160 Ginny Lane Lot 17'�-Xo
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
1
IMPROVEMENT PERMIT
**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 S.S. Chapter 13DA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAE zaZi./in1!' / sDi�d. S PROPERTY ADDRESS -G;A) A) h — 'q 70 a p DATE e D.11V
�',J Al U -
LOCATION
SUBDIVISION NAME .-� /Jr.aJGl (/�'/ LOT NUMBER 7 SEC. /BLOCK NUMBER
RE5IDENTRL $PECIFICRTION: BUILDINNG TYPE DUfw i BEDROOMS
i BATHS _
i OCCUPANTS
GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE i PEOPLE _
i PEOPLE/SHIFT
_ SEATS _
INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY !U DESIGN WASTEWATER FLOW (GPD)
/i
S6 d
NEW SITE
_ REPAIR SITE _[ G
SYSTEM SPECIFICATIONS: TANK SIZE _ GAL. PUMP TAN( _ GAL.
TRENCH ROCK DEPTH LINEAR FT. ,10d
OTHERu��
QWIDTH
REQUIRED SITE MODIFICATIONS/CDNDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
hil; Ud e.
hma
5teiP
A'"'
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY H
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF
OPERATION PERMIT
AUTHORIZATION NO.
BY
��o blen,
.yc
s
I
OF THIS SYSTEM BETWEEN
634-8760.
OPERATION PERMIT BY DATE I"
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE it OF G.S. CHAPTER 1308, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS-, BUT SHALL IN NO WAY BE AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
DAME COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT,and OPERATION PERMIT
''iMPRnUFMFMT DFRMTT
**MKITE** This improyement 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 B.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems) 1,
r C, is
NATE PROPERTY ADDRESS G/A)AJ Ih A 11 , a rlOaP DATE Xr�/%'Dll
LOCATION - w-i+�r-'�'•J .li �.✓ c .
SUBDIVISION NAME '. /i�� LOT NUMBER SEC./BLOCK NUMBER,
IESIDENTAL SPECIFICATION: BUILDING TYPE'''- i BEDROOMS _ !BATHS _ t OCCUPANTS GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE i PEOPLE 4 PEOPLE/SHIFT _ B SEATS _ INDUSTRIA. WASTE: Yes/No
LOT SIZE - TYPE WATER SUPPLY /U DESIGN WASTEWATER FLOW (GPD) gtl6 NEW SITE _ REPAIR SITE s �'
;SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TAM( GAL. TRENCH WIDTH 'fC„ ROCK DEPTH 13 „ LINEAR FT. IMOD �
OTHER /TGi�� �('� ✓ 1� SCJ' CiOy a\
REOX)IRED SITE MODIFICATIONS/CONDITIONS:
**CDNTACT A REPRESENTATIVE OF THE DAVIE COUNTY H
8:30-9:30 A.M. OR 1:W-1:30 P.M. ON THE DAY OF
OPERATION PERMIT
I OF THIS SYSTEM BETWEEN
634-8760.
A
AUTHORIZATION NO. —012--3 OPERATION PERMIT BY mla DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE, WITH
ARTICLE.11 OF B.S. CHAPTER 130A, SECTION .1908 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS-, BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF:TIME.,
DCHD 10/95
�p
AUTHORIZATION NO. —012--3 OPERATION PERMIT BY mla DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE, WITH
ARTICLE.11 OF B.S. CHAPTER 130A, SECTION .1908 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS-, BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF:TIME.,
DCHD 10/95
AA
Davie County Health Department
N ENVIAINJMENTALnHE�LTH SECTION
`..v P.O. Box 665
..
Mocksville; N.C. 27020
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systeis)
+I**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.*-**
AUTHDRIZATION USER .
NAE la 'Azwe.�JA�i,"_t DATE �1'
N° 0 473
NAME ON IMPROVEMENT PERMIT (It different than above)
SITE LOCATION 2Z4
COMMENTS/CONDITIONS ON AUTHDRIZATION.TO CONSTRUCT WASTEWATER SYSTEM
*HNDTICE*H THIS AUTHORIZATION FORK STTEEWAATTER SYSTEM CONSTRUCj/ION IS VALID FOR A PERIOD OF FIVE' (5):.YEARS. ;-:
ENVIRON ENTAL WEALTH SPECIALIST
DATE,
DCHD 10/95 I �,' f t y''
'y t
;
• �! 1 r .n �'.._,.y ..-..,`. -..;f_ o.. y..--. -. _y .. r.r r.4 .1:- r.,. , �Sr 'r!"j. . .�.. .-: .._ .Lc�-., .
P�O��Ep x°
0 d DAVIE COUNTY HEALTH DEPARTMENT F.
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage.Systems v ��� N s g 5 g3 Permit l�er
�eN Nls 6. \ PR A
Name —,T— Jr �—DatQ
Locatio_n 1 ` j \,
/ S r`) -c-
- 1 - - a, �`�.�fcA , \ - 11\ o\ � `, --�
Subdivision Name Lot No. Sec. or Block No.
Lot Size
House�
Mobile Home - Bus iness --
Z
Speculation
-L
No. Bedrooms No.
Baths
No. in Family _
Garbage Disposal YES
NO ❑
Spflfjtign3s�for erh
Auto Dish Was her YES
Auto Wash Me hine YES
. NO ❑
NO C
Q
3 c)
y
Type Water
OU"N:
r✓
'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 intended:use change.
