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221 Redfield Rd DAVIE COUNTY HEALTH DEPARTMENT ,t+ to IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ��a *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a - $anitary Sewage Systems Permit Number Name � �— Date 07 / 6761 . Location ,., rj''�,•, � Subdivision Name Lot No. Sec. or Block No. Lot Size House 1/, Mobile Home _ Business -- Speculation No. Bedrooms —.No. Baths No. in Family?— Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES NO ❑ ,.� Auto Wash Ma.hine YES [ NO ❑ .i�� /�' $ �� 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 revocation if site plans or the intended use change. f. Improvements permit by _ ZZ *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 0 . ! Ms ADf GitF� OVA• !IC'1,,�s -"" �� is1,711 Q f - ' Certificate of Completion ,A// Date /`a *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 betaken as a guarantee that the system will function satisfactorily for any given period of time. ~" APPLICATION FOR _,SITE EVALUATION/IMPROVEMENTS PERMIT P Davie County Health Department � ' ��0pN ti�� Environmental Health SectionCE�VED ,UH P. 0. Box 665 .___Mocksville, NC 27028 D 1 . Application/Permit Requested By Mailing Address -17,J7Z ey a-s, Home Phone Business Phone --� 2. Name on. Permit if Different than Above c 3. Property Owner if Different than Above 4. Application/Permit For: ld General Evaluation S/Tank Installation 5. System to Serve: House 71 Mobile Home 0 Business L Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms - Basement/Plumbing No. of Bathrooms 4. Basement/No Plumbing 0 Washing Machine rj Dishwasher 0 Garbage Disposal 7. If business, industry, 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 S. Type of water supply: 0 Public Private Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes jw' No If yes, what type? a *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. 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 V Signature Directions to Property : -rw.-44 411 zqii�- ✓4 HD-- _ bAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME f .� DATE EVALUATED ADDRESS 17 PROPERTY SIZE .5.� PROPOSED FACIILTY LOCATION OF SITE ; Water Supply: On-Site Well !/ Community Public Evaluation By: Auger Boring f/• Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH -^ Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupL' C° Consistence v- Structure Mineralogy 41 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 / SITE CLASSIFICATION: AC 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-Firrn 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 ■■.■■■■■■■.■■■■■■M■■!■..■■■■■.■■■■■■■■.■..■e...eee.■■e...■ ■■■Neu ■■■■.■■■w■■■■....■www.■■■■■■■■■■■■■■■.ww.ww..■.■■■.■■■■■..■■.■.w■ ■.■NEMS■■■ie.....■■...■■.e■ ■...■■■■..■■.■■..■■■■■■■■■.Mee..ei■■■■ iiiiiiiiiii�iiiiiiiiiiiiiiiiiii�iiiiiiiiiiiiiiiiiiiiiiiiiiiiii�l■iii ■■■E■e■■■■.\!:'1■■■■e...■.■■■ee....aNOON■■N■■■...■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■..■SNE■■!■■e..■■■..■MS■■■■■■■■■■■■SMS■■■■■■.■■■■■■■■■■■■ ■■■■...■■.■.■■■■■■..■...MN■■■■■ e■■■■■■■■■■■Nee■.E.e■■■■■■■■■■■■ ■■■■■■■■■■■■■■EEM■■■■E■■■■■■■.ME..■■■■■■■■■■■■■■■■■■■■■eeM■■E■■■M■� ■■...■tis!%■e■■■■■■■■■■■...■.■....e■ ■...NOON■■N■■eN■■■■■■■■■S■ENO■ ■■■■■■■N■■....■■■n■.■■■■!■■■■■■�■■■■■w.■■...■w.■■....■■■■.ie ■■E ■.■�.■..■■■■■a■■■■■.eee.■■.e.■■■■■■.■.M■■■■■.■■■EM.e■■■■N■■.■■ee■■ ■■■��.■■■■E.■■E■■ME.M■e■■■■ENM■eee■■■■■.■■e■■■■■Me■■■■■NM■■■■■N■■■ ■■N■YI�E.■■EM■E■e■■■■■ESE■■..■■■■■ME■■■■■■■■■■e■■■■.■■■ES■■■■■■■■■■ ■■e■■►l..■■■■...e.■■■...ee�111/■..■e�e.■.■■■i...■■e.ee■■■..e■■■■i■..■ ■■■■ES■SN■■E■■■■■■■■■■%■■■eE■■e■M■■■■E■■■e■■ME■■■e■■■■■■■■■■■■NONE MEMEMNMMMeMM MMMMMm m■iiiiMEMMMEMMEMEME MENNEN ■■■■.■e.►.e■a■....E��.■..■■...e. 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BOX 665 MOCKSVILLE,N.C. 27028 PHONE:(704)634-5985 July 26, 1990 Mr. Wilburn Spillman' Rt. 2, Box 402 Mocksville, NC 27028 Re: Site Evaluation Roy R. West —Buyer Spillman Road Dear Mr. Spillman: On July 24, 1990, as you requested a representative from this office visited the above mentioned site. The soil 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 ,Yo �. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM RECEE Davie County Health Department 0 V lµ' Environmental Health Section P. O. Box 665 _ APR 2 41992 Mocksville, NC 27028_ wCr ` 1 �� Sl CiL ��O�LY1u 1. Application/hermit Requested By /g9ll F 3essiG'), &,5:-- ?/off Mailing Address 101; aw 1AJ 5et^Ilu e-1-fi e- d 7.3 Home Phone 9191 643'3015,.<- Business Phone G e/.3'9�y Y 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation EriTeptic Tank Installation 4. System to Serve:. C'House ❑ 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 3 LRIWashing Machine No. of Bathrooms 7- B'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 R-Private ❑ Community 8. Property Dimensions V4 A+ Y e,00 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 0'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: Nay Al. 4,) S'fJ)//MA�✓ �'ww Q+� d� ��''""� e"� foie,•/ /e P- ..✓ ke.d-C4/d Ad, ..f de,#W 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 appli ation. �I 7�. DATE SIGNA RE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 8-2: I 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 f the Davie County Health Department to enter upon above described property located in Davie County and owned by�Otl llJ0.t to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal sys m. -1� DATE SI RE DCHD(12.90) V