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P8037 Nolley Rd 17c DAVIE COUNTY HEALTH :DEPARTMENT j .3 %A01 "�'I IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION' r' ti ; ? *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a �/� Sanitary Sewage Systems _ Permit Number Name � �� '� C�4�\ �� � \'.i��_` Date- _ N2 8037 Location L�U( _.�.. '� \=\ R r. (`--. 3.-���._S:J.Ii t,52.• 1 :1 ,` �`r. � '' :�_a.. �.•.t'T — � ��� ',�'��4 Subdivision Name Lot No. Sec. or Block No. Lot Size ` ' �`— House — Mobile Home -- Business —_ Industry : No. Bedrooms --'—.No. Baths `y__ No. in Family�— Public Assembly Other Garbage Disposal YES ❑ NO ❑ S ecifications for System Auto Dish Washes YES ❑ NO ❑ Auto Wash Ma^hine YES ❑ NO ❑ t7! _ ,. 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 ATTENTION: , YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. / ------------------------- Improvements permit b '`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 F r (�l � a m�P • FU r 0 ..r /DUB U F N A Certificate of Completion - Date I D� '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. to APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER t ' Davie County Health Department � Environmental Health Section It � P. O. Box 66520J� Mocksville, NC 27028 3 ►`; �a �m oVIE ool iv - to 1. Application/Permit Requested By TSG T_ Q n Q � Mailing Address � ,&��y Home Phone y%� ,��d� e- yl/ Business Phone 2. Name on Permit if Different than Above , 3. Application for: ye General Evaluation optic Tank Installation Permit 4. System to Serve: ❑ House {bile 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 Bedrooms3 ashing Machine i No. of Bathrooms ❑ 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: ublic ElPrivate ❑ Community p 8. Property Dimensions ;t t '� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes E-90-- 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: p 0c/SStJi dv / " d 11Ql / 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. -& a..�4,cj DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: I OWN the property. ❑ 2. I DO NOT OWN the property. ked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. 1�s DATE SIGNATURE DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section l , Soil/Site Evaluation Mw ''�''�\' 'O �G DATE EVALUATED 3 NAE ADDRESS fl M"pn PROPERTY SIZE PROPOSED FACIILTY � H 0 e LOCATION OF SITE Water Supply: On-Site Well _ Community Public Evaluation ByC!>✓L Auger Boring 1/ Pit Cut FACTORS 1 2 3 4 Landscape position -S _r_1 Sloe Z 3S-1s� '1 S-16 s-1 HORIZON I DEPTH G' � Texture group C L C L C L Consistence F Z 1- Structure Z Y.- MineralogX 1 ; HORIZON II DEPTH "-Z." LA Z" Texture group Consistence Structure \C MineralogyI: HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS S -5 S S RESTRICTIVE HORIZON i SAPROLITE — CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,yI \U y SITE CLASSIFICATION: ,S , EVALUATED BY: 4 LONG-TERM ACCEPTANCE RAT : p OTHER(S) PRESENT: RNs' 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 fine Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure 3C-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 ■.■.■■■■■■■■.■■...■■..■.■■.■...■■.■■..■■..■.■■...�.■■.■■■■ NEON.■■ ■■.■.■■■■■.■■■..■■N..■E.■■■..NNE ..■■..■■■�.■.■■.■.■.■.■.■.■■.■■ ................................ ................................ .■......................... .......■►........... 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"ilii �0I i'.�■CON M MEMMOMMENNCmomomm W'HME momo�n'MEN ME' EMMMUMMEMMM =M.MOEN�M MEMO iiEC ■..■.N.■.■■UEMNEUN■■/NEN■NEUN■.■.■NN■■=mMEN.ENEMENMN■UNE■.■■■ ■■■■OEE■■MEEN.NN.■■■■!/./NEON■■■!/■!■■ EMN.E.N.■NMN■NONE■mmm.mmm■ ■MEMMEMMM■/■MMUMME/////N■MMMN■N■■■MEMNON..■■■■mmmNMM■MM■M■/.//■//■ MEN.m.om■■■.■m■om.■■MEM■EMEMEMEMENN■ENE OMEM■ON■MENNEN■MEMEMnE■.M.■ NOON=Eo.n.E.M■■.■■EnsM..n■■ ■■nE■■■■OEO=■MESON O No.MEM omoommmE■■■=E N/N■ NOON■!U■■■■■■■M■m■■NM!■■■■ NONE/ N!■MENNMMOMMOMMOMMEMUN. ■ . 1 tr A Davie County �ZealK Department and Name Nealtli Ayeacy 210 HOSPITAL STREET/P.O.BOX 665, MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 March 24, 1995 Richard D. McCrary P.O. Box 844 Cooleemee, N.C. 27014 Re: Site Evaluation Nolley Road/2.5 Acres Dear Mr. McCrary: As requested, a representative from this office visited the aforementioned site on March 23, 1995. Based upon the information provided on the application for a site evaluation and after an evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. 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)