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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 ■■■■■■■■..■■.■■■.■■■■■■■�.C7G7■■■■ ■■■.■■■\■■■■■■■■t.■■■■■■.■■■�■■■ ■■.■■■ ■■■■■■ ■■■■■■ 1■t■■■ ■■■■.■ ■■■■■■ ■■■■■■ ■■■■■■� :CC :::� ................................................�■...........�■■■■ =:CC::C:C::EC:::C: : ....■.......................................... ........ ........ ■■■■■■■ ■■■_■■■■■■■ ■■■■■■■■■■■■■■■■.■.■..■■.■■■■■■■.■.■■■�■■■■■ NNEENEM ..■ ■■■.■■■.■...■■■■■■■■t■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■ ................................ ................................ .........■........................................................ .................................................................. .......■■.........................■■.n.■■....w.■■■■t■■■■�■.u■..■ ■................... ............................................. ■■■■■■■■■■■■■■■■■■■.C........... ................................ ■■■.■■■■■■■■.■wee■■■■■eee.■e■■.■ ■■■■■■■.■■■■.■■■■..■■■■■.■■■■■.■ 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