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214 Vineyard Ln (5) 7 . 4'�`•'+a m�.s'.*1 r, s.} t t;'Ff _-'w.;�.,'t•,,v y'ee: .,,.._ ...., _ , a.i ..._ .O DAVIE COUNTY H ALTH DEPARTMENT _ 9 �p IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Numbe A I Name -=L'/��r 1 /��. Y� ---- Date _L � ND 7717 .� Location Subdivision Name Lot No. Sec. or Block No. Lot Size _�Z�. - House, Mobile Home LiBusiness - Industry No. Bedrooms-9:�-Zo. Baths, — No. in Family _ Public Assembly Other Garbage Disposal YES ❑ NO ❑ Auto Dish Washer YES ❑ NO ❑ Specifications for System: Auto Wash Ma^hine YES ❑ NO ❑ 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. 1' ,a 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:704634-5985. Final Installation Diagram: System Installed by I' 7 Certificate of Completion )—ZW 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. i b APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE Davie County Health Department R C E,U Environmental Health.Section P. O. Box 665 J U L 14 1994 Mocksville, NC 27028 - - --------- --- 1. Application/Permit Requested By Mailing Address (2 2-44e.&AM- ��'�?,ovCl.�P ��. Home Phone ��� �9 7 Business Phone 2. Name on Permit if Diffefent than Above 3. Application for: a General Evaluation , UYSeptic Tank Installation Permit LTJ 4. System to Serve: ❑ House M/obile 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 ❑ 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: li?Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes Zg flo If yes, whdt 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: 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 BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ;/1. 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. DATE SIGNATURE DCHD(1193) A DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME S/�?, DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY rn�'t'� LOCATION OF SITE Water Supply: On-Site Well Community Public 4� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L Sloe Z HORIZON I DEPTH Texturegroup Consistence Structure Mineralogy HORIZON II DEPTH �' ;?,/ �• �i Texture groupG C Consistence , 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 3 SITE CLASSIFICATION: /J EVALUATED BY:& LONG-TERM ACCEPTANCE RATE: 10 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-V--ry 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 - 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 July 26, 1994 Nathan Smith 214 Vineyard Lane a Mocksville, NC 27028 Re: 2 Site Evaluations Milling Road/3 1/2 Acre Tract Dear Mr. Smith: As requested, a representative from this office visited the aforementioned sites on July 22, 1994. Based upon the information provided on the application for a site evaluation and after the evaluations were completed, two sites were found to be provisionally suitable for the installation of an on—site sewage disposal system on each site. 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 cc: Jesse Boyce Zoning Officer