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121 Raintree Court Lot 22DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NUfF: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name � ;/.�/r, n� �r'%i^-%r7 � ,�� `r'<'/ Date NO Location f/ "` iS i:.� `1 �r"'t"'�� _ Subdivision Name �`�>- J! ��T Lot No. Sec. or Block No. Lot Size House L-� Mobile Home _ Business _— Speculation No. Bedrooms ?J No. Baths ---�� No. in Family _ �— Garbage Disposal YES ❑ NO p- Specifications for System: Auto Dish Washer YES p NO ❑ 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. 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. (71 Final Installation Diagram: System Installed by Int, I Certificate of Completion� Date 11-1`11-60 '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 • Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 �_ 1. Application/Permit Requested By. L//lfi�' r7C- E !� z=5 L Mailing Address & 1:2 � 2 C CdP—c�CO/Z EQ q%�G Home Phone q1� 7� �� Z/�� Business Phone (/cI 7, K-- 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Indust ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision (`iq 1 NT ��� Section Lot # � Z— No. of People 4 - No. No. of Bedrooms No. of Bathrooms Z r 117— r Dwelling Dimensions S67 D�f� X EoW,De- CIMA� 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 8. Property Dimensions 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 7L Basement/No Plumbing Washing Machine ® Dishwasher ❑ 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: Z l -P� Z Z Zi4-, NTS ' e5��,4 7 -E -S 0,..J �N D This is to certify that the information provided is correct to the bet of my incurred from this "plication. DATE I ^7Tv1epi 6,—,=T-- (rc)Ue ; Zvi (f)AJ SIGNATURE I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON 'ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. I OWN the property. ❑ 2. I 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 (12-90) "1 certify that on .... ».�'P�.!.... » :. ............ we surveyed the property shown on this plat; than [ the property Ilaes and location of all structures are accuratelyshown at no structure -I located on this property encroaches on any adjacent stree or pro structure or adjacent property encroaches on the premises survey OQ` A UNIT L enc C P s� Qdva��io�i too 8 to H VO .41 LI Q 00 W w a d to tin4 N • .� w • en CO 0,4 , N � 3, `,,,.. �•r I. %V Q o� N v �o � p Cr /d C00'; APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT, Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 71 1 - '?c1 R 1. Permit Requested By Z �/� C/ / -S Business Phone 9/!? `7 ( (aA 2. Address %� cSL,�G "� S7� �' -/ +E rh m�nJS' _ rV, C - a2 0 / 2 3. Property Owner if Different than Above r r & e --V �'3 &,c Address / 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-DivisionSec. Lot No.�� 5. System used to serve what type facility: House ►'Mobile Home Business IndustryOther b) Number of people - 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes. lavatory dishwasher urinals showers sinks 8. a) Type water supply: Publico2Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions b) Land area designated to building site garbage disposal washing machine c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? N d What type? This is to certify that the information is correct tote best of my knowledge / j Date -@er Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) Address N DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION �y Date Lot Size FACTORS AREA 1 AREA 9 ARFA R AREA A 1) Topography/ Landscape Position �4) 5) 6) 7j 8j 9) S ``iiTT S �� �S C rJ/ ``pp`` S PS U ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S PS S Z S S CE--) 3) Soil Structure (12-36 in.) Clayey Soils S PS S P S PS Z U U Soil Depth (inches) S S S S LI L1 Soil Drainage: Internal S P A c !P (:nPD Q U U U External S SS S & U IJ Restrictive Horizons /O �� �' �� ii Available Space PS S S S U U L1 Other (Specify) S PS S PS S PS S PS Site Classification z'l,S U—UNSUITABLE Recommendations/ Comments: Described by SITE DIAGRAM UCHD (6-82) S—SUITABLE L PS—Provisionally Suitable SO' K" - - -- . )W� -:2-FY Title Date .Z6��Z_ �w OFFICE OF THE DIRECTOR Mr. Gil Davis P. 0. Box 786 Clemmons, NC 27012 Mr. Davis: ailie T01111ty �ivaftlj +lepartment allb 340111e enc P. O. BOX 665 �4Hor1csuillc,arolina 27028 February 3; 1986 Re: Soil/Site Evaluation Lot #22 Raintree Estates, Davie County As per your request the aforementioned lot was evaluated by a representative from this office on January 24 and 27, 1986. The results of said evaluation are listed below. 1.) The middle portion of the lot is classified as unsuita- ble due to the shallow soil conditions and poor internal drainage. 2.) The upper right side of the lot (facing the lot from the street) is classified as provisionally suitable. The soil depth is 12" - 20" deeper in this,area and the soil texture and structure is much better than on the lower elevations. The overall classification of this lot is provisionally suit- able due to the soil conditions on the upgrade area. It must be noted that due to the elevation difference from the middle portion of the lot and the area where the system must be installed, a pump will probably be required. Should you have any questions concerning this matter, please advise. Sincerely, J9 Mando, R. S. Director, Environmental Health skg TELEPHONE 1704! 