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217 Dayspring Way VIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II`of G.S.Chapter 130 , Sanitary Sewage Systems Permit Number Name ��— ` l�. / ,i ✓�,�: �— Date N0 7 3 5 3 Location Subdivision Name Lot No. Sec. or Block No. Lot Size d IX C House Mobile Home Business Industry No. Bedrooms_ No. Baths No. in Family_� � � ' Public Assembly Other Garbage Disposal YES NO ❑ Specifications for System: - - �� Auto Dish Washer YES NO ❑ �,,,�,� �/ Auto Wash Ma-hive YES NO ❑ Type Water Supply da-)- *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. a K eve ku oX� x� i ---.�.... L- r N f� �E 200 tr \ FLfv�N �o,) IN N1_ E- V�� Improvements permit•by �t` �-- *Contact a representative of the Davie County Health Department for final inspection of this systefn 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:7,04-634-5985. Final Installation Diagram: ' System Installed by Y ~_ Y 93 Certificate of Completion Datell - 9 '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 P. O. Box 665 1�b� Mocksville, NC 27028 1. Application/Permit Requested By Dayspring by Hendrix & Corriher Construction Company,Inc T Mailing Address P 0 Box 156 Home Phone Mocksville, NC 27028 Business Phone 704/634-5972 2. Name on Permit if Different than Above 3. Application for: a General Evaluation O Septic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home-., ❑ Place of Public Assembly ® Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home:Subdivision Section Lot # ® BasemenUPiumbirig No.of People ❑ Basement/No Plumbing No.of Bedrooms 5 ❑ Washing Machine No.of Bathrooms I&] Dishwasher Dwelling Dimensions 40 x 115 El Garbage bisposal 6. If business, industry, placq of public assembly,other: Specify type No.of People Served employees 5 patients 20 pegay No.of Sinks 1 No. of Commodes 13 No.of Urinals 1 dishwasher No.of Lavatories 15 No. of Water Coolers 1 No.of Showers 5 Water Usage Figures 7. Type of water supply: ❑ Public El Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 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 seg hQ �s poo19-0 Q /-Y 1 Z-1 led p� This is to certify that the information provided is corre best of my knowledge, and I understand I am responsible for all charges incurred from this application. , A6- DATESIGNATURE CONSENT FOR SITE EVALUATION IQ BED NE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. 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 I to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. c DATE SIGNATURE ocHD(IM) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS S Ac�� PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE V AN Water Supply: On-Site Well V Community Public Evaluation By.(�C L Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position S Sloe 7. 6.30 J 30 S_3b� HORIZON I DEPTH " 61, I' 11 k Texture group 5Z L S CL S C L— (Z_�- Consistence T M Fr _:T Structure Mineralogy '.► 1 1 : 1 1= HORIZON II DEPTH Texture groupe- Consistence r - Structure 't, Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS RESTRICTIVE HORIZON SAPROLITE �^ CLASSIFICATION S LONG-TERM ACCEPTANCE RATE L1 SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: I 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 ........................... ................... .................. .............................................. ........ 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E■■.EEO ■..EMM MEMO ■..N■...■......■........ ...N..H.MEMMEM.MOMEMEN .■M..nO.O.HO.O.N�■■■.■ ■NOON■.A■CO/.%OM...■..... e.■■■M■■■MNHE�_COLC�H..M■.O..C.MMMOMMMMMMMMMMEWMMM ■ ■E.■■NN..■%..E■....■ 1:1C�\■Ili�\..yEM..eO■■..■.■E.MM� .■N■..M..■..O■ ■.■■■EEE■■\■■■■■■■■■■■■■■■■■■■■■■■■.■■■E.E■EeE■■..e%■■...■■■■>��..■■ ■.■E■.E.NE1►\■.■.■.■.■■■■■N■■■.■■..■■■■■..N.■■■NClGi/■■■■■■■■■■Eta■■■■ ■■...■■■N■.....MN■■■.■..■■■■N■.n.■.■■.N..N.■...■..■■..■..N.i.■E.■ L Davie County Nealtk, Depa.* ent and .dame XealtF, yency 210 HOSPITAL STREET/P.O.BOX 665 -Y MOCKSVILLE.N.C. 27028 t Y I PHONE:(704)634.5985 , t ,yF i•1 •, 1 kY� 4. 1993 r. hj k Al Jesse Boyce, Zoning Officer County`Administrative Bldg. , 3rd .Floar. .'. ` South Main Street Mocksv:lIe� NC :27028 �r _ :Re: Site Evaluation & Permit 7204 s , Dayspring .Center/Vanzant Road_ x<a Dear' Mr. Boyce a z As requested, a representative from this office visited the aforementioned site on June .10,_' 1993. The site was found provisionally suitable for the :,installation of a ground absorption sewage system. you have'; any questions, •.please- feel-free to contact .this office. Sincerely -s C3� Charles E. Little, R.S. 4: .Environmental; Health .Section CL/wd- Enclosure. Davie County Nealtfi Department and .dome Nealth' yency 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 October 12, 1993 Hendrix & Corriher Const. Co. P. 0. Box 156 Mocksville, NC 27026 Re: Septic Tank Permit 7204 Dayspring Center Dear Mr. Corriher: This letter is in regard to septic tank permit 7204 issued by this office on June 10, 1993. On September 30, 1993, this office met with you at the proposed Dayspring Center on Vanzant Road. Based on information provided on the original application the designed system on permit 7204 would not be large enough to serve the revised application received by this office on October 5, 1993. Please contact this office when the new site is ready for evaluation. Due to space limitations the system cannot be installed as shown on permit 7204. If you have questions, feel free to call this office. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd cc: Mel Jones, Building Officer