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298 Dogwood Lane Lots 87-88!�'" r• DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name t� ice' �1 i` r x -_r — Date_ N� 7879 Location Subdivision Name '' �+ " 0-1 Lot No. Sec. or Block No. Lot Size _House —�' Mobile Home --__ Business —_ Industry No. Bedrooms No. Baths — — No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO p' Specifications f r ysm: Auto Dish Washer YES NO ❑ %DhG Auto Wash Ma^hine YES j NO ❑ - ' 3GG v/�/ }� 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 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.,✓ 21c'. 6, Final Installation Diagram -1 System Installed by Pi V,,� /p Ju��'� 1-1 Certificate of Completion _ —_ Date f//�/%f _ '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 ✓ (S)� Davie Counfy Health Department (� Environmental Health Section L5 @ IE OW IE �o P. O. Box 665 D Mocksville, NC 27028 Lo 1. Application/Permit Requested By G ✓�/'�� �05 7 -el Mailing Address Home Phone 2. Name on Permit if Different than Above Z ?oZop, Business Phone L 3 rf — 3,517 F�'7' J/ 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: 2 -*House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry _ I 1 ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision ` Irk 1Lc�! �'� p Section Lot # El"Basement/Plumbing No. of People o2 ❑ Basement/No Plumbing No. of Bedrooms 2 Washing Machine No. of Bathrooms 91/Dishwasher Dwelling Dimensions 3 e2l,? ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Sinks No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? ❑ Community '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: c6j� ov 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: 9--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 '6 treatment and disposal system. DATE SIGNATURE DCHD (12-90) r NAME ADDRESS PROPOSED FACIILTY DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Water Supply: On -Site Well Evaluation By: Auger Boring DATE EVALUATED 17—.2!11 ' !9 T PROPERTY SIZE A-10TI 2) LOCATION OF SITE l�4Od�G7,�Qf Community Pit Public Cut FACTORS 1 2 3 4 Landsca a positionSlope NAME ADDRESS PROPOSED FACIILTY DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Water Supply: On -Site Well Evaluation By: Auger Boring DATE EVALUATED 17—.2!11 ' !9 T PROPERTY SIZE A-10TI 2) LOCATION OF SITE l�4Od�G7,�Qf Community Pit Public Cut FACTORS 1 2 3 4 Landsca a positionSlope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 'e- O Texture group Consistence i Structure Mineralogy/ /•'/ '! /•'/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S' LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: 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 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 1 • , pf� Davie Countytfeall Department and .fame Nealtii Ayency 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 July 29, 1993 Carroll Foster P. 0. Pox 751 Mocksville, NC 27028 Re: Site Evaluation Woodland/Dogwood Lane Dear M/M Foster: As requested, a representative from this office visited the aforementioned site on July 27, 1993. 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, ,Oe�qe.� Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure j DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name (' �,,� L- SE, Date Location .`— V _ i?'Y 1 Subdivision Name, gin, .t,1 „ C Lot No Lot Size _ No. Bedrooms Garbage Disposal Auto Dish Washer Auto Wash Machine Type Water Supply Sec. or Block No. Mobile Home — Business —_ Speculation No. in Family Specifications for System:'It�o,�- IZ..' F'oLF -77 "This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit"by =_x? Jr DAVIE COUNTY HEALTH DEPARTMENT -IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION "NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name Date Location +- k4 Subdivision Name ; ! Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business —_ Speculation No. Bedrooms No. Baths _ No. in Family _ Garbage Disposal YES ❑ NO ❑ �° ` Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO "❑ Type Water Supply `This permit Void if sewage system described below is not installed within 36 months from date of issue. 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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by 2 `. A("k1. ` "_ s `' Certificate of Completion "` " Date I' "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 SEPTIC TANK PERMIT ~ �Co, of Bedrooms Date %d -- — rhi.s 'pe.~mit is granted to, %��a.ce "T, Gc, for the installation of aseptic tank.. at the' residence of e X Address c7� Can i��l�S ✓./lH Building Contractor/c�a t'�; %Lj-CAddress Septic Tank Specifications: Length Width Depth Capacity Gal. yda r 9 4<1 :� u ufacturerIs Name �QE� i( i �-'�� Address l Y � No, of lines o width f9/in. Total Length ft. ro. of Sq. Ft. VSO— 3 a a Type of filter material Total tons used i.inimtun Requirements: House Trailer Tank Cap.` 800 Sq. ft. line 400 Two-bedroom /use 800 600 Three-bedroom house 900 900 No one shall install a septic tank in Davie County without a permit from the Health Officer or his agent. Date of Z final approval f b — — G Signed: Sanitarian� _ 1 hereby certify that the above septic tank has been int led accordin to specifications. ,.-y. Signed:. G✓ I Septic Tank Contractor A SI11ote: Make skete:" of disposal system on back of sheet and mail to Health Center, Mocksville, 0 a V s"a ��