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820 Mr Henry Road Lot 1`< DAVIE COUNTY HEALTH DEPARTMENT % bo, t) o l i _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems \ Permit Number Name mc; 1_ a zQ.2Sh Q0 e, Date—a N2 7943 Location,1�2 �1,s• \\�1p1(�n �\\oc�s.�t`�Q_p�y,C`_�O�Y �� n., v \C a Cm�J�Ar� C' Subdivision Name .> �» ����' �� �= Lot No. Sec. or Block No. v Lot SizeE} S House n � Mobile Home _—__ Business _—_ Industry No. Bedrooms -- :�--_.No. Baths _ 2— No. in Family L — Public Assembly Other Garbage Disposal YES ❑ NO 21' Specifications for System: Auto Dish Washer YES p�, NO E)/ O o 0 03 Auto Wash Machine YES 01 NO ❑ c 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 PERMITILAYOUT BEFORE INSTALLING THIS SYSTEM. bb Lk) r 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: 704.634.5985-87/0 Final Installation Diagram: System Installed by. 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�bo.0o P IMPROVEMENTS PERMIT AND -CERTIFICATE .OF COMPLETION "NOTE; Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems (� \ Permit Number Name U =�\1 a -:�,2>� be,c��,:,_ Date �j l 3 �i� H2 7943 _ 1 Location 1 (\.,\I \ a. \-\ C A'N �k. C« V-�'N k.� n V \. `` \ JC ur - ') -c C,;!� c, J15 a Subdivision Name c „h , \ '- 1 \ `° = Lot No. Sec. or Block No. _Lot Size _ `'' House _ Mobile Home ____ Business __ Industry No. Bedrooms .No. Baths _crt�-_ No. in Family_ Public Assembly Other Garbage Disposal i YES ❑ NO p" Specifications for System: Auto Dish Washer YES d NO ❑ O a o '` \t - L \ "\4 Auto Wash Ma shine YES p( NO ❑ Type Water Supply _ { LN5 '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. Lu C9 n s r - Improvements permit by�—�'�L ��•-S�T=� *Contact a representative of the Davie County Health Department for final Inspection of this system 1:00.1:30 P.M. or 4:30.5:00 P.M. on day of completion. Telephone Number: 704.634.5985-O+/0/6 Final Installation Diagram: System Installed by A.M., r p^ Certificate of Completion -- M Data _ '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. B v APPLICATION FOR SITE EVALUATIOWIMPROVEMENTS PERMIT - - - Davie County Health Departmentsr`T Environmental Health Section ',i P. 0. Box 855 ' Mocksville, NO 27028 m ao 1. Application/Permit Requested tC'C 7-l• '`''I lJ �C �By MallingAddress ilpp7N r-/.5 �.0/� �fl �� i�oa,5 V,/�E Home Phone B 7 -,2 Ay ' �SVI�_ Business Phone � 4 - �3y -121513 - 2. Name on Permit If Different than Above - 3. Application/Permit for: p General Evaluation .Septic Tank Installation n System to Sewn: House p Mobile Home p Place,of Public Assembly - p Business p Industry` p Other El Unknown . 5. If house, mobile home: Subdivision S<)y � 1�1 V1M S Section Lot X p Beaement/Plumbing . No. of PeopleBasemai plumbl'ng No. of Bedrooms m Washing Machine - - No. of Bathrooms � Z! Dishwasher Dwelling Dimensions G 6 r r `p Garbage Disposal - 6. It business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Udnals - No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures - Z Type of water supply: PublVic � � Private � - '0 Commonly' r1 i 8. Property Dimensions ? in ,q - Uo Sewage Disposal Contractor 9. Do you anticipate additlons/expansion of the facility this sytem Is Intended to serve? p Yes kQ 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: _ ON Ryehl This is to certify that the information provided is correct to the best of my knowledge, and I understand I em responsible for all charges incurred from this application. - . DATE- SIGN URE . CONSENT EQH On EVALUATION TQ BE DONE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: .1., I QM the property. - O 2. 1 DO NOT.OWN the property. If you checked Box Y2, the rest of this form MU $2 be completed by the owner or a personauthorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to ante( 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 Y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section y- Soil/Site Evaluation IN AME 'RV St DATE EVALUATED ADDRESS SPe PROPERTY SI2E PROPOSED FACIILTY ' H Oy s 2 LOCATION OF SITE Water Supply: On -Site Well ✓✓ -- "- Community - Public ' Evaluation By:C�(. Auger Boring ✓ Pit - Cut - -- --- FACTORS 1 2 3 4 Landscape position S I- S. s Slope z- e S; - IT ff ) 5-15 HORIZON I DEPTH 4.1. b" 4' Texture group C L I - S ct-. Consistence Structure R' k Mineralogy) 1 t HORIZON II DEPTH )-)Z`' 14 7- 2 42 Texture group Consistence V 'VF-1- V --Structure Structure L L G Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV.DEPTH Texture group. Consistence Structure Mineralogy SOIL WETNESS \/S V S V-5 3 RESTRICTIVE HORIZON SAPROLITE — - CLASSIFICATION is LONG-TERM ACCEPTANCE RATE '1 SITE CLASSIFICATION: \y,I EVALUATED BI d).] LANG=TERMACCEPTANCE RATE: �• OTHER(S) PRESENT: jUo!N n :.