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564 Juney Beauchamp Rd I..,r.-.: ..1.—. - .�- y • y'1 ... �;'1'Ak�. rh��.,+L1 4.1 )`'i'��t .T.' "Y; 58•: ' • �b:a't 2 ff H�.`.4 av'..ti: r DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage System Permit �umber Name D t N2 "Location _ V Subdivision Name Lot No. Sec. or Block No. Lot Size House - _ Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES NO p SgeGifi8a�ons Pr �ystem.:� Auto Dish Washer YES NO p l/ UU Auto Wash Ma:hive YES NO 3001 ' �( 3 ' Type Water Supply __— *This permit Void if sewage system described beldw is no't"installed within 5 years from date of issue. This permit is subject to revocation if site plans or;the intended use change. �Uo a -•' 4 I w 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 _ J 1 a 3 �d , g; �� z 44 / / IFC , ( 0,/C/nd /c`/r s��:/,;,fir C� .�O' ;;6F'1 Certificate of Completion Date "The signing of tfiis 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 Art( 14 19931 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address—, l /� �� _, i1f/�� 1�� C• Home Phone ��f l� D 7�� Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation _„_. D Septic Tank Installation 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot #_ow ❑ Basement/Plumbing No. of People 2Basement/No Plumbing No. of Bedrooms Id'W1ashing Machine No. of Bathrooms Dishwasher / Dwelling Dimensions � � 2 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: [Pub�liic ❑ Private ❑ Community 8. Property Dimensions 2�gT Sewage Disposal Contractor �� 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes LTJ 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: �� 4/lf 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 ON ABOVE DESCRIBED PROPERTY Fandd 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 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 al system. DATE SIGNATURE DCHD(12.90) C. Ray Cates certify that on S eDtember 101990. 1 surveyed the property shown on this plat; that the property fines and location of all structures are accurately shown hereon. that no structure located on this property eneroaehaa on any adjacent street or property. and that no structure on adjacent property encroaches on the premises nvwpod.,. St b a SEAL EA f L ? UC t-�s .r . r, ti►P Rpt end 67, 1,5 �_ q5�,E _ S. R._ 1632 _ - - W 2 Pont 01 '_ 0=0 K — — r o N Iran If' PARCEL 5701 0 _91 end RIIN 03 claimed "ERT' H. LUFFMANp v by N C DOT D.B. 144_ 7gg 2 O F 0.37 rnllo to Salf,more Rd. c0 S. R. 1630 Iron found a 0 I— N PARCEL 57.03 t` JULIUS V. TUTTLE U) 3 v i PARCEL 57.01 w � ROBERT H. LUFFMAN Ip -N O D.B. 155-P.528 N O 2 . 884 ACRES ( by d. m.d. ) Iron ~ 0 �PPta* found 219. 58 Iron found — — - - - � N85°-, 43�- 40W - - - - - — PARCEL 5, TAX MAP F-7 LETA S ELLIS D 6 144-622 P"0M FtTY OF LOT 40. Port of 57 IAP O� Davie County Tox Mop E- 7 BLOCK NO. i ',,, DEED FARMINGTON TOWNSHIP PLAT BOOK 29 PAGE 103 DAVI E COUNTY, N. C. I *CAL[: i MCN = 100 FRWT 2866-C JOS NO I �ll..uu rYYaY IYah MIY, a YMI, N.-1,YAeYW�fY DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section \\ Soil/Site Evaluation NAME u�� `1 DATE EVALUATED L\ - " q3 ADDRESS S Qm\4\ PROPERTY SIZE �• C>,r�A PROPOSED FACULTY two s •c LOCATION OF SITE �•?"¢ �%�+- '^�c�� Water Supply: On-Site Well Community Public Evaluation Byre EL Auger Boring Pit Cut FACTORS 2 3 1 4 Landscape position S 99M S Slope Z 5�- tS-0 `6 I HORIZON I DEPTH I7" _)" S" ' Texture group L - L Consistence _S F + Structure >z. Mineralogy HORIZON II DEPTH Texture group �. Consistence Structure 'i" Mineralogy ) , I 1 HORIZON III DEPTH Texture group Consistence Structure "'neralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 SS -5_: RESTRICTIVE HORIZON - - SAPROLITE - — — — CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3.6 SITE CLASSIFICATION: _, V5 EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �'� OTHERS) PRESENT: REMARKS: 1W � e� ��/ -. �a. 9. 14-9_ -Stine LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Footslope 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 3CSinglegrain 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 ..■..■■■■■■.....■■....■■..■■■.■■.■..■.■.■■■■.■■.../...■..■ ■■M.... ■■■■■■...■■■■■■■■.■■.■H■■O■■■.■■■EH■■.■■.■■■.■/.■.■■■■.■■../■■O■ ■■■■■■■..■..■.■■■■.■■■■■■■..■■.. ■..■■.■■■..■.■■■.■.■■■■■■■■■■■■■ .■■.■■.■.■..■■■■.■■.■■■..■■■.■■■ ■..■■■■.■■.■■...■■■...■■■..■.■■. ■■■■..■■■■■..■.■■■.■.■..■.■■■.■.......■■■■■.■■■■■■./■..■..■.■■■■■. ■■■■■...■.■■■.■...■.■.■■■...■■■.■■■.■■...■.■■■■■■.■■.■■.■■.■■■.■.. ■■■.■■■■■■.■■■■■..■■■■■.■■■■.■■■.■.■..■■..■■..■■■.■■■■■■.■■■..■■■■ ■■..■N■■■■■■■■■.■■E■S■■■■■■■■■M■■/■■■■.■■�■/■■■■■.■■■■■■■■.■■mom ■■■..■.■■■■■■.■■■■■■..■■■.■■.■■..■.■■■■■■■ ■■..■..■■../■■.■■■■.■■ ■..■.■■■.E■■M■■■E■MOM■■MOM■E..■■■EM■■■■■■■■■■■■■■■..■■....■■■■■■/■ ■■■.■..■.■■■..■.■.■■■..■■..■■... . ■..■■...■.■■.■.■■NO■.■■E■N■■OO■ ■■./■■/■■.■■.■■■.■■■■■.■■.■■...■ ■■M■E■E■■O■.■.■■..■■.■■■■■■■.■.■ .■■.■■■■■.■■.■■■.■■■...■■■. ■■..■.■.■■■.■■■.■■. ...■■■■■NN■■ ■..NME■■■■■.■■./■■■■...■.■�...■.■■MEMO...■■■.■�.■■.■.MN■■....■.■ ■■NE■O■N■■EE■■M■■NEEM■N■O■M■■■..■■■..■■.■■■E.■ NEEM■■N'■■M■■M■NN■■. ■■■MOMEME..■■■■.■MOM■ME.EE./...■.O■■�■■■ M■iii�inliii ■■■..■■■■■.■■.■■.■.■■H■■.=EEM.■■..■■■.. ■.■■.■■■■■■■■S■■.■■EOO■■■. 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