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170 Longleaf Pine Dr *�'h '�+YY�)'t`">�..y:1f1'1+=y,`wyx . �•!`6.t.{h. .. ., y - - :. L , _ ... .: _ � +'S itx�'1'./7 .r',•i31i+4i'Yr;-,+.. ti�p.v�rr i` ^'4�{ .rix.-�,-i r4,.i`r:. a ,s ., :y, r �4ii" 5 ti� }i z ^i, -:i4- ¢'s:�^j. DAVIE COUNTY HEALTH DEPARTMENT /00. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION •NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Syste\m`s q Permit Number Name�rV W . 1"1 '04 " d N _ Date, - �5 " ! N2 7 4 4 5 Location -7 4 1 VA 00 Subdivision'Name �(acoo �Q Comas bet-rdo. LCL +(j0 Sec. or Block No. Lot Size �• �- House I Mobile Home —T Business _— Industry No. Bedrooms "' No. Baths '3 _q;No. in Family Ll _— Pubic Assembly Other Garbage Disposal ;YES (El' ,NO ❑ Specifications for System.,/O0� Auto Dish Washer YES [V NO,,,❑�`i " ► yM. 4 1 L -`� s Auto Wash Ma;hine YES e NO D V� � "l>> gQy ''"~1 ,; �,,, - So\.a Type Water Supply 'ca' .�eS�- — ---- 5 cx"' k 3 ' x 12 ti Thisermit Void if;sebelow y p wage system descnbed beloww is not installed within 5 ears from date of issue. This permit is subject to revocation if4site plMs or the,intended use"change. n 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. I &, A r r Final Installation Diagram: System Installed by — .... 1 ` 1. . t 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. DAVIE COUNTY HEALTH DEPARTMENT y6 �vo IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION •NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage SystemsPermit Number Name 'o \n �A Date �. ! N2 7 4 4.5 Location rQ 'l�`�.v ' �. �C'v C� U 'P, 0 0 Subdivision Nameh `�uQ ���'�` L�tobio Sec. or Block No. Lot Size C'` House l/ Mobile Home _T Business -- Industry Nq._-Bedrooms . No. Baths " ,,No. in Family _— Public Assembly Other Garbage Disposal YES (y ;NO ❑ -- Specifications for System:,/ r Auto Dish Washer YES p' NO ❑' Auto Wash Ma;hire YES e NO ❑ C> C'.,r,l,�` -1 ( ,,_ 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 plan's or the intended use change. s Improvements permit by *Contact a representative of the Davie CoJrty 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 com*kron.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by — j 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: APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ' Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 FEB 91994 1. Application/Permit Requested By. $rer,'r DAVIE COUNTY HUI I f� �`` �T� Mailing Address -747 r3errK c4 f2,4 x- Home Phone qqg'- 032 Advok r. cP , AJC 7Z-70 oho Business Phone 2. Name on Permit if Different than Above , 3. Application for: ❑General Evaluation l`1 Septic Tank Installation Permit 4. System to Serve: VHO ouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision lkd-h&xoM f}Cites Section Imm" Lot # asement/Plumbing - -No.`of People ❑ Basement/No Plumbing No. of BedroomsI 2INashing Machine No. of Bathrooms 3 `"' 3 L"Qishwasher Dwelling Dimensions 70 ">G 56 &KGarbage 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: pd Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 14 ekWIVIO 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2�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: (51i� Er -r-0 13-4�L-rl v.