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244 Steeplechase Lane Lot 104 5 ✓XD ' DAVIE, COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT-AAND CERTIFICATE OF COMPLETION) y.; *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a anitacy Sewage Systems ''• ���� �"�'� ��', �3'r� fir. r Name l e, f 'Date —Zs' Location P Number NOM 7971 Subdivision Name Lot No.Sec. or Block No. Lot Size __�P_ — House 1 Mobile Home Business Industry No. Bedrooms No. Baths ;, —'No. in, Family _— . Public Assembly Other Garbage Disposal YES NO, ❑ f Specifications for System: 'Au_to,Dish Washer . YES NO ❑ Auto V ash Ma^hine YES N0 ❑- Type Water Supply 'This permit Void if sewage system described below isnot 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. pL. . R QII $, f,,,2JV A. r 1 `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 ' •.. r ��x/,fir 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. y Q_ DAVIE COUNTY HEALTH DEPARTMENT101 �d IMPROVEMENTS PERMIT AND `CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Art"c e I I of C�,S. Chapter 130a Sanitary Sewage Systems Gn/ . Il rvw Permit Number Name zgv"f-4,/ A61,- /// �, Date //' � - 9y N2 7 8 © 6 Location `✓n Amt /� ' z9` liU. // - A-7 iliv / - Subdivision Name a� "�-��Lot No. Sec. or Block No. Lot Size _ _1_�/�C House Mobile Home — Business —_ Industry No. Bedrooms No. Baths � No. in Family 2 Public Assembly Other Garbage Disposal YESNO E]Specifications for System: Auto Dish Washer YES NO E] Auto Wash Ma^hine YES NO ❑ A Type Water Supply -- ------ ,S .s *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. a4 *� 0 1 )lf ifs f I vements 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: 7046345985. 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. . A _> T DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II ofG'S. Chapter 130a Sanitary Sewage Systems permit Number Name!N,! N2 ? 8 Q 6 Location r Subdivision Name -'���ia"�`��1 Lot No. l(� Sec. or Block No. Lot Size''' House _ Mobile Home _ Business _— Industry No. Bedrooms S2 No. Baths No. in Family 2 Public Assembly Other Garbage Disposal YES NO ❑ Specifications for System:' Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES NO ❑ Type Water Supply _ Gli�1/ ---- ;• G'G'��, *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. VJ POO I-Mpf vements 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. Final Installation Diagram: System Installed _ Certificate of Completion — Date t, '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. 0 / APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM Davie County Health Department L Environmental Health Section P. O. Box 665 V t Mocksville, NC 27028 {-C'7BV i AUG 3 0 1994 1. Application/Permit Requested By Mailing Address 53 1 ) J�= pla • Home Phone A? 0/ a, Business Phone 2. Name on Permit if Different than Above 3. Application for: 21 General Evaluation Septic Tank Installation Permit 4. System to Serve: 2' -'House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision (L ('p �JLU Section Lot # y No. of People •� No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions 50 66 7 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures _ 7. Type of water supply: ❑ Public Private 8. Property Dimensions sf, 44 23 2� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? ❑�Basement/Plumbing 2 BasemenUNo Plumbing Washing Machine Dishwasher 2 -Garbage Disposal ❑ 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: <�O 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. - (?4/ ry DATE AIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 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 (193) IL DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation n �/ DATE EVALUATED PROPERTY SIZE NAME ADDRESS �( PROPOSED FACIILTY A&e:c LOCATION OF SITE Water Supply: On -Site Well t/ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L L. Sloe Z .t HORIZON I DEPTH �' �• �< " Texture group IAI X%le Consistence Structure Mineralogy HORIZON II DEPTH '' G " 3 Texture group Consistence Structure le /r -e- 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 SITE CLASSIFICATION: _ fQ LONG-TERM ACCEPTA4CE,42ATU: iC;2 REMARKS: DCHD (01-901 e EVALUATED BY: llkz�z OTHER(S) PRESENT: 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 r: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 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 ., Davie County NealtI De artrfient and .lone NeakfAyency 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 September 15, 1994 Ann D. Swyers 591 Barkworth Rd. Clemmons, NC 27014 Re: Site Evaluation Whip—O-Will/Lot 10 Dear Ms. Swyers: As requested, a representative from this office visited the aforementioned site on September 8, 1994. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on—site sewage disposal system. If you have any questions, please feel free to contact this office. RH/wd Enclosure Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section