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659 Howardtown Rd DAVIE COUNTY HEALTH DEPARTMENT t` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II cif G.S.Chapter 130a Sanitary Sewage Systems Permit Number NameDate ___1 V' N2 8191 17i '12-7 r Location ZZ r Subdivision Name Lot No. Sec. or Block No. Lot Size ,A • �� _ House Mobile Home ____ Business -- Industry 1/ No. Bedrooms '`�—_.No. Baths �--_. No. in Family _ Public Assembly Other Garbage Disposal YES NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ �* p Auto Wash Ma^hine YES NO ❑ Type Water Supply _� 1 ----- -- �i�,{_'' / 10 G *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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. 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 2� - 73/1W Certificate of Completion GG� 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. ,K CENTURY 21 LIFESTYLE REJ 9402511 P. 04 , � � @ � odl APPLICATION FOR SITE EVALUATION/IMPROVEMENTS r D Davie County Health Department r ( ell Environmental Health Section P. O. Box 655 ( Mocksville, NO 27028 X, 1. Application/Permit Requested By - -- - =----- --- - /� ,1 Mailing Address Ll� Y__� �"Y7 I � Home Phane�� Z�f�__ Ka I L��1 Business Phone,_,.. tSL� 2. Name on Permit if Different than Above - ----�--- -- ---- a` 3. Applicatlon for: Q General Evaluation W—Septic Tank Installation Permit Q. SyMsm to SBrvo: X-'louse ,Mobile Home ❑ Place of Public Assembly [3 Business O Industry ❑ Other ❑ Unknown 5. It hGOS9, mobile home: Subdivision_ v —_ Section _.—� .� Lot # --..-_----- [: ► ❑ 112soment/Plumbing No. of People �.,_ _, �-- �_-- ❑ ESasementMo Plumbing No, of Bedrooms 1-<1 washing Machine _ No, of Bathrocros --•----- ------- _ ;'Dishwasher Dwelling Dimensions--_-� _ Garbage Disposal 6. ,if business, industry, place of public assembly, other: Specffj type ---- ,� NO: of People Served —_,--.—�,, _ fv`O, 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 Q � ❑ Private El Community 8. Property Dimensions-•--_--._—_-� Sewage Disposal Contractor a, Do you anticipate additions/expansion of the facility this sytern is intendea to serve9 l/r es J No If yes, what type? 'NOTA: fmprotlernents Permits shall be valid for a prnoc of yea-s i.om c1atF. r.s ed. Unprovements Permits arc) ,,>> s�. �t to revocation, if site pians or the intended use changer. Pfte^tivfr rjc1, "1r--r 1, 1882• - III Directions to Property: AY . 15/4< � r��s lhr � Thi:; is to certify filet the inicrm 3tiCn provided is corse:t to the b& t of my knowlaa•ge, ane I understand t am Ii�C.Urrnri from this a•pp!i __......_. .. _.. - DATE...... --- — - NATURE C c arq_,1;Fr�T FOR s!TF E_!��!A11a 4 TO BE DOVE OH A20-VE ;D.E$C,F&F.0 f-P" -,,TY MUST CHECK ONE: ❑ 1. 1 QYM the property. property. 4 t If you checked Box*Z the rest of this form P..dt 1SI be c-.ompintsd by th:a c,�:.ner or a person autn,ar,-,d b til", ovlf,,Cr: hereby give consent to the Authorized representative of the Dav �� Ca Ito t7 Department to ent r.:,otl a eve descr"Ibed " property loo0od in Davie County and owned by trust to conduct all testing procedures as necessary to determine said .v:s :.tai!._, ^r;; on sr�evagr� Hent ' fns grOr,",ri 8t? y and disposal system. r ' I DATE l i' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �. 