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233 Hilton Rd Nt.._<C.,Y .....,.:. 'K}.......v. s r...•. I ,Y�:-t`...: .w-a�..i +:'41"�p �_ T '` _ .r t .r r - t b � DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION LETION 'e*NOTE;Issued in Compliance With Article I I of G.S-.Phapter 130a Sanitary Sewage Systems Permit Number Name (-�t�r� r��,.�i- r�7�1 ' i is l�%��,_ . +�/' Date '' No Location Zf f,y7 -�' P,� ^ ✓ ffi 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 p- Specifications for System: �s,�s' Auto Dish Washer. YES NO ❑ . Auto Wash Ma.hine YES NO ❑ � �C r� l % �� Type Water Supply' *This permit Void if sewage system described below ' ,_ao te(led within 5 years from gate of issue. Thisrpermit is subject to revocation if site plarTs or the inteade5 u hange. / t 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. i Final Installation S Diagram: stem Installe�_ 9 Y . 30 Certificate of Completion Af// Date i9- 9 "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 i•��u� �l Environmental Health Section P. 0. Box 665 gMocksville, NC 27028 3Q R 1 . Application/Permit Requested By ��T (C• �ySTL� Mailing Address �ocJ` /20X Z/°/ A2V*16�z /✓C Z.7oo4 Home Phone Of/cl ' �7r7Business Phone 2. Name on Permit if Different than Above ��,j, \ 3. Property Owner if Different than Above ��oG/ S7 p� O K-rr') 4. Application/Permit For: 0 General Evaluation S/Tank Installation 5. System to Serve: House u Mobile Home 0 Business 0 Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Z• Dwelling Dimensions 3 y`' No. of Bedrooms Basement/Plumbing No. of Bathrooms 3 Basement/No Plumbing a- Washing Machine ,� Dishwasher 0 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: & Public 0 Private 0 Community 9. Property Dimensions a -t aCp�,S 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes R.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 application. /9 1-,7 ,Qct /gel �/JA� u Date Signature Directions to Property : of .S 1617'1 1:70 S r,!�4 l✓�-+i Ge /s -171-�1 / /41-/ c O� T C',Cl.✓ /'SCC r yvJ �it�li(f C✓Cr/� / ��f �1"'! T/' � ��i✓T� � ,,�1��T-�you ��2� • DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT ._. Environmental Health Section Soil/Site Evaluation NAME ;�®sf� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE ] Water Supply: On-Site Well Community Public (/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position �L ,t_ ._ 1..1 Sloe Z -- _P HORIZON I DEPTH le Texture groupL .L 1- Consistence Structure Mineralogy HORIZON II DEPTH i' Texture group Consistence 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 // o SITE CLASSIFICATION: �)8 1Wae EVALUATED BY: LONG-TERM ACCEPT NCE RATE: OTHER(S) PRESENT: REMARKS: 4•l //�' ,7o ��/—� ./�� , 1 i� /.�/ly�a�%s.��t / �i�/�., LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrade 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 Mineralog 1:1, 2e1, 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 ■■■■.■■N■/■.......■■....■■E...■ .......■.....e.i...Ml.......�ME■ ................................................ ................. ■■..■■.....■■■...■■■■.t■:s■.■■■..�:�===cam.....■■.E.■t...■ ■....■■■ ■■iiiiii■■iiiviie■iiiiii��eiiiiiiw■iiaiii��■�ie�i�■■iiii.�■■iiiiiie■ .....■ ..■■■■ ■■■■■.� ■■■■= MM.■■.��...C*J.�......�...../� ■.■..■■....■....■■...■■■.■■...■./■■.■■■■■■■■.■■■.■.■.......■■ OMEN NONNI ........................................... ..................... ................................ ................................ ................................................................EM ........................................■......................... ■...MEMO.■...■N....■ ■■..■....../.■.....s.eN.M.....■...■.......■.■ ■■.■.■■.......MN.■.w.E..........�■............MME...............■