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554 Markland Rd SO DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Syste s Permli N6mber Name Date NO 6951 Location o 6 Q) SubdiVision Name Lot No. Sec. or Block No. Lot Size House Mobile Home i Business Speculation r. No. Bedrooms No. Baths No. in Family Garbage Disposal YES E] NO Specifications for System: Auto Dish Washer YES [y NO E] 0 0 L) -K Auto Wash Ma shine YES E� NO E] 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 revocatio7Msite-plans or the inten ded,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 by cfv F vlt 1J J 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 EVALUATION/IMPROVEMENTS PERMI "' ' ' lQ Davie County Health Department Environmental Health Section AUG 10 1992 6J P.O. Box 665 Mocksville, NC 27028 _ 1. Application/Permit Requested By ,F _m Mailing Address — ,C. Home Phone �� d c� FL Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation V1000# eptic Tank Installation 4. System to Serve: ❑ House 9 Mluobile 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 OJ-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 `7-4 No. of Commodes Z No. of Urinals No.of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public � 2 rivate ❑ Community 8. Property Dimensions -Z X Ade) Sewage Disposal Contractor 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: / l �5 T n1Ar 1045 s /iN brte/ �Arrr�. 5 js a �V /�� ,/- r 114 A-,2 ?i✓/ l/ c' /0 tx T j `y o �! D yid i4 5 1,-2✓" !fir/vcWAY /i� �"JeJLJ ltc"J i/� S/✓�11E �-i , r1SS �/� .L/�57 p 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. 9,2 DATE 61GNAT4FIff CONSENT FOR,$ITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: ❑ 1. 1 OWN the property. 14 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 fid• S�a�IL all testing procedures as necessary to determine said sit ' suitability for a ground absorption sewage treatment l system. DATE NATURE DCHD(12-90) z DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation l NAME /�1��7/S' DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE �� / Water Supply: On-Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 12 3 4 Landscape position Sloe 7. HORIZON I DEPTH Texture group 4i_ 4f— Consistence — F' P'Z V._ Structure Mineralogy HORIZON II DEPTH Texture groupell, C Consistence 64 F-L StructureS /r S S S aF Mineralogy HORIZON III DEPTH Texture grOu2 Consistence Structure Mineralogy HORIZON IV DEPTH ' Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � p SITE CLASSIFICATION: EVALUATED BY: � �� - 1yc%% LANG-TERM ACCEPTANCE RATE: C 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■...■■.■..■.■.■..■lC:iii■■■■■■■■.■■\.E■■E■■■■..�.......■■■.■...■■ ■■■■■■■■e■■■■■■■■■■■■■■.■■■■■■.'!]�■■■E11■■G■.■■■■■■■■■■■■■■■■■■ ■EE .....................■IIE■OEE■■■■►il■OE.....�.......................IN ■■■■■.■■.■■■■■■■.■■■■.■■■.■■■.■uMM■■MM■■■..■.....■.....■. 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ME■�■MMM.M■■■■.I..MMI.M■■M■■..■1.0...0..0■O.MO■MMMMMM■MMMM■■ ........................�...Ei.EM■ ME■MICYAPA ........................ ■■■■■.■■■■■■.■■■■■■■■■■MIS■■■I/■A■1'1■■■■■■■■■■O■■■■.■■■■■■■O■..■■■■■■ ■■■■■■■■■■■■■■■■■■.■�■■■1/!*011/1■■ ■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■ ■M...MME..MM...■■.M■MMM....►1��r..■■MM■■■.■..■MM.■■M■■.■.■■M..■.■■ ■OE■ ■■■■■ ■■■E■Ilf■■■■■■■■■1!i■■■.■..■■■■M■■M.■■.■MEM■O■ rDw e County NealtFr D7yaemy artment and dome .�lealt�i 210 HOSPITAL STREET/P.O.BOX 665 MOCKSVILLE,N.C. 27028 PHONE:(704)634.5985 August 18, 1992 Karen Lemmons 7368 Crenata Dr. Lewisville, NC 27023 Re: Site Evaluation Markland Road Dear Ms. Lemmons: As requested, a representative from this office visited the aforementioned site on August 14, 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, 447-1Y Robert B. Hall, Jr. , R.S. ,Environmental Health Section RH/wd Enclosure