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1403 Baltimore Rd DAVIE ������ ������ ���������� �~ ri ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION � ' °N��TE:Issued in�onmo|hanoaWith Article UmfG.S.Chapter130a - ~ �� ��� ���M� =�V' �u=����"�s �� ~*� V��Y^� � - ~l"� ' / ' "°AM Name - ` ` ` ` Date ��� Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business ___-___- Speculation No. Bedrooms __-___-_-.No Baths - No. in Fami|y-_-__-_- Garbage Disposal YES ~ ND [] Auto Dish Washer YES p NO [] Auto Wash K8m:hino YES [�, NO Type VVo1ar 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. \� ` \ �------_-_---- R \' ' - � / \ ^ ^ ` ' . ' . ' Improvements permit bv *Contact o representative of the Davie County Health Department for hnu| inspection of this oyo1om between 8:30' f completion. Telephone Number 7046346985 ' Final Installation Diagram: ~�� -^^-m5-) System Installed by ]� ` Certifioat*ofCompletion Date "The signing of this certificate ohm|| indicate that the system described aboxe 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 Mocksville, NC 27028 MAR 2 2 1993 1. Application/Permit Requested By M 4 !-C'l( /�2W�'VlQ✓l L Mailing Address f `f�6K-7 4 ; Ad 0.VlC� NC9-7606 t t O Home Phone Business Phone 2. Name on Permit if Different than Above /' 3. Application/Permit for: ❑ General Evaluation O Septic Tank Installation 4. System to Serve: ❑ House U3*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 ' ©"W'ashing Machine No. of Bathrooms P'bishwasher Dwelling Dimensions Al X 76 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: ❑ Public ❑ Private ��/ / �ecommuhity 8. Property Dimensions Sewage Disposal Contractorw//C�(Cro d r f (r 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 chapge. Effective October 1, 1989. Directions to Property: 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 thip appli ti� t DTE SIGNATURE CONSENT FOR SI?'E-EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: N(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 Coy/qty Health Department to enter upon above described property located in Davie County and owned by �bl'i n ©-1(-ii F WYM a-0 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal sy tem1r3 3 1 t ATE e7 SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section \ Soil/Site Evaluation NAME -C7 ��'a DATE EVALUATED ADDRESS SAM n' PROPERTY SIZE C�-trA PROPOSED FACIILTY V-N ' ���``� LOCATION OF SITE Q _ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % 0- W 0 -�s� HORIZON I DEPTH 5", Texture grouL C 0.L L ConsistenceC- Structure C C C Mineralogy 1 1'• 1 1 HORIZON II DEPTH G" Texture groupC C Consistence Structure C Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS SS SS RESTRICTIVE HORIZON — — SAPROLITE — .- CLASSIFICATION S LONG-TERM ACCEPTANCE RATEItA 14 SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 1-4 OTHER(S) PRESENT: REMARKS: � ��-. � � �Jtk`�. �a•���? � ��yC���s. 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 Mineraloey 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 watet' 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 ■..■■..■■....■■■■.■.■■..■■■■■■■■..■.■■■....■.■...........■ .MOND ■ ■■..■■■■...■■■......■■■....■.■...0■Noon..■././..■■...■■■■■..■■■■.■■■ ■■■..■.■■..!■■.■■MO.NoNo■Mon......■■■■...........■■...■.......■..■■■ .............■............. ...................................... 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Y•''w,. � .a ret r '�; a.p ry 5�!'