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156-172 Fairfield Rd (3) w._ J/X0 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION s *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name l ',;c�.�cc �`_ '. ---Date _', _ N2 8033 Location t ,a(� � �-., GC'. 1� . �',„_�. `~—�_.Ci — '�). t. �`._r�Jr't� `,`�,.�" �: 1 t)c1':] �•, v Subdivision Name Lot No. Sec. or Block No. Lot Size °``' '� House_ Mobile Home /__ Business -- Industry No. Bedrooms -- No. Baths --�-- No. in Family Public Assembly Other Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES d NO u Auto Wash Ma,:hine YES Q' NO ❑ -.�_ 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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTO MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM, I '�I J 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 JY1- N� n,,, � 9 yt�',-- 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. V.o� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE r Davie County Health Department O 0 Environmental Health Section P. O. Box 665I rj095Im Mocksville, NC 27028 1. Application/PermitR,Qequested By Mailing Address %0, C/ �-' 77 Home Phone 03 ' a mQ @ f{,SUI lle /y, d• wok Business Phone 2. Name on Permit if Different than Above 3. Application for: Ur eneral Evaluation 3Kptic 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 - ❑ Basement/No Plumbing No. of Bedrooms GKashing Machine No. of Bathrooms l �,dshwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served ' v 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: Q/Public ❑ Private ❑ Community 8. Property Dimensions 2 A Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 11-Wo 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: J'6 e17 `9 ) 6 00 0 ` This is to certify that the Information provided is correct to the best my knowledge, and I understand I am esponsible for all charges Incurred from this applic tion. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE QN ABOVE DESCRIBED PROPERTY Fandd ECK ONE: �l 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 County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determi said site's suitability for a ground absor ion sewage treatment al system. / DATE SIGNATURE DCHD(1193) - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation L NAME ��c\� DATE EVALUATED J r ADDRESS �` � PROPERTY SIZE 3O,Dcoo UA PROPOSED FACIILTYLOCATION OF SITE �� Water Supply: On-Site Well _ Community Public Evaluation By>ZL- Auger Boring Pit Cut FACTORS 1 1 2 3 4 Landscape position 15 Sloe7. V- HORIZON I DEPTH Texture group �- Consistence Structure Mineralogy HORIZON II DEPTH 14ar .2 Texture group C C_ Consistence Structure `F Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON �• SAPROLITE �^ CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �. OTHER(S) PRESENT: REMARKS: _ �— EGEND 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 <;lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy,clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V+:.-y friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely fine 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 ■■■■Simi■i.■.ii■■■■■■■■■■■_!■■■■■■■■MM.MM..M..�MMm =....■■■.■.■■■ ■.■■■■.■■...■■■.....■■■■...■!.■■■!.■■.■■ ■■M INMINE MEMO ONEEMEMS ME ■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■ ■M■MME■u■E■.■..■■.■..■■■■EMMMM■ ■■■■■■.■■■■■■■.■■■.■■■■■■■..■■■..■■..■■■■■■■.■■ No_■■■!■■■.■■■.■.■ ■■■■■.■...■...■■.■.■■■.E..Mm■...!■=■�!■mm■■�Me.H■mem■..�■=.ee..�� iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii■i1'liiiiisisNiEiiiii�i'iiii.i'ii'imi MEMAIMMEMEMMEMMEM ENE 'ONE SO:E::C:��I ■■...■..■■■■■■■.eMM!■■■■■■.■!.■■■■■■.......■ecce ■ ■H■■..■■ NNE MEMEMMUMMEMEN MIMEMOMMUMMIMMENEEMI MEMEMM ■■M.■■o.M■■■■IMMM.M■■■■.■■■■■■eN M■C MONO ■ ■ ■■U■■■■■■I ■ ■■■■■ME■MMMENNEEEE■■■MEM■MEMM■E� ' ' �■■■ �M■■MM ■.■■■■....■■...!■ ME■M HN■■■■■ ■ ■ No MEMO nommoom EMMEEM EM■Mm E.E■ ■ MMM EEMOM■ ■■■■■M■MMMm.MMmm■■m■EMHm■=■■...■■■■■■ ■ _!■■■.■■■■■■ MOUSSE MEMMEMEM ■■■MM■MME■MM.M■mM■E=MMM■m■MOM■■■�m Nm■ ■ ■■ ■MMMOINE ■MME■■ MMMMEMEME11 MEMNON■■MM■NUMEME ■■MWERMOMMOMMEMMMMM■■M■u■MMIREMEN ■ n■ ■■ ME■M■ ON mummommMOMMOMME MIMMMMMMMMMMMMMMlr ■■■MMM■■EMM■MMMMMMMMm■mMm.■m■■oN ■ MEMMEMEME N■■NM■�..M ■MM■■MM■EMM.rva�..uu.1�1 iii=••• ■ ■ ■ ■m■. ■ ■ .MMM ■■M■M■MM■ ..■►]E!�nMl�■�IMMMI■N■ ■M .■■ M■■■■M ■■MMMSM■MEEM/%M Emkwmmm.m.■■!N■n■ H Oe N■MM■■I ■■.M■■■■■■■oil■�CCa�!'/..■■■■■.M■■■n■ ■. 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