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2930 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT r IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number NameDate N2 /. Location 17, 6 14 �. ,o Subdivision Name Lot No. Sec. or Block No, Lot Size 4-!-;/ House Mobile Home _tom! Business Speculation No. Bedrooms No. Baths _ No. in Family _ Garbage Disposal YES ❑ NO D- Specifications for System: Auto Dish Washer YESNO Auto Wash Ma shine YES Q] E]NO ❑ ' Q' Type Water Supply /46 _ *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: System Installed by 40 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 be taken 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 Environmental Health Section r 1 1 P. O. Box 665 Mocksville, NC 27028 040 s 1. Application/Permit Requested By /`�`S�U :V&1/t 1.- / -'�Mailing Address 13 0 _7 .13 TDS/-eA j3ncicl Home Phone / 9 g 9 Sl• 2%1 FrU Business Phone 170 �63y- y�y 2. Name on Permit if Different than Above 1 !_ 1n-,S4Q 1 a_4Kh% l ��ry ic,-t�14-ea 3. Application/Permit for: ❑ General Evaluation eptic Tank Installation 4. System to Serve: ❑ House " "' ..1 L?zT66iie Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing ,-"-No. of People ❑ Basement/No Plumbing No. of Bedrooms 31 ❑ Washing Machine No. of Bathrooms dda- ❑ Dishwasher welling Dimensions n L ❑ 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. ype of water supply: De. ublic ® / ® El Private 1+ (� ❑`Community ✓ 8. Property Dimensions/ A rx(! . V1 U�S l Sewage Disposal Contractor�i 1�i,�( - d 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: -Jcl e--:� o v\ \�,j Nq I S i DG" 91%.r64 -� Dv2 ►r ro w- GJov l eco, 1 v - 1�� 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. Z /7 92 DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY [and CHECK ONE: ❑ 1. 1 OWN the property. P(2. 1 DO NOT OWN the property. hecked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: y give consent to the authorized represent Liv of the Davie County He�h Dep?.1ment t enter upon above described y located in Davie County and owned by YVI 1M Cn,>1lJWo C.0 uct all testing procedures as necessary to determine said site's suitability ground absorption sewage treatment pos I system. ��jj C�� DATE SIGNATURE DCHD(12-90) s. DAVIE COUNTY, HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME i'//�r !'� DATE EVALUATED ADDRESS PROPERTY SIZE ,� GP 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 % HORIZON I DEPTH Texture groupL SL S� S Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC C Consistence Structure s- 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 I , SITE CLASSIFICATION: EVALUATED BY: e6 LONG-TERM ACCEPTANCE RATE: -gAf, 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 ■■.■■■.■.■.....■.■.■■.......■.....■......■■.....■■.■.■■.....MIN.. ■..■■■..........■.. ■■■■■..■..■...■■.......■...................■.■ NEW NEE■■■/■.■■■■■■.■■■.■■.■■■■■■!■■■■■■.■■■.Ifi■■■■■..■■■■■■■■■.■■■■/NOON■ ■■■.■■■N/■■■■■.■■■.■■■■■■■►7.■/■ ■■...■■......■..............�■■E ■■■■■■ ■■■■■■ ■■■■■11 ■■■■■■ ' NOON■■ ■■■■■■ ■■■■■■ ■■■■■■ ■........■■■...E.....■....■■■■.■�mom.�■........■....■■.■..■■ NONE MENNEN mom ................................ ................................ .................................................................. .................................................................. i " Davie County NealfF De aitnenf .borne Nealtl Aen and y c1) 210 HOSPITAL STREET/P.O.BOX 665 i MOCKSVILLE.N.C. 27028 PHONES(704)634-5985 February 21, 1992 Kristy Marklin Rt. 9, Box 313 Foster Dairy Road Mocksville, NC 27028 Re: Site Evaluation Highway 158E. /l+ Acres Dear Ms. Marklin: As requested, a representative from this office visited the aforementioned site on February 21, 11)92. 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