°''ti�'�� DAVIE COUNTY HEALTH DEPARTMENT /00, z IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 9 '3 "NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a -Sanitary Sewage Systems L Permit Number 93 Name 712 9o Name Date N2' Location \ — �; V Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business -- Speculation No. Bedrooms , No. Bsths No. in Family Garbage Disposal YES ✓ NO ❑ S ecifications , or �' p f Xstem; Auto Dish Washer YES �, NO ❑ L' Auto Wash Ma shine YES NO`❑ 3 Type Water Supply Thispermit Void if sewage system described below is not installed within 5 years from date of issue. This permit is s bject 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 byJ� N T f 11 • `--� G v'r� 910 1. f 't. 3 � i Tjh o 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 EVALUATIONAMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 �m Mocksville, NC 27028 `{{1 APR 8 1993 ' 9 1. Application/Permit Re uested By Mailing Address GL R.3 Home Phone q 99d o .3 Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: ❑ House tKMobile 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 3 ®' Washing Machine No. of Bathrooms - ,� Dishwasher Dwelling Dimensions /C 7D I 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: ❑ Public ❑ Private1 ) / ( Community 8. Property Dimensions /(1 C Y''t'd Sewage Disposal Contractor t / 114T Y!7 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: ne I5g LC � �ic� � f bn /3aL '771 �� U , Frr � ►� 10 5� art r� T3 r I C, ram 'e.n d 0� Of U3© a c �, 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. , 4r DATE V SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: X 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 Da ie Aunty He h Department to enter upon above described cated in Davie County and owned by 3" h n) f'- 2 / z?,).7`;,1:2 � 9 all testing procedures as necessaryto determine said site's suitab I�for a ground adsorption sewage treatment system. r DATE SIGNATURE DCHD(12-90) • - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME U°\\ Np Q]_��� DATE EVALUATED ADDRESS S P `mom PROPERTY SIZE PROPOSED FACIILTY I ' Na Y`r` LOCATION OF SITE awv • st !`� Water Supply: On-Site Well Community Public Evaluation By:CL Auger Boring 1/ Pit Cut FACTORS 1 2 3 4 Landscape position s s Slo e % _ 8-0 6 HORIZON I DEPTH Texture group CL Q L- V Consistence >~ Structure C MineralogXk. HORIZON II DEPTH b ' Z7 0 D Texture groupF Consistence - Z T Fq Structure B F Mineralogy I l ° 1 ° ) • HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS .5"5 SS S RESTRICTIVE HORIZON r SAPROLITE CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATE(S' .3 ` SITE CLASSIFICATION: EVALUATED BY: , 1 LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: KS: � 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■■■■■■■■■■.■■■■II■■11111■■�li■:1/I�■■■/l■■■■/■■■■■■■■■■■.■■■■■■/■■■■ ■■■■■/■■.■■/■e■■■■■■/I/!.'i%■■�■■■■■■■■■■e■■■■■■■e■■■■.■Mee■■e■e■.■e■ ■■■■■■■■■■■■■■■■■■■■■■.■■i�.��..! ■■■■■■.■■■■■■■■■■■■■.■■■■■/■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■.■■■■■e■■�.ee■Mee■■e/■e■.■■ee■■■e■■■■■■■e■ ■■■■■■■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■�\■■■■■■■■e■■■■■■■■■■e■Mee/■ ■■■■■■■■■■■.e■■./■■■■e■■■■■e■■■■e■►�■■eeet►�e■/eeee ■e■..ee■e■e■■e■� iiii■'uiiiiii■iiiiiiiiiisiiiiiiiiii=iiiiii �iieiiai'L.iiiiiiiiiii=■ ■■■■■.■■■■■■■■■■■■■■■.■■■.■.■■■■�■■■■■►■■■�.■.■■■.■■■■■■■■■■w ■■■ ■■■■■.■■■■■■■■■■.■.■■■■■■■■■■■■■ ■■■■■■►�■. ■■►�.■■■■■■■■■MMM■.■■■■ ■■.■.■.■■..■■■.■.■..■■■.■■■.■■..■■■.■..E.►�■■■s.►�■■.■■=ee■..■■.MEIN ■.■■■■■■/.■■■a■■■■e■/■M■■■■■■■/■■.■■■e■■■■►�e■e■e►�e�eee■■■■■■.■■eee 'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiieeiiiiiiiiii�ii■Ni■i�i�oiiiiiiiiiiiii ■.e■■■■.e■■■.■■ee■.ee■■.e■e..■ee eeeee.e ■■■i'een■e�■.eeee.■■■■■■■ iiiiiiiie�iiiiiii■�iiiiiiie�=iiiiiii��iiiiie�■lii�iiii�i�iiiiiiiiiiii� ■■■■■..■■■■■■!■■■.■■■..■■■■■■■■■■l:,e■■■■■/■■o MIM■■■M■■w■I■■■■■■.■ ■■e.■■e■■■e■eNt:■■.■■■■■■■■■■■e■■��nn��.e ■.�■e■i�■■eee ■t�:�■■■eee■■e■■■■ ■■■■■■■■■■r1�ii� i•■■■/1■■■■.■■■.■■\!gW1/■■ ■OMMEM ■ 1■■w/MEMO.■■■■ ME■■■■■■■■■■■■■�■■.■.■I■.■■/■■■■■.■ .■■■ N■■■ISN ■■//■w■NMEMME.■ ■� ■■■.■■■■■.►.e►��t:■■..■■■e■■ii�e■:::�r;�■�r��.■t�ieett�et ■ eniuee�l..■e■■■�e ■■■■■■■■■fi.E■■e.■■■e■■N■■■.■■l/�1f:`.ii ���0.!le■■1 ■ ■■■■■■e■■■\l�ill■■■■■end■.._===:�:ini::i ti���l�iMrenl eee= ■■RIVE.■ ■■■.■e ■ eee11 MMM■MMMMMMM ■■ee■■ee■.■■■■.■■■■e.�e:a::c::::..■■omm ON on ee e�le■e■■■■■■./■ .....n■■■■■e.■■■■■.■�t.e■■■■■ee.■e■e=.��'�i�ii ..C.�t.....N..... 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