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301 Ollie Harkey Rd ; ` DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name�J Yir;,}�ir�i>`� Date1 {.74 7 Y4 v -36 Location �o��r/— �.� G�[,�. �!. j�c�° _ % /�« �-t �'f«.� c Subdivision Name Lot No. Sec. or Block No. Lot Size 4 House L/i Mobile Home Business Speculation No. Bedrooms �� No. Baths No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications fpr System: Auto Dish Washer YES ❑ NO ❑ / % —! - Auto Wash Machine YES ❑ NO ❑ Type Water Supply ��• � �- *This permit Void if sewage system described below is not installed within 36 months from date of issue. 1 PJ (1 I)( 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 �� 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. • t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 �jj SOIL/SITE EVALUATION /'s�� , Name ,�� i'�� Date Address Lot Size 1� 9 FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position ; S S �U C PSS U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) P S PS U � 3) Soil Structure (12-36 in.) S j S S S Clayey Soils ;P PSPS U U U U 4) Soil Depth (inches) S I S S S PS, P P U 5) Soil Drainage: Internal S S S S PS PS UD External - S PS PS ' 6) Restrictive Horizons 7) Available Space S C- S S 8) Other (Specify) S S S S PS i PS PS PS U ; U U U 9) Site Classification U—UNSUITABLE S—SUITTAABLE SPS'–Provisionally Suitable Recommendations/Comments: Described by Title Date SITE DIAGRAMt I a � P r DCHD(6-82) i pubic gauntg pealth Pepaitment anb cIImP Ptlltl� �l Pn ;g P. O. BOX 665 Aorksbille, �gortli Carolina 271128 OFFICE OF THE DIRECTOR TELEPHONE (7041 634.5985 December 21, 1983 Fred Troutman Route #3, Box 22B Hamptonville, North Carolina Mr. Troutman: On December 13, 1983 and again on December 20, 1983 this office evaluated a 6 acre tract of land on S.R. 1324 owned by you in order to determine it's suitability for installing a ground absorption sewage disposal and treatment system. Several soil borings were placed in the rear yard of your partially constructed house. These borings reveal a very shallow soil to saprolite or rotten rock from 12" to 24" from the ground surface. Based on soil depth and severe topography limitations, this office must classify the site unsuitable for any ground absorption system. There is a small area of provisionally suitable soil along the right property line and there is a possibility of installing a system in that area if the adjoining land owner will grant an easement and enough provisionally suit- able soil is available. In the event an easement can't be ob- tained this office recommends you contact Mr. Steve Mauney or Mr. Larry Anderson at the Environmental Management Commission at 8003 Silas Creek Parkway Ext. in Winston-Salem, N.C. phone 919 761 2351 in order to obtain a sand filter permit. If I can be of further assistance feel free to call this office. Sincerely, Robert B. Hall, Jr. R.S. jh APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 } CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. -� Home Phone,�/'�/1 ��J`f� 1. Permit Reque By Business Phone 2. Address 3. Property Owner if Different than Above Address 4. Permit To:a) Install Alter Repair b) Privy Conventional her Type Ground Absorption c) Sub-Division Sec Lot No 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms —Bath Rooms 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 water-using fixtures: commodes urinals garbage is lavatory showers washing miachine dishwasher sinks 8. a) Type water supply: Public Private— Community b) Has the water supply system been approved?Yes No 9. a) Property Dimensions 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? What type? c ' This is to certify that the information is correct to the best of my knowledge. i� Date Owner Signature •', WNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAW Allow 5 days for processing Direction!06 property s � Ile: r•, oaao(6-84 C, DAVIE COUNTY HhALTH ,DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE-OF COMPLETION `NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130.Article 130 Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name �'�,�l✓ �� 1r9� Date /,�� N2 3 4 3 6 Location Subdivision Name Lot No. — Sec. or Block No. LotSize House � Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES':E] NO E] Specifications fpr System: ` Auto Dish Washer ; YES p NO p Auto Wash Machine YES p NO 1] Type.Water Supply - d11Z_ _ 'This permit Void if sewage system described below is not installed within 36 months from.date of issue. El1 i Si S 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 I' 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. 17 , This is a-'-statement to certify that we give promission for the installing of septic tank, lines on .our property.,. r it a,� .� G�l��.+.'.• Date � I sEP` OFF�p Qat\0 .eC Seal h Goto��a 5I(ZOVO• Ny.C�0 o� Notaryl// Y��- f Bate "� 4 eX--- . i