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177 Everhart Rd (3) o DAVIE COUNTY HEALTH DEPARTMENT L IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G;S.Chapter 130a Sanitary Sewage Systems. Permit Number Name ��<<�' /'/+�6r rf y � /./ �7,, /�r Date �Jj+ N0 Location ' 141 Subdivision Name Lot No. Sec. or Block No. Lot Size '�� 70'- House Mobile Home _L'' Business - Speculation No. Bedrooms ��``�—.No. Baths ' No. in Familyd� _ Garbage Disposal YES ❑ NO [2� Specifications for System: Auto Dish Washer. YESNO 'S- Auto Wash Ma shine YES LJ E3 , � _ G}��NO E] / � 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. 4 I�G �'V'1 •// f } 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. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-.5985. Final Installation Diagram: System Installed by ?�l �T VZz' 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS. PERMIT Davie County Health Department _ Environmental Health Section'- R 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 99,x'-8 6 1. Permit Requested Ry 9�KBusiness Phone S104nYL— 2. Address 3. Property Owner if Different than Abov _�r e e � Address cAS f 4. Permit To: a) Install 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 IndustryOther b) Number of people 6. aj If house or mobile home, state size of home and number of rooms. House Dimensions X 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 2 washing machine dishwasher 1 sinks 2- 8. a) Type water supply: Public Private_ Community b) Has the water supply system been approved? Yesy No 9. a) Property Dimensions b) Land area designated to building site c) Sewage Disposal Contractor r=. 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. 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 S DATE EVALUATED ADDRESS PROPERTY SIZE ��' PROPOSED FACIILTY �/T LOCATION OF SITE �✓ A�� f Water Supply: On-Site Well tf Community Public Evaluation By: Auger Boring I Pit Cut FACTORS 1 2 3 4 Landscape position e Slope % 61L HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texturerou 0, ('i 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 SITE CLASSIFICATION: ► EVALUATED BY- LONG-TERM ACCEPTANCE RATE: V" 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 Mineralogy 1:1, 2:1. 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