170 Tailwind Dr Lot 14 ••i
4, 7. DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article II of G.S.Chapter 130a
Sanitaty Sewage Systems eo 6 Permit Number
Name Richmond S. "Dickie" & Sharon Vogler Date 8-27-92 NO .6892
_NE; -244106-
Location 158E. ; 801S. ; Peoples -Creek Rd. ; Marchmont - Lot 14
Subdivision Name Marchmont Lot No. 14 Sec. or Block No.
Lot Size 5 acres House X Mobile Home _T Business Speculation
No. Bedrooms 4—.No. Baths 3 No. in Family 4 _
Garbage Disposal YES ® NO ❑ Specifications for System:
Auto Dish Washer YES j NO ❑ ` �.
Auto Wash Ma.hine YES NO ❑ '��(�� y`�
Public ✓ f Y
Type Water 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.
1�
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
IJ ~
Certificate of Completion �� Date 22
*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
4 > ? Davie County Health Department r-* WED
Environmental Health Section U
J P. O. Box 665
ov
f Mocksville, NC 27028 i J U L 1 7 1992
1. Applicatio /Permit uested By QS"
Mailing Address
Home Phone `�d � Business Phone,
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation tic Tank Installation
4. System to Serve: Ouse ❑ Mobile Home. ❑ Place of Public Assembly
❑ Business ❑ Industry �.t ElOther El Unknown
5. If house, mobile home: Subdivision re
An•s. & — 1 Section Lot#Iq
"R`16asemenolumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms m�ashing Machine
No. of Bathrooms 'Dishwasher
Dwelling Dimensions D 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: /Plublic El Private ❑ Community
8. Property Dimensions C r7 L' Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes o
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: `` �Y�,-A f-Q-, A,1 T— �, •Q
This is to certify that the information provided is correct to e b st of dge, and I understand I am responsible for all charges
incurred from this ap ication:
DATE SIGNATURE
FtaonCONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
d
ECK ONE: ❑ 1. I OWN the property. ❑ 2. I 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)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation �J ,
NAME DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITEj� i(ii
Water Supply: On-Site Well Community Public !/
Evaluation By: AugerBoring Pit Cut
FACTORS 1 2 3 4
Landscape position
Slope % — — -
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH Y4 t _91Z,_ V
Texture group
Consistence
Structure l�
Mineralogy A/
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 RATE IX IQ
SITE CLASSIFICATION: / EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: 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-Finn 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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Dade ( ountg Pealtlt Department
Unb Fume Pealtlt �Settrg
P. O. BOX 665
.Marksliille, �iortli (garalina 27028
OFFICE OF THE DIRECTOR TELEPHONE
17041 634.5885
July 22, 1992
Richmond S. Vogler
c/o Potts Realty
P. 0. Box 11
Advance, NC 27006
Re: Site Evaluation
Marchmont — Lot 14
Dear Realtor:
As requested, a representative from this office visited the aforementioned
site on July 22, 1992. 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
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMITS""
Davie County Health Department f
Environmental Health Section 0-
C�\v4'�
P. 0. Box 665
Mocksville, N.C. 27028.-
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requested By� J P-66,e. EA Xer Business Phone 3 3
2. Address?.(). o .2,1f) A-1 7
3. Property Owner if Different than Above
Address ,
P��'��
4. Permit To: a) Install Alter Repair ff0 Re9u►� a s `mt� e,
b) Privy Conventional Other Type
Ground Absorption lOn 16130197,
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House-SeL'Mobile Home Business
Industry Other
b) Number of people 13
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions /D9J( Coo
Bed Rooms Bath Rooms 4112- Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of yvater-using fixtures:
commodes •c� urinals garbage disposal
lavatory showers washing machine
dishwasher sinks —
8. a) Type water supply: Public ✓ Private Community
b) Has the water supply system been approved? Yes✓ No
9. a) Property Dimensions SAcges
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? /YD
What type?
This is to certify that the information is correct to the best of my k dge.
-10-b7 /.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANgE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: 64 C,9s 1 '�6 y0/ _ j 4�,� ���� 4wAad AcluAl!ce,
...L n Ad VAnce,, �u2n �-� . on �ec�o% aizee.K
M m;/e S A rc{t �f ?1An-
/ a /�
�# blq-
aoct4 h r Corn cry d re
LOA.5 i s on 2;sh f
� b u �;��' �Oxes'
&' i nc�ccdes
p��� o� cut-de. -sq C,,
Y ear Cert 10,E
Thi home '
-� �{1e �� W'to yow . A-
XAnce w; 6e 5�ra�( D A��hmorrE 5£ • P� /�
y �u�rd��i� -Ej,t✓. {�ou s-e down
DCHD(6-82)
` DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental -
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
1 11,L /N r-chmon f ?Ard 4on (office use only)
yes no 1. I am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
es no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
-10 -fir 7
DATE SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
Owners designated representative
Anyone requesting results
— Only those listed below
DATE SIGNATURE
DCHD(11/84)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name � "i`(� �- Q Date
Address Lot Size S
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
P PS PS PS
U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) PS PS
U U U
3) Soil Structure (12-36 in.) S S
Clayey Soils <f*T PS PS
U U U
4) Soil Depth (inches) gg S S
P PS PS
U
U U
5) Soil Drainage: Internal S S S S
PS PS PS
<:=Pr U U U
External S S S S
PS PS
U U
6) Restrictive Horizons --�
7) Available Space S S S
PS PS PS
U U U
8) Other (Specify) S S S S
PS PS PS PS
U U
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:-- R. ���'�`
Described by Title Date
SITE DIAGRAM
DCHD(6-82)
�tti�ie (Noun#� �#ett1#1� �e�ttr#men#
ttni7 Fame xeaft4 '�kgenrg
P. O. BOX 665
ELAS) IL, VvO4 fdttralinu 27028
CONNIE L.STAFFORD,8A,MPH June 11, 1987 TELEPHONE
Health Director (704)63-5985
(704)634-5881
Mr. Jim Eaker
P. 0. Box 210
Welcome, NC 27374
Re: Site Evaluation/Lot 14
Marchmont Plantation
Dear Mr. Eaker:
On June 10, 1987, as you requested a representative from
this office visited your site and found the soil provisionally
suitable for the installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this
office.
Sincerely,
Charlie Little, R.S.
Environmental Health
Enclosure
CL/wd