�Z 2p. Sova-%�-ro j_,,V& C^-P PING O(2. 11 tO L_`h v,--c-) P--- lq-C f-Q5 o tie�� C-� A-PP.-ey,. � r\d e_ e5 (Jr.,jew 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 SIGNATURE CONSENT FOR SITE EVALUATION TO BED NE 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 County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. D/Ar E. SIGNATURE DCHD(11M I CLINTON CORNATZER _�-rrocr L °e: D.B. 65 PG. 401 1 (xr mro oo L)� - - ' 49 54 2 g g 97° 55, 21"E-... (265.62 total) - I A..�= S. 87° 35 21" F-� _ 890 24' 52" E + Q 't6g,8) 93.82 419.00 S 89° 24' 52" F-.- 323.5.CO S 89°25' 20"E Ir W $ 275.20 � .1 =� fiJ0 53 ni o 0 AREA= `t. 714 ACRES N o L� O AREA = 5.2,7 ACRES ogG 2so.00.TOTAL o S E AREA= 5.474 ACRES ` 60 EA,.EMEN7 � _ S 67-0 33� 2l"C' 8 _ �` � o ENO MEti7 . I 200.co - - --- _ _ (_�4 69 TOTAL) I EASEMENT I.D. EASE F 50 2'00.00 -_ Y 00- .-2.•• - � (60000 TG TAL) E h' _ _ 1 300.r0 i 7--�.�J 1;7>-SS 21••-Ijy.- I_ /-'� 0' (608 64 TOTAL) 230.00 TOTAL R f - - -� .. 8469_ _/.- 29?Ls_ - _- -!• 3U245 8� }� /�— N 870 55, 21" w 521 09 ELI o AREA=5.425 �`_'��L • ��a �<_aW1.E �TAREA-- � 5.392 A V'ACRES AREA= 5 20o ACRES Z - - u 1 z ° P •�,CRE AREA 6.594 ACRES \ I/ ° 8 39.25 150.77 266 88 N T-N 88°06'06"W a... N 8�' +�1: 482 25 °i o ON ( 250.00 TOTAL) ` •16 •V. _. S"e. �.' w• �_ 64 ? n Y 88° 21 26 w ti z 40000 JAMES THOMAS CORNATZER �'z 'N 89°25. 20' w DB 72 PG 614 N °2.' 26" w OO _.. _ 53 321 p N N O ) _C� � A u � O IC' O O w 56 [O '65.33 F. S44NA7ZER '9TAii N e9025' 'w} J 122 PG, 4D8 R. J. REYNOLDS TOBACCO 119 36 CO.I PL. BK. 3 PG. 121 I ., DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �'2 - \� 0 DATE EVALUATED « ' - 9 y ADDRESS p Cis PROPERTY SIZE SQ QJ� PROPOSED FACIILTY © LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation ByML Auger Boringy Pit Cut FACTORS 1 2 3 4 Landscape position SS I—Slope Z co O _So o . O8.0 arS45 o-EO HORIZON I DEPTH J g" IV 12' 77' 2" 17 Texture grouk- C L C 1_ L. C Consistence IFY Z ,ZFT \' Structure 7Z �- MineralogX HORIZON II DEPTH 46 O Texture group 1Z C C Consistence 1~ V r Structure Mineralogy '•1 �' 2' ► 2' �'• HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS 5s VS VS S RESTRICTIVE HORIZON — — — SAPROLITE — — CLASSIFICATION 5 V V S V S U. LONG-TERM ACCEPTANCE RATE r -- SITE CLASSIFICATION: @ •S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: '3 OTHER(S) PRESENT: REMARKS: Q`S. �' �• 4 LEGE D 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-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 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 ■..■...■■■..■...■....■■'■.....■...■■■■■.■■..■.■.■.■t■■■■.■■■■..■■■ ■.■■..■■...■..■.../.■t-■�e�t�■..■Ott■..t».■■■■.■■�■■.■■■■.■■.■..■..■ moommomm ■..■■..■...■.....■.■■.■...■ii■C: !■■.■■......■.■I..■.......■i....■ ■.■...■............■......■■..■.....■■ti.■■..iii■■..■■■■.■■..■■■■■ ■■■■.■.■■■.■■■■.....■...■■■.■■■..■■.■■..■■■..■■■.a■..�i.t■■■.■.t=■.■ ■■■.■■■n■■■.■■.....■■■■■■■..... .■..■..■. ....�1............. ■■■ ■■■■■..■■..■...■■■...■■..■■..... ■■...■... 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