this office. Upon the return of the application and the request of the prospective homeowner, we can schedule a time to review the data on site. Should you have any questions, please feel free to contact this office. Sincerely, Joe Mando, R.S. , EH Director