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127 Cricket Ln SCJ .«/� v11.i-„Ivu r,a ;�-.orf.7 iY-�`-a .✓4 ..a`yi' .-.- ,.+n-.. r.t. _. • a'. -...;.. .. { _ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit pNumber , Name 2,ces-Qyle,, evof �7��"�i',Y-21-2`/1� Date /_ 'V_ + N2 7 O 4 0 Location e,5 EDO lt%� firs Subdivision Name Lot No. !Sec. or Block No. _. Lot Size__L� House Mobile Home �''� Business __. Industry No. Bedrooms .2 No. Baths _ No. in Family Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES ❑ NO Auto Wash Ma^hine YES ❑ NO �t 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. fj e { 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. Final Installation Diagram: System Installed by ooPxe4 Certificate of Completion �L�` -- 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 EVALUATION/IMPROVEMENTS PI EMIT .. ,y Y... Davie County Health Department IR TT Environmental Health Section P. O. Box 665 DEC Z 9 694 Mocksville, NC 27028 ---------------- 1. Application/Permit Requested By l eResa Be2c Mailing Address � gDX 7 Home Phone ocksV )fir V1 e 29O2B Business Phone 2. Name on Permit if Different than Above DAMS. 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House ® Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People r ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms —� ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 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 ❑ Community d/gz 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes JW No 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. Directions to Property:Il 6(�` j f � r ��/�al-f 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. 12--,2,g W DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: ❑ 1. 1 OWN the property. 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie Cou ty Health Department to enter upon above described cated in Davie County and owned by �QlYLO� a/- C all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. /�.-2g—y �a &44 DATE SIGNATURE DCHD(1/93) JOAN e. B001-6- 88-217 8001E88-217 1 o,f 209.75• ` ` JAMS% �.. ..•r. 9%4TLEOGe I�o3- Io5 c \m 44,35o SQ.Fr• \ _ !. 0/8. Ac, CD \A\ 1 V' Ic() Ln z IW� OD I a N O '/P n/0Y0 59 54-- E N W /87. 93 CD 40 I C z to I-P q.5 J g�T S a • (=T. U� .0.1 (LN V 1 .052 Ac I N 0 I6. pI f JOAN B. �� 102-rs� • MOPS�� MowE I r I I NIP oIF . N W I b. v —�--- 15010551-54" vl 220.o5' B % K 13-( Rod&.0 THIS WILL CERTIFY THAT THE SUBJECT PROPERTY ( ) IS j (p() IS NOT LOCATED IN A SPECIAL FLOOD HAZARD AREA AS DETERMINED BY THE DEPARTMENT OF HOUSING AND URBAN DEVELINNENT. PROPERLY OF "I 4<eaacr#4 L- ryIrE l- CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN A1-SN • ) • Sc,o,_N ACTUAL-FIELD SURVEY MADE UNDER MY SUPERVISION ON iZ- z 19 SW I FURTHER CERTIFY THAT ACCORDING TO SAID FIELD SURVEY, THE PROPERTY LINES GUPTON-FOSTER ASSOCIATES, P.A. AND LOCATION OF ALL STRUCTURES ARE ACCURATELY ENGINEERS-PLANNERS-SURVEYORS SHOWN H EON." - n 2200 SION CIM PKV( - SUITE 213 WINSTON-S4LEN, NORLH CAROLINA (910)723-1459 Cm MAP OR 2O �0\1507 J'� = SEC. P.B. PG. S E A L D.B. IG4- PG. 3t TwsP. FaRmsaUToa • <7 .� �/ TAX LOT l • yy�°sJ P.I.N. t E COUNTY, N.C. TH LE K1 gN ! SCALE: J 1i� SO TJNOO! DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME c8 P/ll' DATE EVALUATED ADDRESS �J PROPERTY SIZE ZeE PROPOSED FACIILTY 7/ LOCATION OF SITE �•��.�� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring / Pit Cut FACTORS 1 2 3 4 Landscape position Sloe :Z HORIZON I DEPTH 41, Texture groupr Consistence Structure Mineralogy HORIZON II DEPTH O r 11Dr Texture group lei 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 S S LONG-TERM ACCEPTANCE RATE n c SITE CLASSIFICATION: EVALUATED BY: ZZ LONG-TERM ACCEPTANCE RATE: 1 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 i;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 3C-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) ■■■.■■■■■■■■■■■■.■■■■■■■■■.■...■■.■■■■■.■■■■■■■■■■...■.■.■ ■■■■D■� ■■■.■■■■■■■/■■..■■■■■■■.■■■■..■■■■■H■■■/■■■■■■■■■■■■■■.■■■■■■■.� ■■■■/.■■.■■■■■..■■■.■■■■■■■■■■■■■■..■■■.....■■.■.■■■.■■■■■■■.i■ME ........................... ...................................... .................................................................. ■.■.■■■■.■■■■■■E■■■■■EE..■EEE■.■■■�■.■■■■■■■■■.■■■O■■■.■■■■■■■■t. ■■.■...■■■..■■■.■.■■.....■■..■■■..■MME■E.■■■E■■U■■■■�..■..■■.■.■■ ■■■.■....■■■...■■■■.■.■■.■■!■.■■■■■■■■■■.■■■■......■■ .■..■...■■ ■ /■■■t■■■■■■■t■■■■Nt■■.■■■■■■■■■■■■Ott■■■■t■■■Ott■■■■■■■■■ttt■■t■■ ■■.■■■■■.■■■■.■■■■■..■■..■...__��■/■ii■ ■�i■.■■■■■■■_■■■■■■■O■!E■■ ■ ■.■..■■■■...■■■....■.■■■ni■■i..■■.E■t■EE�■ISEM ■■■■E■■■EM■■■■■■■■ ■■■■■■ Ilmomom O■■■M■"■■■■■■u ...........E■■...E..■.E■.....■■E..EE■ENE .�...... 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