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P7550 Heartside Ln r s>,. -•.�('"°"dWM..iaaif�.,��4 y Y ...'r).- .^^r."r,.y .. .r,:_. a"Y'F �4 a a•f:.z Y"" �.� 'u:yr. t - _ ... .., . :t" .., v . : - - w � DAVIE COUNTY HEALTH DEPARTMENT �-� IMPROVEMENTS PERMIT AND CERTIFICATE-OF COMPLETION _ *,NOTE:Issued in Compliance With Article II of G.S.Chapter 130a .z Sanitary Sewage SystemsPerm.1t Number C' 5 N-0 . Name�..� �► c} �e 4Date 7550 Location Subdivision `Name Lot No. Sec. or Block No. Lot Sizee.� s4 House "` Mobile Home Business —_ Industry No. Bedrooms .No.'Baths No. in Family 4 — Public Assembly Other Garbage Disposal YES NO ❑ Specifications for System: Auto Dish Washer YES (tom ..NO ❑ �' � .- , ) � -Zlox Auto Wash Ma thine YES ,[�. NO ❑ `i c t/ J 11 ,.r Type Water Supply — --- J� f 3 X L' D *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 pl�r the intended use change. r • ti } u°i a r . . f • .� 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., *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 _ � a Certificate of Completion �� Date signing of this certificate shall indicate that the system described above has been installed incompliance with standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function _ Wstactorily for any given period of time. F61 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ' ' • Davie County Health Department • ' '_` Environmental Health Section • - r P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By A N N �n 5 Mailing Address t` �� 8' U n/G� 6� Home Phone Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: -- lrGeneral Evaluation ❑ Septic Tank Installation 4. System to Serve: 911!!Ouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # 1� ❑ Basement/PlumbingNo.of People ` ❑ Basement/No Plumbing No. of Bedrooms 3 3-Washing Machine No. of Bathrooms 2 G-Dishwasher Dwelling Dimensions a 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 9?'Private ❑ Community 8. Property Dimensions- /3 VZ Ae,r� S Sewage Disposal Contractor ? 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 9-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: stied o m <��Fk+, This is to certify that the information provided is correct to the best of my knowledge and I unders nd I am responsible for all charges incurred from this application. mss-95� - - DATE NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. B"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 representati f he Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to eterm' a said site's suitability for a ground absorption sewage treatment and disposal system. DATE 60NATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation q NAME t;K�vo DATE EVALUATED 1J -�� J ADDRESS ' -r"" PROPERTY SIZE 13 � PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation ByL rc.l. Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH Texture group Q L C,I— Consistence li�m V-71- Structure QSir Q,V_ MineralogX , 7 ' HORIZON II DEPTH Lt:00 b` a` Texture group C S C Consistence '-1' Structure Mineralogy ` HORIZON III DEPTH 4, Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS %N S S RESTRICTIVE HORIZON — SAPROLITE y S S CLASSIFICATION �' S S LONG-TERM ACCEPTANCE RATE a SITE CLASSIFICATION: �S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 44 OTHER(S) PRESENT- REMARKS: ,,� ^ S> G+Q - \1\ Q �•S (p�v LEGEND 114 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-Finn 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 Mineralotty 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 ■./.■ee■■e■■■t../.■...■■■..■.■■t.■■e.■eee■■■/��...■...■e/.teeeeeee■ ■■■■■ecce■■./..ee■..■■■een■ntr,N■.e■■..■■■_.t.....e:.■B■■■.►/....■■■ ■■.■.:aee•t.�>it.e/..■eee.■.iiti�■�J. ■t■■■.N■..r...�■.►�►.�.Et■N/..e■■t■ ■■■.1.■■■..■iii...■...■■ee..'�t7.1�■�...■■...■.Il.ir►./1%l:\.t■■...■■..■ ■.■■i■..■.eye.i■../■N..■..■rr!t..'i.■........■..►�■■�■■■I■■.■.■■■■■■■.■■ ■■..i..■.■rye■■I....■■e....■��e5a.e..■.■.N..../..1►.■ .r�ri■.■■■■■.■.t.■■■ ■■■■i�■■■■�■■■�■■■■■.■■■■.ti■■_■_■int■■■■■■■.■■t■■■►■■■■■■.■■■�■■■■■■■■■■ ■.■...■■■.■■■■■.■■■■■..O\■■.■■■■■■ ■■..■E■■■■NB=C.// i7.■■.■■■■■■■ .■.■...N.■.■/...e..■/.■/■B\..■■ .■../....�.li.\�liN�\.It....... 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