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P6821 Southwood Acres Lot 4 Block B{A* VXv f DAVIE COUNTY HEALTH DEPARTMENT _ 90 '�`f` • IMPROVEMENTS PERMIT AND.CERTIFICATE OF COMPLETION �n y,,�✓� NOTE: Issued in Compliance With Article II of G.S. Chapter 130a�1 �R Sanitary Sewage/ Systems Permit' Numt%rL£NS Name ate 7—/-9.7 N2 U)91 6821' Subdivision Name�i��/a�r,�' 116 Lot No. X Sec. or Block No. *� Lot Size 1?D X 90 r/ House ✓ Mobile Home _ Business Speculation No. Bedrooms ',�? ,No. Baths 42 No. in Family Garbage Disposal YES ❑ NO [g -- Specifications for System: Auto Dish Washer YES NO ❑ /�o�,-�- Auto Wash Maohine YES NO ❑ yJ j eol Type Water Supply %l/ '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. 1,107 �P r �n 3 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 S 'The signing of this certificate shall Indicate that the system describ d 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 i1 1. Application/Permit Requested By Mailing Address AA -2) �Qf Qn Home Phone 2. Name on Permit if Different than Above 3. Application/Permit for: 4. System to Serve: ❑ Business 5. If house, mobile home: Business Phone ❑ General Evaluation House ❑ Mobile Home ,t U al -1 1992 Tank Installation ❑ Place of Public Assembly ❑ Industry ❑ Other ❑ Unknown No. of People No. of Bedrooms h No. of Bathrooms o� Dwelling Dimensions 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: Ef Public / ❑ Private 8. Property Dimensions 3 ��� Y c Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? 4 ❑ Basement/No Plumbing 24ashing Machine. Dishwasher ❑ Garbage Disposal ❑ No ❑ 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: This is to certify that the information provided is correct to the best incurred from this application. La l// 7� D T knowledge, and I SIGNATURE I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. Er2 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 d�iie DVe C my Health Department to enter upon above described property located in Davie County and owned by l�'ir/f/Z/�G to conduct all testing procedures as necessary to determine said sit 's suitabllity-feta ground absorption sewage treatment and disposal system. (�/LJ\) 40 z- It E SIGNATURE DCHD (12-80) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section % Soil/Site Evaluation NAME' ADDRESS ` J PROPOSED FACIILTY ,�4 f� DATE EVALUATED PROPERTY SIZE ! y/ LOCATION OF SITE cJEJuS�L(IDd�P/(i Water Supply: On -Site Well --Community - Public Evaluation By: Auger Boring C/ .. Pit .Cut' - FACTORS 1 2 3 4 Landscape position G 4- -Slo Slope e Z ^ HORIZON I DEPTH i0 " Texture group S G G Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy A / , 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: /JS, EVALUATED BY: /141 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 Moist - .. . VFR-Very friable FR -Friable ' FI -Firm VFI-Very.firm EFI-Extremely,firrn 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 . meanie County Nealtif department and Nome Aealth Ayency 210 HOSPITAL STREET/ P.O. BO%885 - MOCKSVILLE. N.C. 27028 PHONE: (704) 834.5985 - - -- June 81 '1992 Swicegood—Wall & ASSOC. 300 S. Main St. Mocksville, NC 27028 Re: Site Evaluation Southwood Acres/Sec. B—Lot 4 Dear Realtor: As requested, a representative from this office visited the aforementioned site on June 2, 1992. The site was found provisionally suitable for the installation of a ground absorption sewage system. 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.