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1571 Cherry Hill Rd S ' x= DAVIE COUNTY HEALTH DE PARTM Id V IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number6.jq q6 Name �� - � \ �i ;(_�— Date �� No 8 0 5?` N .. s, y Location 'got - Subdivision Name Lot No. - Sec. or Block No. Lot Size House — Mobile Home —�—_ Business -- Industry t n z fly --% — Public Assembly Other r O o < D T N = 0 < Specifications for System: a d , M omaZ .,L � o '° ' = Z --- MM r) of installed within 5 years from date of issue. 2 tended use change �c OQ O 0 n r7'I a WO EE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS • Ty� � u r W _N o In �� r 0 0 cnn > p nn ' ❑❑❑❑ p ' coo�Z C3 C."m aoc3�, O �mc'�_ Mr- -M r —=-icy N .� Cm C n A M ort a lmm r� �t mM;0 0 11 Om n .Q Cm f m,i ems+ rt W M C3 N 0 M ' �� `""� � e EDS \ Improvements permit by r C) c:-.. - � � ent for final inspection of this system between 8:30-9:30 A.M., - - - one Number: 704-634.5985. a ©' nio rr System Installed by O n T o� r'r7 e. W 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. J • ,- ' APPLICATION FOR SITE EVALUATION/IMPROVEM NTS S 3� a Davie County Health Department Environmental Health Section uA P. O. Box 665 MAY 19 5`11(4 ksville, NC 028 Moc\-.0��27Q •� 1 �'u„O;J.,EF3t �R �s.ts�ttt 1. Application/Permit Requested B ce-e D ,• m01 /� Mailing Address /0c) a�no y- w` Home Phon o216 1 q Business Pho �� 2. Name on Permit if Different than Above 3. Application for: J2Teneral Evaluation ❑Septic Tank Installation Permit 4. System to Serve: ❑ House C9'Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms 2'• ❑ Dishwasher Dwelling Dimensions 70 ❑ 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: C( Public P�— ❑ Private ❑ Community 8. Property Dimensions I� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of th acility this sytem is intended to serve? ❑ Yes ❑ 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: YD � 400 T n J This is to certify that the information provided is correct to the best of my knowledge, and I ynderstand I am responsible for all charges incurred from this apoe9tion. K=18 DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 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 representative of the Davie Co myHeh Qgpartment to enter upon above described property located in Davie County and owned by S''f q r ee, Z) 1. l n a N to conduct all testing procedures as necessary to determine said site's suitab'ity for a ground absorption sewage treatment and disposal system. R DA E tl SIGNATURE DCHD(1193) woo Kocdd -. ----------------- l!J n 15 4 � � •r t M N' nn Al `l O 1 0 i.. 07 r��f cn �n N 4 r ' DAVIE COUNTY HEALTH DEPARTMENT � 3 : Environmental Health Section Soil/Site Evaluation r NAME (J��G DATE EVALUATED ADDRESS S P'�� PROPERTY SIZE PROPOSED FACIILTY �� LOCATION OF SITE Water Supply: On-Site Well _ Community Public Evaluation By:t"-,1_Auger Boring `� Pit Cut FACTORS 1 2 3 4 Landscape position "-7 Slope Z CAX a' HORIZON I DEPTH l' t' Texture group 1Z,L. L Consistence Z Structure C t2 Mineralogy HORIZON II DEPTH Texture group C Consistence IF T. Structure K Mineralogy '.� HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS RESTRICTIVE HORIZON SAPROLITE — — CLASSIFICATION V► ,,S LONG-TERM ACCEPTANCE RATE y SITE CLASSIFICATION: •� EVALUATED BY: LONG-TERM ACCEPTANCE RATE: H OTHER(S) PRESEN wo A REMARKS: "A !�"JA �s 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-Ve.-y 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 5C-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/fu DCHD(01-901 ■sttttMM■■■M■■M■■t■t■■■■■■ttt■■Mt.■■tttMMMMM./Mt.■■..■.■Mt...ttt.■ ■■■.■M■tMM■■MMMMM■■MM■■■■■MMt.■■■.■NNN..e■ OMEN mom ■t■...■■■■.■■ ■MEMO■t....■■MMM■Mt■■...■MM■MMM. ■■...■..........■ ■...■.■..■■..■ SEE IN MINE EEiiiiiiiiiiiiiiiEEEEEEEEEE'EEEE■■EEEEEEEEEEEE.'EEEE'EE'.E'EEEEEEEE ■....■■..........■...........................■■..Emom MEMEMMEN ME ■■.... ...■■...E ■..■■■...........■..■......■..■ ■■■■■■■EEEEE■■■..■■■EEEMES■NEEE■ EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE:EHEE:EEE■E■E■EEE:EEEEMEMO ■...■.N.N.ENNNN....N.E...........■ ■E■.■N..EN..N....N■.E■ /.EM■MEMEMEMENE EMEN EEE ......................u.......................■■OMEN E■■■E■■E EE ...EE ■.■.■...N./.MM.■...■..■■MtMMMEMMM...■...MNMN/.■ NNE. 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 June 14, 1995 Stacee D. Spillman P. 0. Box 738 Cooleemee, NC 27014 Re: 2 Site Evaluations/Sites 1 b 3 Cherry Hill b Boxwood Roads Dear Ms. Spillman: As requested, a representative from this office visited the aforementioned sites on May 31, 1995. Based upon the information provided on the application(s) for site evaluations and after the evaluations vere completed, tvo sites vere found to be provisionally suitable for the installation of an on-site sevage disposal system on each site. If you have any questions, please feel free to contact this office. Sincerely, Charles E. Little, R.S. Environmental Health Section CL/wd Enclosure(s)