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-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 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 N 0.1'53'09'—E 395.18 1ct. 19) rl to 901.8 VI WM'r" CAWXJNA DAW COUNTY The foregoing certificate isla- certified m Lccru-ft Th:s it fell registration iwi,.-] r crr'r. ' in rage -54,..., . Tl*.(A—day fof._V*f - I ; ly� A lima an By - AO.44� Awfa"WOY In to rn I 0 OD (n ip 0 O 0 0 W'., is WM'r" CAWXJNA DAW COUNTY The foregoing certificate isla- certified m Lccru-ft Th:s it fell registration iwi,.-] r crr'r. ' in rage -54,..., . Tl*.(A—day fof._V*f - I ; ly� A lima an By - AO.44� Awfa"WOY In to rn I (n Oj W'., is �•^ APPLICATION FOR SITE EVALUATIONAMPROVEMENT Davie County Health Department ` Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed G uc- oT o,- S�1 Q tCt Contact Person h i I [ fJ �� .�D ((-F — Mailing Address :P.o . 6N Home Phone k4 City/State/Zip 0o01 E7=R) t- 1 A % Zh flI t} Business Phone '7D y - (0 3 3 i 2. Name on PermidATC if Different than Above Mailing Address I City/State/Zip 3. Application For: [ 4 iteIEvaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [House [ ] Mobile Home [ ] Business [ ] Industry [ )Other i 5. If Residence: # People -3-- # Bedrooms- # Bathrooms -4— Dishwasher [ ] Garbage Disposal [ Washing Machine jI/f Bas �3 , gumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers - # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [ ] Well [ ] Community 2 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No/I If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A Ii`AfIXOF THE PROPERTY MUST BE SUBMITTED WITH APPLICATION. Property Dimensions: of . a `(�1 e i WRITE DIRECTIONS//(�from ocksviilllee) TO PROPERTY: Tax Office PIN: # 5716 y� t ich O C l.t.r c—h -Road O td Property Address: Road Name 1 ' t� Road � • ' r City/Zip mockSville l�azR `��� • f�� k arm. If in Subdivision provide information, as follows: Name: Section:-);at#: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans of intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred'from this application. 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 t LL S� 1! l`-1. nci bP . to co��,��,�[�`jjuct all testing c ures tas necessary to determine the site suitability. DATE i3-9 SIGNA� ZI � A ) \ ' 1/( c7�4� — Revised DCHD (06-96) THIS AREA MAY BE USED FOR DRAWING YOUR SITE -Alil/ k - lbte ,1bb97u, I L DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation I q. , APPLICANT'S NAME ��� ¢ DATE EVALUATED 3 q i I PROPOSED FACILITY. o V SQ PROPERTY SIZE (�J O�r.S�9.D SUBDIVISIONROAD NAME Water Supply: On -Site Well 2 1 3 4 5 6 7 Community Public Evaluation By _�L Auger Boring V 'Pit Cut ' N Texture group C Consistence Structure Mtass %ss FACTORS 1 2 1 3 4 5 6 7 Landscape position S __s - I - Slope % o g 0 HORIZON I DEPTH ' N Texture group C Consistence Structure Mtass %ss Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure MineralogyL 1 1 HORIZON III DEPTH Texture group Consistence . Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS s RESTRICTIVE HORIZON —* SAPROLITE CLASSIFICATION S •I V .'!io LONG-TERM ACCEPTANCE RATE m �] M l C LAASS1r1LA 11UIN: + CVALUH11U1N b1: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:.y REMARKS:" i N, 1N.� Jam i,1d) 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 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 DCHN01-90) - Davie County Heath Department and .dome Health Agency Environmenta(Heakh Section P.O. Box 848 / 210 XOSPIT& STREET . COURIER #09-4-06 - MOOx9VILLE, N.C. 27028 PHONE: (704) 634-8760 - March 24, 1997 0uentina S. Price P. 0. Box 44 Cooleemee, HC 27014 Re: Site Evaluation South River Farms/Tract 1 Dear Mr. Price: As requested, a representative from this office visited the aforementioned site on March 21, 1997,. Based upon the information provided on the application for site evaluation and ,after the evaluation was completed, the'site was found to,r: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. I, r Sincerely, Charles E. Little, R.S., Environmental Health Section CL/wd Enclosure(s)