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686 Ollie Harkey Rd "".Y "sr �, `4" Rcte�,' �t�i r��"#'::�"v- ^;tr ..'.d' i• ➢ i .a•-.. at ..... - .1;."z-. � �... r.� 000W.- ' DAVIE COUNTY HEALTH DEPARTMENT •6 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 13pa/, Sanitary Sewage SystemsP&A-17i d,/U�- Permit Number Name—r�LL / ort i'�1 17Y1 Jj %"/1�� N0 6 H 7 .�.®i�i'� r,- <' Date Location .� e -;7, r�i7 �—' /�iy,�� r I Subdivision Name Lot No. Sec. or Block No. Lot Size — House Mobile Home — Business Speculation i No. Bedrooms No. Baths — No. in Family _ Garbage Disposal YES ❑ NO d Specifications for System: Auto Dish Washer YES NO ❑ , ' Auto Wash Ma shine YES LJ NO ❑ Aodd��" ' ��IOI3', V ' Type Water Supply ol � i *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. i Ac on . 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 Dlr�' r O Certi� ate of C pletion Date "The signing of this certificate shy indica that t e'system described above has been installed in compliance with the standards set forth in the abdve rgg�I tiorY;. shall in NO way be taken as a guarantee that the system will function satisfactorily for any given pePod of fi e. 4 r� �r APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER ` ,J Davie County Health Department "I Environmental Health Section P. O. Box 665 Mocksville, NC 27028 2 2 1. Application/Permit Requested By - R� Cil 'i I HEAE�K pEpT. Mailing Address aQ n N\ C Home Phone �91�_�k'71S - C. Business Phone 0 1c1 OS5 -,DI PO 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluua ion CEJ Septic Tank Installation 4. System to Serve: ❑ Hous ❑ Mobile Home ❑ Place of Public Assembly 70 LATeP- i„uiLo HCU64- ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision rA Section Lot # ❑ Basement/Plumbing No. of People a ❑❑/Ba'sement/No Plumbing No. of Bedrooms 3 p'Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions WVN2yA 1jou5c 1-,) `6u\LT APPeoX 1500 sQ ,=Ec7 ❑ 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: El Public Ei Private ❑ Community 8. Property Dimensions __ B YL4 Sewage Disposal Contractor U N(�N10k)t,-' 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 22 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. Tv `�G`1CN '�=jeoP�scO Directions to Property: T2A �c 2 61 TC : ENT-CL L TRKE COO (No2Ty� vu-r Of /YJvcKswLec , Ncic,HEVQoS DQ»cl CrO 70 oma LoGOia` RPfMZ. (C6n4 QRWC 0OwtJ ( PIWIC rWC, rmpxt cr-6 TUQnI. LEFT ptil Ur3C2TY CN URL!} Z17. 60 APKO- Mo yma PINK rLAG wiLL ac TufU4 LES=T CN '3C�R L`2CCr- (ZHUPO-r! �. r"AQKcn ON L�-r. ,�dPosco.� Nei(,n?OCh � ��o PoSc D TRA i�C 2 T11�+�1 W6(�T ON i3t-AI RNQr'R�L/�l � GDTD SZ�P SIGnI, Taa,��q, 4r,�cv,�s�n- SATE �� RPPe�7. Lob fcc7 L�ERInI4 -M/at,] LEFT C>14DLuE NI92Kc'Y. (0�N 1 1.000 �2DPOscO 1WPPcRTY 1S R PPPOK Y8 of A All LE oN acuoeva� c` t"�LtrP,s£s couiac r 6A24 CuRitio �F i�ays�e+.c* ro LISTtQ u�QtQ CE�.1-�Y o2l '��AL'('Y, mem w�+E+.c 7csr �s t�CRR� 0 1 .a$o This is to certify that the information provided is correct to the best of y knowle e, d I understand I am responsible for all charges incurred from this application. V I -Q C) I 9,L ATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 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: 1 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 s'e's suitabilit or gro nd absorption sewage treatment and dispo al syst m. 2v DATE SIGNATURE S !PLTb u T C !V DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �� DATE EVALUATED ADDRESS PROPERTY SIZE (/ . PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well 1/ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH r" t ` 410.4- . Texture �. Texture group112 e- Consistence Structure -C S' .e S Mineralogy ,'I 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 ,D I 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-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 OMEN E:::::::::::::� ■.■■■■■H■■■■t.■■■■■■■■■■■/■ ■■■ ■t■■■11■■■�r■■■■■■■■■■■■■■■■■■ t■■ ■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■era■!■■■■■■■tet■■■■■■■■■■■e■■■■■■■ ■■ss■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ear■■■■■■■�■•a■■■■■■■■■■■■■■■■■■■■ ■■■.■■■■■■■■.■■■■■■■■■■eery■■.■t■�■r�■■■■■■■r■c�■■■■.■■■t■■■..■..■■■ .■■■tt■e■■■■■■■■■■cert■■■■■■e■■■��r■■■■■■■■■e■t■t■■■a■■e■■■■■■■■■■ ■■■■■■■■■■■■■■elft.■■■■■■■■■■■■■�■►�■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ iiiiiiiiiiiiEmmums ■Eiiii0iiiiiiiiiiiiiiiii ■■■■■■■■■■■■■■■■■t■■■te■■■■sir■■■■■■■■te■■■■■■■e■■■■■e■■■■■■■t■■■■ ■■■■■■■■■■..t■■■■■■■eel■■■■��■■■■e■■■■■■■■■■■■■■■u■■■■■■■■■■■■■■ ■■■■■■■■■■see■■■■■■■■■te■lett■■■■e■■■e■■■■■■■■ee■■■�■■■■■■■■.e.■■■ .■..............................it::C :::CC:C:::.::■::::.::::::. ■■■■■■■■■■tit■■■■■.■■■■.■■■■.■■..■■■■t■■■■t■■■■■■■t■■■.t�■■■■■■■■_ ■■■■■■■■ ■■■ ■■ ■■■■.■■■■.■■.■ttt■.a■t■■■■te.■■■ ■.■■■t■ ■■tt.�ae■e■■■t■■■■■ ■t■■ ■■■■■■■.■.■■■■■■■■II■■■■■■t■■.■■■ ■■■■■■■�■■■■■t\e■■■■■■■■■■■■■■■■ ■.■■■■■■■■■■■■■■■ri■t■■■e■■■..e■e■�R■■■■rte■■■■■■■r�■■■■e■■■■■■■■■■■ ■■.■e■■nee■■■■ee■■■■.■■■■■tnrr�y�e■��■■■et■■■ee■■■�r■■■■■■■.■■■■■■t■ ■■■■■■■eel■■■��e■■■■■■■e■■■■■e■■e■■■■■■■■e■t■■■■■■.■■■■■■■■■■.e...■ ■■■■■■■■■■■e■r�ee■■■e■ee■■■■■■■■e■■■■■■■■■■■e■■■e■■.■■.e.e■e■■ee■e■ • Dade County Jfealtli De artment and .moo e .�l�altli Aen m e y cy 210 HOSPITAL STREET I P.O.BOX 885 MOCKSVILLE.N.C. 27028 PHONE:(704)834-5985 July 29, 1992 Gary Curtis Rt. 1, Box 270 Randleman, NC 27317 Re: Site Evaluation 011ie Harkey Road — 48 3/4 Acres Dear Mr. Curtis: As requested, a representative from this office visited the aforementioned site on July 24, 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