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:
*The signing of this certificate shall
the standards set forth in the above
satisfactorily for anv Given narind of
il System Installed by A)o b
C op ry 1kt3--,1k
a
k r
C Z;3Zx4 l-�6--9,-i
Certificate of
C mpletion _ Date
icate that the sy tem described above has been installed in compliance with
ulation, but shall in NO way be taken as a guarantee that the system will function
APPLICATION FOR SITE EVALUATIONAMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section AUGRECEIVE.15
P. O. Box 665 4 �4 1999
Mocksville, NC 27028
1. Application/Permit Requested By U e n s _IQ f\
Mailing Address (}� 15 S__n�CM e f\ l 0 •) C
Home Phone '{ r r�q(
� 04 %S Business
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation
st'�ens ori 1U��7y0�
/ ' ❑ Septic Tank Installation
4. System to Serve: O House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision r t r_1% &\6 G' I —Section / Lot #.
>1X
No. of People
No. of Bedrooms
No. of Bathrooms o�
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories _
No. of Sinks
No. of Urinals
No. of Water Coolers
Basement/Plumbing
❑ Basement/No Plumbing
P4ashing Machine
8'6shwasher
❑ Garbage Disposal
No. of Showers Water Usage Figures -
7. Type of water supply: ❑ Publ11ic�t/((`` ❑ Private �C=MUn =_
8. Property Dimensions �U.s+ tI 'P,r t -M p `Z J Sewage Disposal Contractor c'O uA y
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No
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: (SO - -f0 -� O \AW I %01 �*'A '
Recd\a(\ck- Tooke Ie -\o CraC�on'o�
(_a &0 abo0:1 I��a
Cro le -F4
1'e (--� , TCA-�e
ry II -es, Take
r�Ch'c• �n�� R�&CIe -'r e,
V\oe�
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. I ,
DATE IGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
V [ri4v0A
MUST CHECK ONE: El 1. 1 OWN the property. 9/2. 1 DO NOT OWN tte
propert
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
to conduct all testing procedures as necessary to cleterrhine said site's stftability fora ground absorption sewage treatment
and disposal system.
`7 D-3-93 AA61 k
DATE SIGNATURE
DCHD )12-90)
,404.DAVIE
COUNTY HEALTH DEPARTMENT
2
3
4
Environmental Health Section
S
__5-
Soil/Site Evaluation
Sloe Z
NAME
S-
DATE EVALUATED
- S
HORIZON.I DEPTH
ADDRESS
PROPERTY SIZE
° 9
PROPOSED FACIELTY
.
C_ I.-
LOCATION OF SITE
Consistence
Consistence
. _Water Supply:
On -Site Well
Community -
Public
Evaluation By:M\-
AugerBoring
� - Pit
Cut
Mineralogy
FACTORS
1
2
3
4
Landscape position
S
__5-
-'9_
Sloe Z
_ t a
S-
g• _ 15
13't
HORIZON.I DEPTH
Texture group
.
C_ I.-
Consistence
Consistence
F1'
Structure
C
to 4P
Mineralogy
I
ilkI'1
HORIZON II DEPTH
Texture groupC
Consistence
Y Z
�-
Structure
>c
Mineralog':I
2
HORIZON III DEPTH
Texture grcup
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS.
RESTRICTIVE HORIZON
—
SAPROLITE
!-
—
CLASSIFICATION
-5
s
S
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: \\�S EVALUATED BY:' s�
LONG-TERM A EPTANN����EE��RArTE: OTHERS) PRESENT
REMARKS: ���t7
GEND
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 SCI. -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(01-9o)
Dade County Nealtkr Zyaency
artment
and 9�ome NealtFr
210 HOSPITAL STREET/ P.O. 13O% 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
Carla Duggins
c/o Boger Real Estate
5248 U.S. Hwy. 158
Advance, HC 27006
March 20, 1996
Re: Sewage System Check
Springdale -Lot 17/160 Ginny Lane
Dear Ms. Duggins:
As requested, a representative from this office visited the aforementioned
site on March 20, 1996. At the time of the visit, there was no visible
indication of any effluent from the sewage system on the surface of the ground.
Please be aware that the above statement is in no way intended, nor should
be taken as a guarantee (extended or limited) that the sewage system will
function properly for any given period of time.
Please advise should this office be of further assistance.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure(s)
r
j�
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
`w r_� _- �� APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)` / �lSs�z 7
�
1 /EP DAVi PHONE NUMBER
NAME
A4va',C' LOT #
DIRECTIONS TO
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION TAKEN BY,
This Is to certify that the Information provided Is correct to the best of my knowledge, and that I understand I am responsible for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT,
Rev. 1fe3
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665 oil
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name lde b cam— Date $ 2 _ i
Address Lot Size
FAnrnRC ARFA 1 AREA 2 AREA 3 AREA 4
Topography/ Landscape Position
S
S
S
PS
PS
PS
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
PS
U
U
U
U
I) Soil Structure (12-36 in.)
<::395
S
S
S
Clayey Soils
PS
PS
PS
PS
U
U
U
U
Soil Depth (inches)
-Z!:g>
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Soil Drainage: Internal
(f5
S
S
S
PS
PS
PS
PS
U
U
U
U
External
(!5>
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Restrictive Horizons
Available Space
S
S
S
PS
PS
PS
U
U
U
U
3) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
)) Site Classification
U—UNSUITABLE —SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
1�
Described by S. Title Date ,2 ^�
SITE DIAGRAM
/?a LoT017
9 i yiP4
DCHD (642)
k