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P6096 Hwy 801N o vR DAVIE .COUNTY HEALTH DEPARTMENT - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:-Issued in.Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems _ Permit Number " �r1a//�r� mor-//V e� 'V'' r -�—��� N° 6096 Nam , Location .,�<�s Subdivision Name Lot No. Sec. or Block No. Lot Size �� House Mobile Home _ Business Speculation No. Bedrooms .Jf No. Baths c2YA, No. in Family _ Garbage Disposal YES NO ❑ Specifications for System: "Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO ❑ p l� 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 intended use change. �,,�7 r i 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: System Installed by )10 c a S Certificate of Completion `/ Date "The'signing of this certificate shall indicate tMtat.A q system descr bed above has been installed in compliance with the standards set forth in the above regulation, but shall—in TV0 way be taken as a guarantee that the system will function satisfactorily for any given period of time. ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME f�ICP DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY � 1��1 LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .S" f ff Ar S' Sloe Z -91 HORIZON I DEPTH W,/' J• �' S'�' 'f Texture group Xd- .S'.t_ Consistence A, FY fr Structure 10, � G; Mineralo / 2 HORIZON II DEPTH - d 3 Texture group t4 L IfL Consistence 1_ r Structure _< �5_j/11-/ 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 RATE SITE CLASSIFICATION: �C dY% ///0/ J EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 13 OTHERS)/PRESENT: REMARKS:_rP,C 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-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/fta DCHD(01-901 ■e■■e..■.■■e...e...■■■e■e.■■■■ee.s....■.e■ee.e.e...e...■.■ 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■/■e■./e//ee/e■■c//■e■ee■■■eee.■�ieaes■ee■ee■eeee.eeeeee■■eeeee.■■ ■e.e■eee■■■■■■■■■.■eee/■■■■■■■■//■■■■■■i■■■■■eee■■■■/■e.e■■/.eeeee APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1 . Application/Permit Requested Bye ' Mailing Address `- ' ,I Home Phone C(��f-�nq�-'::�--550q Business Phone 2. Name on Permit if Different than Above .,_-9 3. Property Owner if Different than Above FkOA cis 4. Application/Permit For: 0 General Evaluation Q/S/Tank Installation / 5. System to Serve: D/House Mobile Home Business L Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People 3 Dwelling Dimensions No. of Bedrooms 7Z� Basement/Plumbing No. of Bathrooms c�-�- Basement/No Plumbing O'Washing Machine ;y Dishwasher (Garbage Dispusai 7. If business, industry, 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 S. Type of water supply: C Public /Private 0 Community 9. Property Dimensions I 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Yes Q/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. 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 a cation. , Date Signature ,.a.,... Li Directions to Property : 9l9-7�f-Ddf� DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, R O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) yes no 1. I am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from :;:4nkf' k A-0C-E' owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: —Owner only — Owners designated representative �L Anyone requesting results Only those listed below DATE SIGNATURE DCHD(11/84) ttbie (IlQun# ettl#h �e�tttr#men# q%ct to RA, 2 Soq ttn�r ume ett1#h lgentg tie P. O. Box 665 L2 HIItksuillE, IIrth (1IttrIIlitttt 271T2$ Vho�IL�•`•Lle- w-c. Z76%T OFFICE OF THE DIRECTOR TELEPHONE May 22, 1985 97041 634•5965 Mr. James Nance - Route 03 , Mocksville, North Carolina " RE: Acreage Tract,'Highway 801/Howell Road " - Davie County - Mr. Nance: As per .your request the aforementioned property was evaluated by this office with assistance from Mr. Joel Cawthorn, State Soil Specialist on April 10, 1985. I have just received the written report from Mr. Cawthorn, concerning his suggestions in regard to installing a ground absorption sewage treatment and disposal system to serve a three bed- room home. Please note below the following conditions under which this office could issue the necessary Improvements Permit. It must be noted also that all the following conditions are based on the fact that the proposed dwelling would be placed in •the same area that was marked on the date of the evaluation. 