6345985 r + DAVIE COUNTY HEALTH DEPARTMENT /66, Ub ,- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION P 'D *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a 6 Sanitary Sewag em _ _ Permit Number Name ��� a Date - N0 6008 Location Subdivision Name Lot No. _ a– Sec. or Block No. Lot Size- House Mobile Home __ Business -- Speculation No. Bedrooms 3_ No. Baths A D- No. in Family �— Garbage Disposal YES ❑ NO EV Specifications for System: Auto Dish Washer YES Rf NO ❑ J D a a �� ' s�) _ Auto Wash Machine YES K► NO ❑ it 'k I a 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. 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 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. 1� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS .PERMIT AND CERTIFICATE OF COMPLETION VO l �� ? ''NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage-System _ Permit Number Name ��, " Date J �J U N2 6008 Location �\ 'C� Subdivision Name " r 47, Lot No. Sec. or Block No. I!ot Size Mobile Home Business Speculation No. Bedrooms 3— No. Baths No. in Family �— Garbage Disposal YES ❑ NO Ep/ Specifications for System: Auto Dish WasherYES NO ❑ f U O a Auto Wash Machine YES Q' NO ❑'x 3 , ,��► 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. I 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 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. Xp DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION SIV©TE: Issued in Compliance With Article 11 of G.S. Chapter 130a `/ `I'J Sanitary Sewage-ays 11mc_ Permit Number Name ��� \ . �*. _ Date C ` > N2 Location-\ ur �`> R�`� c. L`� V �;,, ea c" +�� �.�• ��);.,1� — Subdivision Name Lot No. Sec. or Block No. Lot Size I QL'=3- House Mobile Home — Business _— Speculation No. Bedrooms , — No. Baths �' No. in Family -1 _ Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES NO U o c, C -- Auto Auto Wash Machine YES Ea' NO ❑cs --� 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. ImproJ,ements 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 Irjstalled 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 take as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Aam Davie County Health Department 1- '`' Environmental Health Section P. 0. Box 665col d Mockoville, NC 27028 R� 1. Application/Perm Mailing Address r ` ) Home PhoneO )ffz'�Z51— z Business Phone(/% Z�2 C� 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: TGeneral Evaluation 0 S/Tank Installation 5. System to Serve: House u Mobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision KlAih _ Sec. i Lot#_Q� No. of People Dwelling Dimensions or -,lo? X 'FC 55P7 of Bedrooms Basement/Plumbing No. of Bathrooms /'Basement/No Plumbing Washing Machine JDishwasher 0 Garbage Disposal 7. If business, industry, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 8. Type of water supply: Public 9. Property Dimensions 10. Sewage Disposal Cont No. of Sinks No. of Urinals No. of Water Coolers 0 Private 0 Community 11. Do you anticipate additions/;,No pansions of the facility this system is intended to serve? 0 Yes 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. 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 incurre�d�}from this application. Date Signature Directions to Property: 15 > lin 4 /� 7 /e7,/- L5 0Cj4 1 DCHD (10-89) EPA DAVI ENE ORONMENTiAL HLEAL D SECTION T oN L�m SITE EVALUATION CONSENT FORM 41��1. Complete the form below and return to the Davie County Health De2. Carefully follow the procedures as outlined in the enclosed "Inform NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) ,��u L yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the aboyle described property, however, I certify that I have consent from owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conductall testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: — Owner only Owners designated representative Anyone requesting results Only those listed below DAT SIGN URE DCHD (11 /84) r �` • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY _�-- DATE EVALUATED _ `7 - a. -11b PROPERTY SIZE LOCATION OF SITE V Water Supply: ' On -Site Well Community Evaluation By-( r - Auger Boring Pit Public J� Cut FACTORS 1 2 3 4 Landscape position �< S 5__ Sloe % HORIZON I DEPTH Texture group C Consistence Y Structure G,R Mineralogy�► 'i '1 '� HORIZON II DEPTH L42' ' Texture group CZc- Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS SS S_S RESTRICTIVE HORIZON-- SAPROLITE —' CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: , } LONG-TERM ACCEPTANCE RATE:' % REMARKS: DCHD(01-901 EVALUATED BY: 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 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 watef 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