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1185 Eatons Church Rd t v •� � tom' ` - '� � V V DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name— 4. VJ \ �-c, P. Date 1 N267. ().YL . Location R- fi V a u\\ 0, Subdivision Name Lot No. Sec. or Block No. Lot Size C C, ' ' House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ , NO E' Specifications Jor System: Auto Dish Washer. YES ❑ NO E) ! U CSO Auto Wash Ma,hine YES Cp NO ❑ _ h t Type Water Supply *This permit Void if sewage system describe below is not installed within 5 years from date of issue. Tlis;permit is subject to revocation f site plane r the intended use change. OU r 1 � 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 K'�'cC c le- ,r /Op� r- Certificate of Completion I 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,wR - 10_. '0 :�' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT _ ' 1. Davie County Health Department �R j ,j' Environmental Health Section RE�+�•"� P. 0. Box 665 Mockaville, NC 27028 1 . Application/Permit Requested ByJ A Mailing Address _ �7J�c�� "�P;.6 2 Ja � Home Phone o rte- Business Phone 2. Name on Permit if Different than Above y 3. Property Owner if Different than Above 4. Application/Permit For: C) General Evaluation RS/Tank Installation 5. System to Serve: House mobile Home 0 Business L Industry - Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. ,-pf People �- Dwelling Dimensions ,,,No. of Bedroom Basement/Plumbing "'No. of Bathrooms Basement/No Plumbing Washing Machine J Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type w No. of People Served No. of Sinks No of Commodes No. of Urinals No..4 of Lavatories No. of Water Coolers No of-,',Showers 8. Typle 'if water supply: C Public Private Q Community •4k ACS 9. Property Dimensions 110'. Sewage Disposal Contractor 11 . -.,Do',you anticipate additions/expansions . of the facility this system is intended to serve? 0 Yes 0 No { :I'f"'=yea., 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. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. Date Signat re Directions to Property : 7171' 0 7f— / o 7L l >. DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME _ �� \ 4 A �� DATE EVALUATED ADDRESS PROPERTY SIZE3�� PROPOSED FACIILTY \x\• LOCATION OF SITE Water Supply: On-Site Well ✓ Community Public Evaluation By:C3t 1- Auger Boringy Pit Cut FACTORS FCL L'2 3 4 Landscape position ° R Slope Z (0 - 20 O HORIZON I DEPTH 8'" F1"Texture group _ $o L C L C L Consistence '-1 Structure L1 P, Cr MineralogX 1 . 1 HORIZON II DEPTH fs' `D_11 LI a 6 Texture group C C C, C Consistence El F j -1 -� Structure B k 8 K lc- Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS .s s .Ss ss RESTRICTIVE HORIZON - — SAPROLITE - CLASSIFICATION ,S S LONG-TERM ACCEPTANCE RATE 4 y ,4 SITE CLASSIFICATION: . S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: ► 4 OTHER(S) PRESENT: REMARKS: S''� s.� 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-Firrn ' 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, 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 ■■.■.■■■■■■■■■■■■■■.■...■■!.■■■■■■■■t■■■■■■►■�■.■■■tom■att■..■■■■.■ ■■■■■■■■■■!■■■■■.■■■■■■■ !!/!!ll�r■■■■■■.�■■.■■moi■■■■■■■■1■■■■.■■■ ■■.■■■■■■■ttt■tt.t■■.■■■■It■■■i�\17t■■■■i./..■..'��■I.:1■■■ ■■■ 11■■■■■.■ ■ ■■■.....�..............■....�.....�.I�1■■■.ti!.■t■■■��1f111ttt�t..�1■■■■.t■ tt ■..■■■■t/r■.■..■■■■11.■.■�.i.l■■t.■■It.■t■■■ ■�!J■■■■■■■ 11■■■■■■■ ■■■■...■.■■■■■11■■■�,�.��J■■11■■t■ ■■■t■■■■■t■ttt.l■■tt■■■t■■tttlltt■.■■■ ■..■■■tt■■■■..'itC\ll;►mat■■tl■tt■.■■■�■t.■■■■■■t■Itt■..■.■■■■■.11.■.■■.■ ■■■■■■■■■..■.■.■!�'J..�J■tib■■■■■■■ ■■■■■■■■■■11■.■■.t.■tt■t■It■■■■■■■ ■.■■■■■■ ■t■/1...�■■%..■.....■t.!\epi:■■■■■■:/ttttt..t■ttt■1■■t■t.■ ■C■■■■■■ ■■■■■i■■■t. .............................................. 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