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130 Hampton LnDAVIE COUNTY HEALTH- DEPARTMENT 1I,. 0 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION * NOTE: Issued in Compliance With Art_igle) I of G. . a tV0 it S wa systems �Permit Number Name ? / �r / l • Date " X/ �h,�_ N2 7 5 9 G • Location Subdivision Name Lot No. Sec. or Block No. Lot Size —'Z � _ House Mobile Home —T Business -- Industry No. Bedrooms No. Baths <S) No. in Family _ Public Assembly Other Garbage Disposal YES p NO [X' Specifications for System: Auto Dish Washer YES NO Auto Wash Ma^hine YES NO r ` Type Water Supply _ __— -- rd ,mss' X/� *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. 1A Improvements permit by —A)/ *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Q 2 of 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 betaken 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 l� Environmental Health Section . P. O. Box 665 Mocksville, NC 27028 1. Application/ Permitr sted By ��y 6R ��- � �9 F'S _rw _ Mailing Address gty:� 2V Home Phone 900_ 3t� L�-S Business Phone < C� �� 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business l�,eneral Evaluation 11YHouse ❑ Industry 5. If house, mobile home: Subdivision No. of People _ No. of Bedrooms No. of Bathrooms Dwelling Dimensions ❑ Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ©-Washing Machine ❑ Dishwasher ❑ Garbage Disposal 7. Type of water supply: D -Public ❑ Private (� p ❑ Community 8. Property Dimensions f /L'� - Sewage Disposal Contractor -I%° J— 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes m-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: II 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE QNN ABOVE DESCRIBED PROPERTY Ftaondodisposal 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 representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. DATE SIGNATURE DCHD'(1193) =� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME / D 5 ADDRESS PROPOSED FACIILTY h5�J1 DATE EVALUATED PROPERTY SIZE /W LOCATION OF SITE a!Zltll Water Supply: On -Site Well Landscape position Community Public Evaluation By: Auger Boring Pit Cut Consistence FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH " Texture groupS-C Consistence Structure Mineralogy HORIZON II DEPTH _4e+ Texture groupv Consistence ,- Structure Ap/ Mineralogy' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATEI Vy , SITE CLASSIFICATION: '�n LANG -TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: 1/% /Z OTHER(S) PRESENT: 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 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 w V ' Davie County JkalPi Department and . oine NealtFi .gyency 210 HOSPITAL STREET i P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 c March 2, 1994 Bob Potts Builders, Inc. P. 0. Box 74 Advance, NC 27006 Re: Site Evaluation Highway 64 West Dear Mr. Potts: As requested, a representative from this office visited the aforementioned site on February 25, 1994. Based upon the information provided on the application for a site evaluation and after the evaluation was, completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal 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 Parcel #: H30000005002 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search VleO Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: H30000005002 Account #:43654500 Owner Information Tax Codes LACKEY KATHY S ADVLTAX - COUNTY T kIREADVLTAX 130 HAMPTON LANE - FIRE TAX MOCKSVILLE NC 27028 Market: Property Information Township Land (Units/Type): 1.000 AC CALAHALN [Address: 130 HAMPTON LN Deed Information Local Zoning Date: 06/1994 Book: 00174 Page: 0577 Plat Book: Pa e: Legal Description PIN 78 AC HWY 64 5719825717 Property Values Buildin 85,60 0011 BXF: 66 nd: 1809 Market: 10435 ssessed: 10435 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00174 0577 06 1994 WD Unqualified Vacant 9,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 0 Page 1 of 1 oN.tcz Davie County Web Site All Information on this site is prepared for the inventory of real property found within Davie County. All data Is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the Information set forth on this site whether express or Implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountyne.gov/itsnet/View.aspx?prid=1459477 7/12/2016