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P6019 Hilton Rd sp tp DAVIE COUNTY HEALTH DEPARTMENT q IMPROVEMENTS PERMIT AND CERTIFICATE .OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a y n Sanitary Sewage Systems Permit Number 6 X -11711!/1! Name ,l. _l�.r-,>l<.; / �r' ;�'v p N� Location .,"` �� �° ;� 11 1. i Subdivision Name Lot No. Sec. or Block No. d Lot Size House dam'"' Mobile Home _ Business _— Speculation No. Bedrooms No. Baths e4V- No. in Family Garbage,Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES n NO � u,/r.,/ ' Auto Wash Machine YES [h NO ❑ Jr, Type Water Supply _ � ;D A6,X *This permit Void if sewage system dedesaribed-betow-i of installed within 5 years from date of issue. This permit is subject to revoca ro�f` n•if•site��tans oi-fhe'in ded use change. y � f s� 3 Improvements permit by _ /-Z �` *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 J3� 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. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section f Soil/Site Evaluation NAME / DATE EVALUATED ADDRESS , � PROPERTY SIZE PROPOSED FACIILTY7 6 LOCATION OF SITE /�"=1�di✓.�'� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L 4- e—Slope % HORIZON I DEPTH " y Texture group S'.4- Consistence 19r Structure C C. Mineralo /.'I /- T i. -7 HORIZON II DEPTH <l Texture group [� Consistence A= Structure 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: EVALUATED BY: ��l 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(01-901 ■■..■/.■■■■■■■■■■■■■■■O■■■t■■i.E■■Ont..■■t■■■■■mtt.ti■■■■■../.... ■■.■■■■■■.■■■/■■■■.■e.e■■■e..e.■ ■■■■nee■■■.■■.!!/■■■■■.lei■■■..■■.1 ■■■■■..■■■■■■/.■■■.■■.■■■■■■■■■■��■■..■■■■.■.■..Gid■.■..�li■■■e■■■■ ■■■■./■t.■■■./...n■..■■■/.■■■■.■��..■Ott■■......■C�./�■.■/,/■.■■■■■■ ■■■■■/■...■■■■..■/.■■■..■■e■.■.■■■■■■■■.■t..t■EMIL/�C9C1.■■■..Ei.E■■ ■■■■■■.■...■■■■■■......■■..■■■■■.n■■..■■.■■■■■■■■..■■■■■n■■■■..ice■ ■■■..i■..■.OEt...■t....EtEO..■.iE■.N■.EE■.NNE...■■�.EE■..■.■■e..i ■■....tt■..t....■....■..■...■■■■ r .■■..■...■...■wry■......■....■..■ ■..■.■..........t....■..wee■...===■:�i■.►�■■..■■m■■Fan■■■■ ■■■■■E■■ .................................................................. ......................................................... ........ ■.■i■..m■■E■■■■■m■■■■.■■m■■.■.E■/iii■■i■■.i■.■■.■■.■m.e■..■...■ mono :EMEM::Z ................................ ................................ RNME.'iii iii�iiiiii'i=i��ii'i■ iiiiiiiiiiiiiiiiiiiiiiiiiuiiii.�ME ........................[.......�........................... NONE ................................ ................................ ■.■■.....■....n■.■.■..■.. C..............■..............ion....... .................... ............................................. .................................................................. ■■■■■■e..eee.eeeeeee■eee■eee.■■■■■■■.e.e.ee■■e.e■e.e■e■e■e■e.■e.■■ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT �. Davie County Health Department Environmental Health Section P. 0. Box 665 RECEIVED Mocksville, NC 27028 MAY© 8 1 . Application/Permit Requested By Mailing Address4_ Ail .1-t-C Home Phone Business Phone Ph/o�ne 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation S/Tank Installation 5. System to Serve: House Mobile Homej` Business L Industry Other 0 Unknown 6. If house, mobile home: ' -Subdivision Sec. Lotit No. of People Dwelling Dimensions No. of Bedrooms '2 Basement/plumbing Na. of Bathrooms Basement/No Plumbing 0 Washing Machine Dishwasher Garbage Disposal 7. If business, industry, 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 8. Type of water supply: 0/public 0 Private 0 Community 9. Property Dimensions gc rr.-< u7 X �7n 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes 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. 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 applicatio Xez S Date Signature Directions to Property : Me le DCHD (10-89)