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242 Rockhouse Rd �17,1 DAVIE COUNTY HEALTH DEPARTMENT ,- JIMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION * OTE:Issued in Compliance With Article I I of G.S.Chapter 130a --- Sanitary'Sewage Systems Permi t Number Name /�(l P/�� oa � �l'�t2'1��&/�_L5 Date ` N2 1 6 I C: Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home �~'"� Business ,— Industry No. Bedrooms s No.Baths — - No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer. YES NO El Auto Wash Ma.hine YES LJ NO ❑ ���n� V F��7 Type Water Supply — I.UP *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. 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., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by \ /5 -O 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. ri ATION FOR SITE EVALUATION/IMPROVEMENTS. PERMIT NOW Davie County Health Department / D Environmental Health Section P �-C 7 �U 4 3 l lr"i. P. O. Box 665 n � Mocksville, N.C. 27028 ►v�E�� _ CONSTRUCT, N SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 7(D 1. Permit Requested B m(6- .JALEL Business Phone 2. Address AN K0&& AIVU16' 0 t--! V/ 6 3. Property Owner if Different than Above __n 1p,' w �N ski Address 4. Permit To: a) Install Z Alter Repair ftw#L b) Privy Conventional Other Type c&l ri00A_Z)/LGt/ be Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home ✓ Business CR if(Y Industry Other b) Number of people 6. ar If house or mobile home, state size of home and number of rooms. House Dimensions f. 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 disposal lavatory showers '� washing machine dishwasher '� sinks // 8. a) Type water supply: Public Private.Z Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 3q .15 ACAS 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? This is to certify that the information is oto the best of my knowledge. .(�- 0- c� 1-f OJJIC_�' Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: Vf 4 *% FA-/"ifN b"o enyir -- L zriT -m t g, Lerr o1v 1� Ki6�-r vAl Vag 1419 copb � Klof o" � uc, 4&btr� 20 41 NV � © DCHD(6.82) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation NAME �/I�i�l�//� DATE EVALUATED �11>21A410"" ADDRESS PROPERTY SIZE �y/� � Ile Icam / PROPOSED FACIILTY ���' LOCATION OF SITE Ce leU 'P lej Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L .4- Slope Z ---SloeZ a HORIZON I DEPTH 62 �• '' �� Texture group Consistence Structure Mineralogy HORIZON II DEPTH S''' -?4' Texture group ell- Consistence f'� Structure Mineralogy 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: EVALUATED BY: A if LONG-TERM ACCEPTANCE R T 02 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 :lay 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 Mineralosty 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 ■..■■■ii■■■i■ii■/■■/i■■■■i■■/■■■�■■■■■■■ii■l■iii■i.i.li.i■ll■■ii■ ■■■■■/.■.■■.■/■■■■■/■■■ll■■■■t■ll■l■■lll.■ll■.■/■ill..■ll■■■l/■ll■ ■■■■■■■■■iii■■ii■i■■■■■■■■■■.i■.■■■■i■ii■i.i■■i...■■iii....ii■.i■■ ■■■■■/■■■■■■■■■■■■■■■■ill■■■ll/l■■■■i..i.iii/■iii.■i..i■ii.■i■■■■■ ■■■■■i■li■■■■l■/■./lll■■■■■■l/■■■■■l■i.i■■i.i.i■■iii■...■■..■..■. ■.■■lil.ii■.l■■■/■■■■li.■■l■Bill/i ■■i■ll■i...■iiiii.i...ii...■iii■ ■l/i.■iii■i■ilii■■■ilii■■■■i..■i�■■i.11■i■■..■.........■....■..i■ ■.■■■i.■■i.■i■i.■lli...■■■■■ii■■■■■■.■■ii...■..■..■..■.....■.■■.■. ■■..■.....■....i■■■i■.i■ii■■i.■iii.■■■.i■ ■i.■....■.■.. ..■..■ MINE ■■■.■.■..■.■■..■■■...■...■.■..■...■■...■�....■■■■■.■■■...■.■. .■ ■■■....i..i....i■i■i■■■■■■./.i■i■■■■i■..ii■..■.iii..■ii.■■.i■ii..■ ■■■.■lll■ll■l■.l/i■i.11l■.■.iii■ ■■..■..■...■..■..■..■■■■.■■.■■.■ ■■■■■iii.■■..■■■i.i■■i..■■./i..■■■ii■■■■■■■■.i..i..■■..■.■...■■..■ ■■■.■i..■■..■/i.iiiiii.■■il■■...■ill.■l7".�w■■■i.ii..�./.i..■■..ii■■ ■■■■■i.i.......i....ii■■/i.■i■/■■■ ■i■Bi/■i■.ii.N..i......i....■■� ■■■.i■i■ll.■■/■.i■l■■/l■■ll/l■■■ ■■ll■l■il ill■.l.■i■■■i./■■i ■i■ ■■i.■i■i■iii..■i■.iii■■.■ii.■■il�■i■...i..�..■■.■i■.i.■■i.ii■■■i■ ■.i■■iii.■/■.■..■i.l■i■l■ll■ll■ll.lill■■l/.■il■.i■ i/../i■l.il■i�. ............■...............��....................■...........■■.■o ■■i..■....wii■.ii■..i...■i.Bt11■i. .....i.ii..■...u...i.......i..■ ■■ii..■■■■■i.■■■■■il■■■i■l�l��!!��=:it/l■l■��I■.■i■i■ ■■/. ■■■l■.■ ■.....■...■..■....■■..i.11..■...i■.....■. ...tl./N.....i..i....ii.■ ■�=iiiiiii.�iiiuii�iiiii'�iiiiitti�iiiiiii�i �ii�iiiiii■�=iiiiii� ■■■■■■■■■...■i..i./.■■i■11��■■ll/■••��C �....mummo■ ■ ..■■■.■.■.■.■■ ::::::MUMMM::::::::mmomm: mmmumm::mmomm mall mm m ME MMUM:::I ...■■■./■.i...l.i.■.■.i■i■■.■■■.i1.■■.U■...■... ....■..■u.. ■..i ■■.■■■■■■.■■■...■.■■....■.■..■.■■■■■..m.■■■.■ttt � ■.■.■■■■■■.�i■■■ ■.■..■i....■.ii■.0■....i.■■.■..■■.... .N. .. ■uN..M■■■... ■ ■......■■■.■.■..■■.■.■u.........■■_..■..■.■ ■ .. ....... ......�. i.i.i■i.�...i..�...i.i■�...ii■i.i.i■i.iii■i!1■i.i■i.i.�...■i.i■i.ii■�i.i.iia..■�i�Bii■■ i�ii�i . iiiii N■/■ i■■■■■.■.■■■ ■i.iii./.■.■..i..■■..■7■■■■.■■■i�■....N.■.. ■....i...■■/.... 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BOX 665 MOCKSVILLE. N.C. 27028 PHONE:(704)634.5985 June 22, 1994 Mr. & Mrs. Del Welch 241 Piccadilly Dr. Winston—Salem, NC 27104 Re: Site Evaluation Rock House Road/39.75 Acres Dear Mr. & Mrs. Welch: As requested, a representative from this office visited the aforementioned site on June 21, 1994. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on—site sewage disposal 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