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P6141 Williams Rd DAVIE COUNTY HEALTH DEPARTMENT f: bXe 0. K� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a oy-4 anita Sewage Systems j-�`�; Lis '4'. 'Permit=Number Name � � -- X SIN ', 1 Date l_ NO 614�. Location �' v .° % �` - o/•� ,� ,� I = Subdivision Name` Lot No. Sec. or Block No. Lot SizeHouse Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family, Garbage Disposal YES-E] NO.f- Specifications for System: ;- Auto Dish Washer YES NO ❑ ( .-- JX :vim Auto Wash Machine YES 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. 1 .F � 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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by < f F Certificate of Completion Date ap _ "The signing of this certificate shall indicate that the system described above h s b en installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guar ntee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested ByBA y Business Phone 2. Address o a 3. Property Owner if Different than Above jar ' ',Q uA Address 4. Permit To: a) Install 2 Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home --� Business Industry Other bj Number of people 6. aT If house or mobile home, state size of home and number of rooms. House Dimensions �a Bed Rooms—Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory showers washing machine 1 dishwasher sinks .3 8. a) Type water supply: Public Private Com unity b) Has the water supply system been approved? Yes No 9. a) Property Dimensions G7 S b) Land area designated to building site j yq g–r L c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? N L9 What type? This is to certify that the information is correct to the best of my knowledge. 91W& IMA Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS l C- /C� / PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public `J Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L-- L Z_ .L— Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group e179 Consistence i i- Structure /l i Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON f SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , ' i SITE CLASSIFICATION: 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-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 Mi neraloity 1:1, 2:1, Mixed Notes a Horizon depth - In inches Depth of fill - In inches t Restrictive horizon- Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free watef 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 ■■e.ee■■■■n■■.e■■■■■■■■■■ecce■e■■■e.■■nn■■■..■■■■■.■■e■■■■ ■■■.■eti ■■eee■■.■e.ee■nee■■.ee.■■■■■■■■■ ■■■eeee.ee■■e■■■..e.ee.e■.e■e..■ ■eee■■..■■.■■■e.■■■ee■■■.■■■■.■■■■■■e■eeeeee■■■■eeeee.e.■■.e.e■■■■ ■e■■■■e■■■■eee■.■e■■■■■■■n■■■.n■■■■■■.■.e■■■■■.■■■■■■■.■■■■■■■■■■■ ■■■eeeee■■e■n■■e.■ne.eee.■■■eee■■■■....■■■■..■.■.■.nme.■■.■.■■..■ ■e■ee■..■■.■..eee.■■e■en■eee.■ee�■.■...■■..■.■■■■..■.■■.■.■.■■.■■ ■■n■e..e■.......e■....ee■.e■.■eee■.■..■■■.■..■me■■m■.e■.n■■■■■.■■■ ■■■■e�ei.■.....■■■■.■..■■.■.■A.n■■■.�.■■.■....e■■■.■■■■■■■■■■■�■■■ e.■e..ee.eee.eel.C.. �■��i�.■...■.eee■■....e■■.■■ e.. ■■■r�e.�■e......■■...■..e..eee..�3■■■ne.iae..■.n.e■.■■...■■e.....■■ ■e.[�■....■...■..nnee■e■.eee.■■e.■■■ee.eri.■.■n■e■■■.■....■....■.■ ■ ■.eee■/i..■...■■...■...■..■■..��.■.■■■■e.i...■.s■■■■e.■■..s■■■e■■..■■ ■■n■■■rim■■■■■■■n■■o■■....■■■■i.m■■■.■■.■i.■■.■.■■mnnm■■■■■n■s■■■.n■■ iSGGG�GG�lGGGGGG3000GGGGSmmolimG GGGGCIGGGGGGGGGGGGGGGlGGGGGGGS ■■...,....■m■■.■■■..........■.■s■�e■■■■■■.......■■■■ moon ■■■■■■■ ■■..rim■■n.e■■.■.■nee..■■.■.■eee. ■..e.■e..■■■■ne..ee..e.■■e■ nee■ GGGGGGGGGGGGGGGGGGGGGGGGGGGGCGGGGCGCCGGCGCCCGCGGM=GGGGGGGCGGGGGGGG MMMAIN GGGGG:G:GGGGGGGGGGG:CGCCGCGGGGCGGGGCGGCGGG=GG:GGGGGMOON 0 ■■■■■[�■■.■■ee.ee..e■..■■..■■e■■■ ■nee....■■.■.. ■■■■n■e.e■■e...e■ GGGGGIIGS"'GGG�GGGGGGCGGGGGCGCCGCGGGCCGCGGGGCGG"■CGG:'.GCCGGGGGGGGGGC ■■■■e[Im ■n■G.■m.■■......■.■■■■■■■■■■.■■■■m■m.■■■■■■■.■■em■.m■■■■■ GGGGG�IGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGCGGCCCGGCGGGCGGGGGGGG=GGG■ ■■.■■.■■■....■n.■■e.■■...en■r�e■se■■■nee■.■e.e■■e.en■■■■.eN...■■■■ ■■n.....ae■■■■..s■...e■..■eee...e.■■...e.■■■■■■..e.ee..ee■e■■■.■e■ ■■e■ee■eeee■e.�...■■■e.■■■■■■■.■ ■ams■■e■■■■■.e.e..■■..■■■ee.e■e■