130 Hwy 801S{
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DAVIE COUNTY HEALTH DEPARTMENT ✓�=-
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issped in Compliance With Article 11 of G.S. Chapter 130a -,
Sanitary Sewage Syste s Permit Number
Name � %y Date �L -�9- �-� NO 1 7 3 1 9
57
ci '//cam
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Or& Mobile Home _ Business Industry
No. Bedrooms &Z/!! No. Baths No. in Family__ Public Assembly Other
Garbage Disposal YES p NO
Specifications .for System:
Auto Dish Washer YES ❑ NO
Auto Wash Ma,hine YES p NO
Type Water Supply
*This permit Void if sewage systedesc ibed below is not installed within 5 years from date of issue.
This permit is subject to revocati n if s t
This permit is subject to revocatfinplans or the intended use change. ^,
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i
9
Improvements ermit b
P Y
*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
QyF�1--- -0-
F r
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 -;ND way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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a DAVIE .COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NO-E.Jed-in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Syste s Permit Number
Name Irl t W
•'i�c%' DatLL N2 7379
Location 1 %�aO
Subdivisidn Name f-� tot No. Sec. or Block No.
Lot Size House Or—&f Mobile Home Business Industry
No. Bedrooms viI—Z�No. Baths No. in Family — Public Assembly Other
W-.
Garbage Disposal YES ❑ NO
Specifications for System: �.
Auto Dish Washer YES ❑ NO _ sl
Auto Wash Ma;hine YES ❑ NO
Type Water Supply — �� ---- /DOI��aY
'This permit Void if sewage systemdesc ibed below is not installed within 5 years from date of issue.
This permit is subject to revocati n if s t plans or the intended use change.
P 1
��
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 ttzt'� ?L-
lip
k,
Certif cate 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 periddl bf time.
t
.l
4
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 ttzt'� ?L-
lip
k,
Certif cate 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 periddl bf time.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
v
ADDRESS a.? SUBDIVISION NAME
LOT
DIRECTIONS TO SITE /S - X-7- eV,11 " / E6&/ 'o) -
DATE SYSTEM INSTALLED E2 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY < iy SPECIFY PROBLEM OCCURRING'
DATE REQUESTED ��<�'�./Q� INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI
Davie County Health Department REMOVE
Environmental Health Section
P. O. Box 665 SEP - 7 193
Mocksville, NC 27028
---------------
Application/Permit Requested By L 3 T r `f D • Car be //
Mailing Address
q 734. 3 13a -)C St17 /"!ac/►s✓•'//e /(/. C- 4-2
Home Phone Business Phone 1198
2. Name on Permit if Different than Above
3. Application/Permit for:
4. System to Serve: ❑ House
2"Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
Er-G-eneral Evaluation
❑ Mobile Home
❑ Other
❑ Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served y °7'�"` 07E� No. of Sinks
No. of Commodes S No. of Urinals 0
No. of Lavatories 0 S
No. of Showers
No. of Water Coolers 0
Water Usage Figures /ham her s A•P u s es 17,i `vH per 14f- Pv/4
7. Type of water supply: 2"Public star S�'tdts ❑ Private
4" C.-
8. Property Dimensions 5-1/a 8.9 , /20 -1*7 , 2 Sewage Disposal Contractoi
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Yes Erle o
❑ Community
'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:G4. &Wy 8,0 / "- /. & — 1-/% /ISdate " 0W 8a/ -S,-� , 60 x,
=,1v`S� uNI�oN %3aN�
Pe 11-d
A
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.
, /993
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: [91' I 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:
I hereby give consent to the authorized representa 've of the vie o my Health epartment to enter upon above described
property located in Davie County and owned by. a.,�,
to conduct all testing procedures as necessaryto d6Wrmine said site's s itability for a ground absorption sewage treatment
and disposal system.
a
1/ 9 93 a -`'I CO) l' �
DATE SIGNATURE
DCHD (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED � y/ 4o
PROPERTY SIZE F✓ a
LOCATION OF SITE /,�_9 " l
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1
2
3
4
Landscape position
G
Sloe % -�
HORIZON I DEPTH G
Texture group
11-2
1,./—
Consistence
Structure
Mineralogy
HORIZON II DEPTH
-W f
_VP
Texture group
C
Consistence
Irl
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: �'-s EVALUATED BY: ,14� &
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
DCHD(01-901
OTHER(S) PRESENT:
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
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
Mi neraloey
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
' Davie County Aealtlr Department
and .lame Nealtli� .1yen
cy
210 HOSPITAL STREET/ P.O. Box 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634.5985
September 24, 1993
Larry Campbell
Rt. 3, Box 507
Mocksville, NC 27028
Re: Site Evaluation/Highway 801N.
Barber Shop & Office Complex
Dear Mr. Campbell:
This office has evaluated a tract of land at your request on Spetember 16,
1993, to determine the soil/site suitability of installing a septic tank system
to serve a barber shop and office complex.
Based on the soil conditions that exist on said site, this office
classifies this site provisionally suitable provided that a 120 -foot X 70 -foot
area on the back portion is made available for the installation of the proposed
system. This would ensure enough space for the initial installation and repair
space.
If you have any questions, feel free to call.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure
cc: Jesse Boyce