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P7782 Jamestowne Dr �;.- _ ✓xp a. �, DAVIE COUNTY HEALTH DEPARTMENT J G o ,o .. _ ` ` IMPROVEMENTS 'PERMIT AND CERTIFICATE, OF COMPLETION, *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Perm-it '7Npumber Name P�� v N \ c\.���s Date - N27782 I V 2 Locationr — (� 3hsr. . Subdivisioh Name Lot No. Sec. or Block No. Lot Size9� 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 Q,. NO [ /•0 0 0 ::Ie'111 R, . `. ,� - O - Auto Wash Ma^hine YES '',NO p 3n 00 X 3' x I t� Type Water Supply _ C o`v..a�y --- (0 4G *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. w0 }- u� pug C 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., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day gf,corr�p e' n.Telephone Number:704-634-5985. yr ev �� i o Final Installation Diagram: Evf System Installed by — Ll If / A Certificate of Completion �_ Datil r) - 2 - L4 '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 s" Environmental Health Section R 1E C E�V�/1p E P. O. Box 665 Mocksville, NC 27028 OCT 1 71984 1. Application/Permit Requested By. -Y V RNA Mailing Address �310 a To A 12d d/R il/G-1— _ /bf._ 7Zb/- Home Phone Business Phone 2. Name on Permit if Different than Above 3. Application for: C'rG eral Evaluation El Septic Tank Installation Permit 4. System to Serve: E] Hou 0'Mobile 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 1]0 Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ 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. Type of water supply: E-Public ❑ Private ❑ Community 8. Property Dimensions a•/7 AV Aa S Sewage Disposal Contractor � �c�c &A&_ 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: U 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. � -A- -pDATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY [andd ECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 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 Cou y He partment to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determin said site's uit ility for a ground absorption sewage treatment al system. ATE TIGNATURE DCHD(1193) •• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Q NAME QgV\ VN \V c �� DATE EVALUATED l ADDRESS S P`n`�"� PROPERTY SIZE • �� Q�� PROPOSED FACIILTY \�`� LOCATION OF SITE �- Water Supply: On-Site Well Community Public Evaluation ByCTf1,_ Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z ' l HORIZON I DEPTH Texturerou C L e L L Consistence L- Structure C Mineralogy HORIZON II DEPTH Texture groupC Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION Q2,S 5 , LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: \X�S`s EVALUATED BY: LONG-TERM ACCEPTANCE RATE: ` `\ OTHER(S) PRESENT: REMARKS: N�.\ 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 ■■/■.■■■/.■/■■./■■■■■■■i■■./■■e..e.//■■■■■■■e■■■■■■■■■■/■■■■■are■/■ iiiiileiiiiiiC�CCCCCCCCCC•iiiiiiiiiiiiiiii■■CGCG CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC�CCCCCCC�CCCCCCCCCCCCCCCC■.CCC■.CCC CCC■�C�i�CiiC�CCiiiC�iiiiiC�'�./■,',C.�C�■i�CCC C■CCC■�iC�■CCC� ■.■■■■■.■■��■■■.Ise.■..e■.r�■■■■■■�■■rv■..■■......■ ..C■.■.■■■■.■■..■ CCCCCCCCCI�CCCCt:CCCCCCCCCCC SCC►:'� .::::'.0 .M..... ........ .........r�■■■■.ri■/■■■■■ee■■■■/■.■,.... CCCCCCCC%�CCC::CC► :��►,�CCCC Mon MEN :MUMMI ■■C■C■so EMMONS ■C=..■■■■� ■/.■■■■■r.■■■■.■/■e\1i.\�;�1l1■■II■.. ■■■ MENS.�.O.■�C ■■■■■.■n■■lM■■■■ ■■.■■.../..■.■Ii■■■\■.11v/11Tii:.■/.�/A!�■■.■CC■ ■I... ■■■ee■■■■■■ ■■■■ ■■.■.■.r�.■.■■.1�■..■..■..■..►�■■■■.■. ■■■■...■CCC■! ■■■■■.■C■■■■■■ ■ .■.■■■■r1■■.■.■r��l■■■■■r�■■■■.�■■■�i■■.■ .■e■i■■.C■■■� ■.■■■■■..■■r�■■■ ■■.■■■.1,.■..■■■■.....u■.■..■..r�■■■.■■eRI- ■.C■ ■�• ■ ■■■■ n■.■■■■ .......■...................e.....■_■...EC■ .... C.=■m.CC■■■N..■. ■.■■■■.■■■■��---- --_,.-�...■■■.■.�■ ■■■.n MMMEUMMMMMMAMIIMMMM ■■■■■■■ �■R■■■■■ ■■■L■..■■I,. 11■■■■ ■.■■■■■ C.■ ■■■�r.►,■���■■■■..■■■...►.:■..a■■■■• ■■■r.■■■■■e.►�■Crl■ ■■ MEMEMEMM - --- -+�■i■■■E�rc�moo.��1[IL�� 'r I1. ..■■■■Iie.■1X�■■ ■■■■■■■■■■■Fr�l■■■■■■■■■■■■■■■■■■.■■►�-CE..■CC.REM■■■■■■■C MON moo ��■■ ■/■■■.■■PVt',Zs...... :1....■■.e.. ..■....�►■.■■......■■/■■■■l.■.■■■ ■■■■■■■■11N1.M11.■..� ■■■■� �e�l �.'/■■■■■■.■.■ ■■..■■.■■■■■■■■e■■■■■■■■ ■■.■■.■■i/.■I1■.■Falls■C���:� ,A■!�f■■/■■■■H.■ i■11■....■e..■■■■■.■.■■■. ■■■■ ■.■//■N/■■■■■//■.■.■■■■e/■ /■■■■/.■■..■i■■■■■.■■■■■■■.■■■■■ ■e■.■■■.■■■■■.■■■■.■.■■■■■■.■■■■.■■■.■/i■■■■■■■■.■■■■.■■.■■.e.■■■� Davie County Nealtli Department and .dome Neaff,, yency 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 October 19, 1994 Marvin Nichols 360 Potts Rd. Advance, NC 27006 Re: Site Evaluation Jamestown Road/2. 17 Acres Dear Mr. Nichols: As requested, a representative from this office visited the aforementioned site on October 18,1994. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the upper portion of the site was found to be provisionally suitable for the installation of an on—site sewage disposal system. The back portion of the site is unsuitable for a septic system. If you have any questions, please feel free to contact this office. Sincerely, Charles E. ..Little, R.S. Environmental Health Section CL/wd Enclosure