1. A diversion ditch must be constructed above the system to keep all surface waters off the area. 2. Interceptar drain must be installed above and on both sides of the system. This will eliminate any lateral water movement in the soil itself and prevent the system from being flooded by ground water. , Enclosed is a sketch regarding the above-mentioned items. In summary, after careful consideration it appears that a ground absorption. system can be installed on the property. Before any construction begins it is imperative that the homeowner obtain the necessary Improvements Permit from this office. Please advise should you have any questions. Sincerely, • Joe Mando, R.S. Env. Health Coordinator jh Enc. 1 . ,• ,,,,, - , —I __~ — to "}tw �Mi.. - �:; , .. • \FIs,.' 4 - . �tt11IP �IIlt2t�� �E�I��� �E�1tIX�IttElit Mtt� �IIIttP �PMIt� �l�P2tt�1 P. O. BOX 665 �uchsirillE, �artf� fattrulinu z7IIz8 OFFICE OF THE DIRECTOR TELEPHONE May 22, 1985 (704) 694-5985 Mr. James Nance Route #3 Mocksville, North Carolina RE: Acreage Tract, Highway 801/Howell Road' Davie County Mr. -Nance: As per your request the aforementioned property was evaluated by ' this office with assistance from Mr. Joel Cawthorn, State Soil Specialist on April 10, 1985. I have just received the written report from Mr. Cawthorn, concerning his suggestions in regard to installing a ground absorption sewage treatment and disposal system to serve a three bed- room home. Please note below the following conditions under which this office could issue the necessary Improvements Permit. It must be noted also that all the following conditions are based on the fact that the proposed dwelling would be placed in the same area that was marked on the date of the"evaluation. 1. 'A diversion ditch must be constructed above the system to keep all surface waters off the area. 2. Interceptar drain must be installed above and on both sides of the system. , This -will eliminate any lateral water movement in the soil itself and prevent the system from being flooded by groundwater. Enclosed is a sketch regarding the above mentioned items. In summary, after careful consideration it appears that a ground absorption system can be installed on -the.property. Before any construction begins it is imperative that the homeowner obtain the necessary Improvements Permit from this office. Please advise should you have any questions. Sincerely, U Joe Mando, R.S. Env. Health Coordinator jh Enc. cc: Roy Potts 4-11-89 t i 1 1 1 � � h A�a STATE GINM North Carolina Department of Human Resources North Central Regional Office • 310 East Third Street • Winston-Salem, N. C. 27101 James G. Martin, Governor May 6, 1985 Phillip J. Kirk,Jr.,Secretary MEMORANDUM TO: Joe Mando Environmental Health Coordinator Davie County Health Department FROM: Joel W. Cawthorn Soil Specialist Division of Health Services SUBJECT: Soil/Site Evaluation of James Nance Property near intersection of Highway 801 and Howell. Road On April 10, 1985 you and Buck Hall accompanied me and assisted with the soil/site evaluation of the above named property to determine its suit- ability for installation of a ground absorption sewage treatment and disposal system for a three bedroom house. Mr. Nance was present during the evaluation. There is about 9:38 acres of gently .sloping land with two intermittent drainageways running lengthway of .the property. There are many large stones on the ground surface and in the soil. Water can be obtained from the county system. ,There is a, small, well-drained area in a depression near the back property line which has 20 to 40 inches of loam .over`.clay loam subsoil. This area is provisionally suitable for a conventional system using a .5 gallon per day per ,square foot application rate if there is sufficient space. If a system is installed here, a diversion should be constructed above and an intercepter drain should be installed above..and on both sides of the _system. An Equal Opportunity/Affirmative Action Employer Mr. Joe Mando May 6, 1985 Page Two The remainder of the land is unsuitable for-installation of a ground absorption system because of the shallow and variable depth to unsuitable soil material, sparolite and/or seasonal watertable. If there are questions concerning this evaluation, please contact me. JWC:kd. cc: Gary Cole Steve Steinbeck