1YS DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITEw� ��-�.. Water Supply: On-Site Well Community Public Evaluation By: Auger Boring J Pit Cut FACTORS 1 2 3 4 Landscape position L- A-- ,C. Slope HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH 3'al f 3G t- Texturegroup Consistence i Structure Mineralogy HORIZON III DEPTH Texture grou2 Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 7 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-Vc.-y 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(01-901 ■■.■.■■■■■■.■..■■....■■■■■■■.■■..■■■■■■■■■.■�■■■.■■■■■■■■.■■■.MEMO ■■■■■■■■.■■■■■■■■.■■■■■■.■■■■■N■■■■■■■■.NEED ■..MEMO ■■■M.■■■■■■.■ ■■■■■■..■....■■■■..■■..■..■■■■■.■.■■■■■■■■■■EEE■■■■ ■■■■■E.■.■E■■ ■■...■.■..■.■.E..e/............. ■■.■NMMM■■■■■■■.■.■■■■MM.■■■■■■■ ........................... .............■■.■■._■■■■_■■■■_■.■....■ ■■■.■■■.■■■■■■■■.■■■■■■■■■■■■MM■■■■■■.■.■■■.■■ .■■■■ON ■■■■■.■■■■ ■■■■■■■■■■EE■■■.■■■■■.■OE.N■/■..■■■■■.NOM .■■ ■ ■ .■■ �■■.■■■ ■■ ■■■■■■■.■■■■■■■■■■■■■■■■■■■■N.■.■■MN■■N.�E■■Q M ■■■Q■■■■M■n�■■ ■■■.■■■■■■■.■■.■■■■■■■■M■■M■■■■■■■N■■.■.■■■■■■■■O ■■■■■■■■■■■■■■■■ ■■■■■■■.■■■■■■.■■■■■■■.■■■■■■■■ ■MEMO.■N■■■■.■■■■■■■■■■■■M.mom ■ ■■■■■■■■■■■■■■■■■■■.■■■e■■■■■E■■.■■■ N.■■■■.■■■■ MEMO■ ■■■N■■■■ ■■■■.■.■.■..E■.M■.■■■■.EEE....M■■■■./MEMO■.N.■/■■O ■ .■■■.■■■ ■. ■.....■■■■■■■M■■■■.■■.■■■■■.■■M■ MONSOON■ MM=MMMM MM■■ ■ME■■■■■.■. ■■■■■■■.■■■...■■■■■■■H■.■■■..■■■..N■.■■■■■■■ .................■■■■.N.■■■■■E■■■■.■■■.■■■■..■/M ■OMINEEIE.■NM■I� �L � OM :Q:QQQ:.':Q:::QCMEMEMMEM ' ■ 'QQ\Q�QQQQN�'n'Q�QQQQQ�QQQQQ..QMEQQ:QQHNM 0 mi N■ ■QQ"CQQQQoon ■■N■ ■.■■.■■■■■■■■■■■■■.■■E■■■■■■■■■■■ ■EMNONM■�■ ■■■H ■■E■■M/ ■.■■■■■■■■/■E■.■...■■■■■■■M■■■■N ■ NONE ■ ■ ON EN is QQ minQQI � SEM IENNE ■E.■M.■■■MEMO■E■■■�iir■�■�Il.■■■■■■■■■■ ME ■' H.N ■■■.■■■■M� ■.■.■.■■■■.■..■■■.I/■O/tom! .■■M■■■■=M■■ -M_ WOMEMEN Room M■MMO■■■ ■■■■■■■■■■■■H■■■■Y�t�.■■��■n■■■■M■ n ■■ ■.■MENE■ ■■■■■■■■■■■■■N■■■.■..■..■■ MEMO MEN--- ■ ■■ ■ON= ME ...■..■.■.■N■.■■M■.■■■..■.Q n.=■_BM ■ ■■M■■ ■■ ■■.■■■■.■■■MM■.■eE■■u■■■,■.■■.■■ ■HOMO■ IE= ■e■■M.■..■■■ .NNUN■ (�■. .M■ ■■M■ ■ ■ MONO ■MM.■■■.■ .■iQ■■.u■..■ i1�.M=.N■ ■■ No ■u■M. ■ M MIN so SOMEONE :000QQQ:Q :Q: :S I:::::: ONES SM NEON... ..Q..Q.....C..NE..QQ.'.N..S.E.E.M.M.:..�Q...�Q.'■■l.n�.ME.0.Q. .■ ■■':" u'::Q �Q MENMEM■■MNMUE■ ■ . ■ WEBB .■o.M.■■ ■■■■■■■■■■■.■■■■■■■■■■■.■■■■■.■.�QQ�iQ'.Q■' ■ ■ ■=SEREENENESS ■.■..■■E■■M■■.■.■■■■■■■..■■■■■■ ■■ ■■■■■O■■■■ ■■ ■■■M■.■ -- ■■■■■■■■■■■■■■■■�■■■EM N.mom NEW M.. iQQQQi"QQ.i.='.'000QQQQQQQ'i.QQQQQi■Q" ' ■ ■QI'i'QQiMMEMME MMEMB .:"':=:QQ=:'::Q:Q000:QQ::Q Q: ■■Q ON ::::::MMEMMM0 NONE ..QQ:/■■M■■.Q■■■■■N■.■■■ ■Q■■n ONENE■QQ.■■...■N■.■■■...■ ■......H■M■■■.N■MMEMEMEM.■MEM■ M■.■■..e■.■.■.....■....e.......■ .......... ........................... .......................... .................................................................. 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