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135 Brookhaven Ln - �; r.- DAVIE COUNTY HEALTH DEPARTMENT f +� IMPROVEMENTS PERMIT AND CERTIFICATE„OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary�S,�elwage Systems 9V0- G�� 7 PermitNi sumber Name &62 L� �a c/ Date N2 1 I Location -l-1_�r s /�i�ry,�iA r'�lU r - 4�9_4�,- ✓-W 7zl; n t '11100) brook_ Subdivision Name., Lot No. Sec. or Block No. Lot Size 2� House 1-� Mobile Home _ Business ,_ Industry— No. I ' No. Bedrooms Z _.No. Baths —�% L No. in Family Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: ' L�r��,lrCia Auto Dish Washer YES NO ❑ ,�.�. Auto Wash.Ma^hine YES NO ❑ �r Type Water .Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permits subject to revocation if site plans or the in d use change. x .t !• f Improvements permit b *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: D 4Sstem Installed b L 3 6u r ion f: /; Certificat of Completion Date *The signing of this certificate shall indica_ t M­syst derscnbed above has been installed in.compliance with the standards set forth in the above regulation, all id e-taken.asaddAfantee that tete system will.function satisfactorily for any given period of time. : t c., APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Pp t Environmental Health Section } P. O. Box 665 St t� Mocksville, NC 27028 JUIV i '993 � 6 ' 1 iJr�. Q� r `�1I0 1. Application/Permit Requested By Leo- ' �h Mailing Address 5-0 14 , LeI� �� -Or r QA4 2 9 is Home Phone / h��5a RBusiness Phone 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation eptic Tank Installation 4. System to Serve: Ouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry El Other ✓�O ,f ❑ Unknown 5. If house, mobile home: Subdivision 110 rl Ir�S� r i G t ci Section Lot# E-Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms D—Washing Machine No. of Bathrooms �I Z- Dishwasher Dwelling Dimensions 'ag X too 9'G`arbage 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: Public ❑ Private Q ❑ Community 8. Property Dimensions 5 /1CfeS Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes P-N'o 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 Prop rty: rAoc-GSv fled J • �u4uw r; ti.F �ugc Sl'rxllo'o Lroo4Or So,ifs r"11- 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. X19/t9'3 93 2 6 _ DATE SIGNA7VRE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: . 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 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. 04/93 DATE SIMATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED 1;_'_1WA_ ADDRESS \7 PROPERTY SIZE '�5'4C7 Ick PROPOSED FACIILTY / "/���� LOCATION OF SITE Sita-/�O U&Zl 6-�fes-u2- Water Supply: On-Site Well Community Public L_— Evaluation iEvaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .1, L A L Sloe % G✓- 7 HORIZON I DEPTH 9 1. X, %"" 0 Texture group Consistence Structure Mineralogy HORIZON II DEPTH .2 ZIP aF' 3`l Texture group C K, C' Consistence 4.1 42 - Structure /J/>.c' -e Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S1-115 LONG-TERM ACCEPTANCE RATE ,,^D I _� a , 2 SITE CLASSIFICATION: by L/FJ,/ e 70 AG' EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 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 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 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 DCHD(01-901 ■■■■■■e■.tt■■tata■■t■■■■■i■■■■■e■■ea.■tees■t.■t■et.■ttt/■■.■■■m■■■ ■■■■■..■■■■t■■■■■■■t■■t■■■tam■■t�■■ee■ttittt.tlll■t.ttt■tattttC.t ■■■■■■■■.■■■s■■■■■■■■.■■■■■■■■a■■■■■.emaaattettta■■t■l./tttttltt.■ ■■.■■.■.■l■■■amort■■■t■■■■■■.■■■.■■m.■■ttttttttt■ettttttt■ttttttte■ ■.■■■■■m.■■■■■■■■■■■■■■■■m■a■■.■■.■■■■■■■aetimt.t■ttt■■moat■■■lt■ ■■■■■■■■■■■■■■■■■■■■■a■■■t■■■■■■■■■■■m■■■emttttte.tt■tat■tam.e■■■ ■■.■■et■teett■■■mte.t.amtt■m■■.■■.■tet■.■■./ltt.tl■ttlltt.ttl■/tt■ ■■■ma■e■■m■t■■■■.■■■■■■■■■■■■m■■ ■■■■e■■ttlte■tttt■tttataa■tette■ ........................... ...................................... 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 June 30, 1993 Bea P. Drugan 51011 Letchworth P1. Winston—Salem, NC 27104 Re: Site Evaluation Shallowbrook Drive Dear Ms. Drugan: As requested, a representative from this office visited the aforementioned site on June 29, 1993. The site was found provisionally suitable for the installation of a modified—oversized, ground absorption sewage 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