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207 Mr Henry Rd (2) 6 DAVIE COUNTY HEALTH DEPARTMENT 4. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems �`a?v.lrf,�d r'/ Permit'Number Name n I7�IG1 r eft'{.��.,.,i4 rTGt ��<% ae ,�� :>. ND ? 7005 Location r`F �: ri y`r moi; :/ /° �i.�, ��' /:`; //. ✓ ff ? :.J/ ��,,1>, ',.,Subdivision Name Lot No. Sec. or Block No. Lot Size I,�t Mobile Home_T Business Speculation /: �v' 1��' House ►!' \ --JNo,Bedrooms No. Baths -1� No. in Family — Garbage Disposal YES ❑ NO EJ Specifications for System: Auto Dish Washer YES ❑ NO ❑�' Auto WasFi Ma shine----YES O'�"NO pOH v1 Type Water Supply' *This permit Void if sewage system described belowis ndt installed within 5 years from date of issue. t This permit is subject to'revocation if site plans or the intended use change. ,4Al7 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 — moi i l C r n C " s Certificate of Completion ��-*'� Date ez 2 '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/IMPROVEMENTSn� Davie County Health Department �5 1�/ Environmental Health Section P. O. Box 665 DEC 1 81992 Mocksville, NC 27028 i 1. Application/Permit Requested By V 9 F G( �f— 1 Mailing Address � r7� ��r/�� /�1��t _/ >�i�5 Uf I /U• �. v����J Home Phone___ � - PIS 99 Business Phone 2�29Z 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation peptic Tank Installation 4. System to Serve: OHouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing No. of People 2 ❑ Basement/No Plumbing No. of Bedrooms „� 2Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ,!� �X ' p ❑ 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 G?"Private ❑ Community 8. Property Dimensions 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 Jssued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October'1, 1989. Directions to Property: /�?�2 l�e�v e - % i-Y► 1 e o ry /`te t . old /O�X/-n � dam /5T 6/Ye ;000J v ill to �Pi� l'>`rt J ll b�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. DATE IGNA E CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 53 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 County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. �;� - DATE SIGN UFS DCHD(12-90) ` PIf � APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section i P.O. Box 665 /( Mocksville, NC 27028 it '�i `Z b 1997 - ———— - -- 1. Application/Permit Requested — - Mailing B Address C � w D s� + OC Home Phone Cry - — 7 7 Business Phon 2. Name on Permit if Different than Above ,ter 3. Application/Permit for: General Evaluation 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 # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathroomsy ❑ Dishwasher Dwelling Dimensions ❑ 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 /f Private ❑ Community 8. Property Dimensions �y l� /'TGI��� 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: Ogr AIZ, I,--71dll e t � This is to certify that the information provided is correct to the best of my krpwledge, nd I ndersta d I am responsible for all charges incurred from this application. L/ _ /D zt _cl� DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: ❑ 1. 1 OWN the property. J 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 avie tQnty ealth Department to enter upon above described cated in Davie County and owned by ,n e v'/(nom/ �S all testing procedures as necessary to determine id site�itability for and absorption sewage treatment al system. �M DATE SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section i Soil/Site`.Evaluation NAME _ ,/� 1/ C` DATE EVALUATED xv 92 ADDRESS PROPERTY SIZE &V�fic PROPOSED FACIILTY LOCATION OF SITE lzl�e- /1G/1ry 4 Water Supply: On-Site Well �_ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH J-1 1_ Texture group C Consistence 0_ Structure Jil .S/l e f Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S77 LONG-TERM ACCEPTANCE RATE , i , c SITE CLASSIFICATION: EVALUATED BY: LANG-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 ■■■■■■■■■■e.■.■.■■■ri■rice■b■■■t■■■■■■■■■■■■■■■■■■■e■.■.■■■■■■■■ ■■■ ■■.■■■■■.■■■■c■■c■■r�cececr�.■■r�.■ ■■■■■■■■■s■■■■■■■■■■■■■■■■■■_■■■ ■■■■■■■■e■■.■■.■■■e�c■■■�c■.■e..■■...■■■..►..■■■■n.c■■■■■ecce■■■■■■■ ■■■.■e■.■■■■■■■■.■■■■■■■■c■.■even■■■.e■.■e.■.■■■■■■cee■■■■c■■■..■■ ■■■■■■.■■■t■■■■■■■■■■■.■■■.■■■r.1e■■.■■■■e■■■.■■■■■■■■■■■■■■■■■NOON i■iiii�iiii■ii�iiiiii�iiii.■iiii iiiiiiMEMMENEMEMEM"iiiiii ...............................i■■e.■.....■....■�■.■■■.....■.....■■■ ...............................r................ ■■■■■.■■■■■■■■■c■■ :C: ........�. .. .... ....... ............................................................. .... ...........■..................c■■ee■■Oce■■■■■■■�c■■.■■uc■�r■■■■.■.�■ ::::::: ::: ■..■■■■■■e■■■■■■■■■..e■■■■■■■■■■ ■.NOON■ ■■■■■■■e■■■■■■■■■■■ ■■■■ ■■.■■■■■■■■■.■■■■■■■■■■■■■■■■■■■' ■■■■■■■_.■■■■■■e■■■.■.■■■■■■■■■■ .................... ■■n■■.■tl■It ■...........................■... ■■■..■■■■■■.■.................l■ .i3................................ ■e...■e■.■ee.e■e■■Nee■ecce■■e��eeeee■e■eeeeeee.■e■■■■e■ee.eee■■■e■■ ■■■■■■■■■■■■■■■■■■■■■■SCO.■O■■■e■■■■■■■i■■■■■■■■■■■■■■■■■■■■■■■■■■ ii. Davie County Yleakk 7yen artment and .dome Nealt§ cy 210 HOSPITAL STREET/P.O. BOX 885 MOCKSVILLE.N.C. 27028 PHONE:(704)834.5985 November 9, 1992 Tommy & Brenda Guye Howard Realty Attn: Red Foust 330 S. Salisbury St. Mocksville, NC 27028 Re: Site Evaluation Off Mr. Henry Road/10 1/2 acres Dear M/M Guye As requested, a representative from this office visited the aforementioned site on November 3, 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