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124 Hepler Rdi T R1,/x0 10 DAVIE COUNTY HEALTH DEPARTMENT -- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a San itary\Sewage.Svstems �,� _ j _ c� 3 Permit r er 1- 'r Date 0 Name ✓0 �-! S V3 V\c. Locatjon 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 ❑ Sp6q fic,#�ons fo!SySem: Auto Dish Washer YES [� NO ❑ ' �' y' Auto Wash Ma thine YES, --E] NO -❑ \ ,� c) Type Water Supply ! __— *This permit Void if sewe This Permit_is_smtbiect1tt system described below is not installed within 5 years from date of issue. vocation if site plans -or tthb`intended.use change. M 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: �y L F,r d. '11 c 1 System Installed by j D 1 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. APPLICATION FOR SITE EVALUATIC Davie County Health ment Environmental Heait c ioWr'Uu 1 .;3 "3- P. -P. O.. Box 6 Mocksville, NC 7�U►- 1. Application/Permit Requested By E$ 0 f f SpA R I ' Mailing Address 6 c4 E5 D'2 C 6-m --'n 000 s lo/(f 1:') 7 O/ -7-- Home Phone '76 G r9Z'09 Business Phone 7G a Ufa 5� 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation ❑ Septic Tank Installation 4. System to Serve: )51 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 3 No. of Bedrooms 3 No. of Bathrooms A Dwelling Dimensions X (c D 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: ❑ Public No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures )Y. Private 8. Property Dimensions 60t.34 x 5''37- 9 X X E'/VpSewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Basement/No Plumbing JZ Washing Machine (0 Dishwasher ❑ Garbage Disposal ❑ Yes g 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: Si✓ E �TT�Cfii'� /� .L /.5 i /tiG- "/ //06 I `y rl/ 1 fe s'� g98 -ll �z. This is to certify that the information provided is correct to the best of my knowledge, incurred from this application. DATE I understand I am responsible for all charges IGNATURE CONSENT FOR SITE EVALUATION TO BEDONE QIV ABOVE DESCRIBED PROPERTY MUST CHECK ONE: -9 1. 1 OWN the property. ;0 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 Davig County Health De artment to enter upon above described property located in Davie County and owned by H X ZJZZ ) A�sX :,R E J z-- CvTd,V to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE 1j, x _(►1 ^ �.SIGNATYF 4 Triad MLS r` Y 4�5 •q d 01:47 PM ML# W55093 Status ACT Type r L/Price S •�' .. r� : 314.8 ' •• •.,.•, Fld Zone NONE Zoning - City MOCKSVILLE County DAVIE Zip 27028- Grid 508C2 Area 508 r or y.. CT 803 6 A r, 4 Pg 272 TaxID Assum Cash Assum S 2nd Mortgage ------------------------- LISTING OFFICE INFORMATION -------------------------- t• � 'C iA'�r •f �..'t{1••�t• Compensation %/ 5.00 List ID 1, •n. r•. ••• 1•.�. 1 List Agent CASSIDY, HELEN J Agent Phone 704-634-2600 . .; fir,,,'. ,3,•::.g •� Q Office Name HUBBARD REALTY ..;?C^ .�.:• Exp Date Owner Name HENDRIX Prpty Phone 919- LT E Photc ---------------------------- GENERAL INFORMATION ------------------------------ Triad MLS LAND 07/12/93 01:47 PM ML# W55093 Status ACT Type SINGL L/Office WHUB02 L/Price S 24000 Addrss / /HEPLER ROAD RT 3 Fld Zone NONE Zoning - City MOCKSVILLE County DAVIE Zip 27028- Grid 508C2 Area 508 Subdiv Lot Blk Sect CT 803 TM G-6 TB 00 TL 107 Book DB/52 Pg 272 TaxID Assum Cash Assum S 2nd Mortgage ------------------------- LISTING OFFICE INFORMATION -------------------------- Possession CLOS Show/Agency /BOTH Compensation %/ 5.00 List ID WCASSIDY List Agent CASSIDY, HELEN J Agent Phone 704-634-2600 Office Name HUBBARD REALTY Offce Phone 919-998-8816 Exp Date Owner Name HENDRIX Prpty Phone 919- LT E Photc ---------------------------- GENERAL INFORMATION ------------------------------ Best Use SINGL Deed Restrict N Appr Total Acr 6.00 Location RESID/RURAL Easement Y S/Acre $ 4000.00 Fencing / Land Use S/SgFt S #Transportation / / KnwnEnvHzd N Appr Wood Acr Topography WOOD /ROLL / Appr Clear Acr Bldgs on Prop / / / / / Mn Rd Frntg Miscellaneous GRAVL/ / / / / Tot Rd frntg 601 Documents ARIAL/DEED /FLDMP/TOPO /SOIL / Sell Options Lot Size 601.34 X 537.9 X 602.56 XD 514.8 Rmrks WOODED LOT WITH PRIVACY -PERFECT FOR BUILDING -ROAD ON LIST TO BE PAVED PER NC DOT-HR#12993 Direct 140W -L 801-R 158-L PUBLIC SCHOOLS Elementary PINEBROOK Middle NORTH DAVIE Sr High DAVIE ----------------------------- AVAILABLE UTILITIES ----------------------------- Elec Y/OTHER Gas N/ Wtr/LnSz Y/PUBLC/ Swr/LnSz N/ / Phone Y Cabl Y --------------------------- FINANCIAL INFORMATION ----------------------------- 1Ba1/Type S / Rate % Pmt $ / Loan# Lender/YR / Assum Cash Assum S 2nd Mortgage Tax Value S 13820 Tx Rt .6100 Tax S 84/92 Possession CLOS Suggested Financing Rmrks (OV ER••) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation NAMEl .9 S DATE EVALUATED ADDRESS 5 P � Q PROPERTY SIZE PROPOSED FACIILTY �Ga `rn� LOCATION OF SITE��� Water Supply: On -Site Well I/ Community Public Evaluation ByQ�.V,, Auger Boring Pit ►- Cut FACTORS 1 2 3 4 Landscape position Slope % - S 77 HORIZON I DEPTH Texture group S C L S 'L L SCL X0.1. Consistence Structure C Mineralogy ', 1 HORIZON II DEPTH qW, Texture group C Consistence V —4 - Structure Mineralogy '.\ '. ' 1 1:1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS .Ss Ss _SS RESTRICTIVE HORIZON -- SAPROLITE-- CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �1 -� 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(01-90)