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550 Rainbow 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 ( Tti '//�� '�' . //;� ar ,�,, , Date Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family : — Garbage Disposal YES ❑ NO pr Specifications for System- Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO ❑ Type Water Supplyiy *This permit Void if sewage system described below is not installed within 36 months from date of issue. ------------ r La h 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 -'`)'�'ZZE7i ,--`10' Certificate of Completion -� 1�- 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 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: A. Home Phone 914 -7.?y -_11(69 1. Permit Requested By 12L rn• K k M Business Phone _5 t9 -7-73-3q-i cj 2. Address 1Z. A4 '(I(RP&or4P, , (.jl N5TbN- SALFfNl- C, Al 107 3. Property Owner if Different than Above Address .4. Permit To: a) Install Alter Repair b) Privy Conventional-lef"6ther 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 :15 X (..S Bed Rooms_ Bath Rooms -9�- Den w/Closet b) If Business, Industry or Other, State: Number of persons seryed What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal d lavatory �"" showers washing machine 1 dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes NoL 9. a) Property Dimensions g0 0 1-7 g:tl, 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? N What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: -P .- DCHD(6-82) a 1 ° T�� �� t•r " 7 N 'HIM: 1'I d I �d t' 1 ron, 4,�.,-i (3) F' 1003.2 - 34t. ( Act }' U RR Ac,' z e 14.6,E : 35 28re 3b ♦a 3h Ac s32 n- (7 Ac) '•p,, N .N '-- N Y^'1'_ ,w4 > AC 21 0 s z 39 29T AC 293 1.4 AC 1 r^ Il1� r} a Ike+ —+► 3.17Ac 41, ^ 7 M N — 13.16 AC 90 Aac- („ (5:25 Ac) 15 As '' 16 em �' \��.in i'jl► ,r,•yv' 83.66 ACC ��,, qf1. A0) . .7} 0. � yeM `,x, r, x �' '' dl`•{']��r. I t, f =4 Yi` i., ��,� t. �\ `j'r•";, 'by" 0. av L r r �i� \fir• ,� 0 26 , (5.50 Act N N `1_'x'3.1,; �,i �� ,- -- . .. . � f� 1 � •1�1^ 1 i ri.50kw 9 62040 I (rk ) ,60 t f I +4,11 8.55 At, K ISQ3 � .. Ac) ------ 2r1 Ac) ( 11 Ac) v c�N In � i r I f � Y / Mf; n � o M 1� IV V ,1 118 Ac r '5 I - - - -- dA-ll_1 c - i, �. DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name— Date a���X l Address Lot Size l FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position SS S S &U , PS U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) S P PS U 3) Soil Structure (12-36 in.) S S S S Clayey Soils a ®PS PS U 4) Soil Depth (inches) S S S S PS PS P PS U U. 5) Soil Drainage: Internal S S S PS PS U External S (SS S S U Tf' S U 6) Restrictive Horizons �< 7) Available Space © S S PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification U-UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: O Described by Title Datelee �/ SITE DIAGRAM DCHD(6-82) • � p - + M11tE �Oun� EM.�� E MX�tttE1T#. ' lI2t� �OtItE �Ettlf� ��P2TL� P. O. BOX 665 cmarksbille, �qurth Carolina 27028 OFFICE OF THE DIRECTOR - - - TELEPHONE December 23, 1985 Foal 634.5985 Mr. Carl Kimel 1628 Paragon Dr. Winston Salem, NC 27107 Re: Soil/Site Evaluation - 17 acres Rainbow Road, Davie County Mr. Kimel: As per your request the aforementioned property was evaluated by a representative from this office on December 11, 1985. The soil conditions on this property ranged from unsuitable to provision- ally suitable; however, due to the amount of available space to install a sewage system the property has been classified as pro- visionally suitable. It must be noted that between the present time and the time in which you might start construction of your home, the site must remain unchanged. Furthermore, due to the soil conditions that are present, an oversized modified sewage system will be required. Please advise when you are ready to proceed with the issuance of the improvement permit. Sincerely, J e Mando, R. S. 9 Director, Environmental Health JM/sg