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P6191 Burton Rd DAVIE COUNTY HEALTH DEPARTMENT 111 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - *NOTL:[pued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems A Permit Number Name \P'!) V.�*,��.Q Date N� 6 Location S ision Name Lot No. Sec. or Block No. i Lot Size 41 ��s '�`w House Mobile Home — i Business Speculation No. Bedrooms % No. Baths No.-in Family _ Garbage Disposal YES ❑ NO [R Secifications for System: Auto Dish Washer YES V NO p 7 p o Auto Wash Machine YES E? 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. i V3 M 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 %9_aL R Fv57 ►J p W dog Eue >J F.,. ,. F-VC r, foo f : Certificate of Completion Z! 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 PER I Ct1r r Davie CautLy Hs81. De_pjLr rpt Environmental Health Section 1 P. 0. Box 665 OCT 18 Mockoville, NC 27028 j 1 . Application/Permit Requested By Mailing Address ` v �/- 646 •� /� Home Phone y/l — 727--/7L-o Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than .Above 4. Application/Permit For: 0 General Evaluation N?zS/Tank Installation S. System to Serve: D House y8 Mobile Home2)4u0 Business Industry u )the �' 0 Unknown 6. If house, mobile home: Subdivisionpec. Lot# No. of People Z. Dwelling Dim io� 2 No. of Bedrooms -0 Basement/Plumbing No. of Bathrooms 2 Basement/No Plumbing Washing Machine ,&=Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type No. of People Served C_. No. of Sinks �3 No. of Commodes '7 No. of Urinals No. of of Lavatories Zr. No. of Water Coolers No. of Showers Z. 8. Type of water supply: -ta!!�Public 0 Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor U: 11 . Do you anticipate additions/expansions of the facilit this system is intended to serve? WYes 0 No If yes, what type? v,C�i .(/� %i�Te/�► *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plane or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to tree best of my knowledge, and I understand I am responsible for. all charges incurred from this application. Date Signature Directions to Property : mil / DCHD (10-89) •�' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 1Soil/Site Evaluation NAME 1'��+c�'0 2' d W DATE EVALUATED 1 - ' c? 0 ADDRESS S h n` PROPERTY SIZE p PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:C. NL Auger Boring Pit Cut FACTORS RQ) 2 3 4 Landscape position Sloe Z % d- _HORIZON I DEPTHTexture rou L Ct_ C L S CL Consistence Fri I Structure Mineralogy1 1 HORIZON II DEPTH iA 61, 1 Q b'. Texture group Consistence 1=T T PT Structure kZ #, 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 LONG-TERM ACCEPTANCE RATE U S- d 5 b S''l•D SITE CLASSIFICATION: u EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 3,S 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, 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 1 ■■iii■ii.iii■.■ii■i■■ilii■■■■■■i■■■■■■c.ii■■■l■■c■■■■ii■■ecciill�.11 ■■.■■■■N■■irr�\■■■■■■iiiii■■iLi■■■■■c■■■■iiiiii■iii...i■■■■■i■./1■ ■■■■.■C.!i/..■■ill■ii.■'t.■■■.■■.■�■.■■■11■■/■■�..■■■■■.■■■.■■■■/I■!■ ■■■■/■t■■■.■■.■Iii■�'1i�1/■■■■e■N■■■■■■■■■Ile■■■■■■■.■.e...■■N■■■►t■.■ ■...■■■.■■■iii:.J■c■■.'/■■■■..■■■■.■.■■..11■.■■.■■■■.■■.■■■.■■■■■■I/■n ■.■■��■..■.■■..■■.ell■.■.■■■■■.■■■■■■■■11■■■■■■■.■■■■■..■■■■■■■■7►7/1 ■%!!iY■■■■■■...C�►'i■■iiC:iCiiiilllr:l��l:�■■■■■■■■■■/�■ii��:1■■■■■■/it` i/ ��/►�e� /■■/■■■■■r:�■■■■■■■■■■■Ir��■■i_�u:e■■■■■■■.■■../►,eeene�e..■■ne..r� ■\'iiiiii■iiiiiiLal>■■■■�■■■■■■r/Il�I�r�■ciiiii..�..i.iiiJ■■■■■■■■■ai■■■ ■■.■...w■■iii■1i■�iii■■■■■■■■■■\\�►Ilii■■■■..■i..■■.iiiii■ ■■■■ilii■ i■Nii�iiiiiiiiiiiiiiiiiiiiiisiiiiiiiiiiiiiiii�iiiiiiiii. ■■iiiiiii ■■■.■.■iliiiiiii.i.ii.iiiii■■■■■■■■■iii.iiiii.ii■■■iii■■li■.■■..i■ ■■■■■■■■■iiiiiiii ■.■.■■ilii■■■i�■■■■■■■■■Ili■■■iiiceil■c.Ic.■■.■ iiiii ■■■■■■■■■■■■■i■■�■i■■■i■■■■■i■iii■■■■iiii■i■■■■■ii■■■■■■■■■■■■i■i■ ONES■■■...■■�■.■■Ii■ ii�c.■■■■■.i■■■■■■■■■ec■■■■ici■■■■■.iii■■■■■■.■.■ ■i■■ilii clii.ii.■i ■iii■ii■■■■■ii■■■■iii■■■1e■■i.■.■■I■■■i.■■iii■ ■■.c�■■.■■■i.i■■IIIc..■■■iiiii■.■■■■■■ce.I■.e.■■■■■Tie■■i■e..■■.■■ ■■!e.■■ ■■i■ i..■ilii■i■.■■■i■i.■■■c■■..■■■■■■■..ilii.■■■i..■■■.■ .............. ................................................... ■■■.■■■ic■.■■■ii■iiil■i■iii■Ic..■■■■■■I■i■l■■■■■■■Illi■.■illi■Ie■■ ■ii■iiiiiii■■■■■ii.■■■■■■iiiiiiii■■■i.il■■.■■■iii■.■■iiiiiiiiiii.■ ■■■.■. ■.■cc■ ■■■■■■ ■■■■■■ .■■■■ee■■■■■ ■.■■■■ ■■■■■■ ■■■■■■i.i■■■■..ilii■■..■■■■■.■■■■I■■■e.■■■■...■■■e■■■■ii■■iIi■e■.■ ■iii■i■■e■ti■iiiiiii■■■..■■iii.■.■■■■■■iiiiili.il■■i.l■ii■i■i■■i.■ ■■iii.■■iii.i■■■■ciiiii■ii.i■iii/iiiii■■■■■iii.iiiiiii.iiiii.i■i.■ ■■i..iiiiii■iii■!■iiiiii■i■i■ii■ilii■ii■■ii■ii■■■ii..i■■i■iiiiii■■ ■ii.■■■.ii■■■illi■iii■■■■■■■■iiiii.■i■■iii.Ii.i■ii■ii■iiI■i.■i■ii■ ■.■ ■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■i.■i.iiii.ii■ii.■■■iii■■iii■iiiii.■i■iiiii■■.ii■■iiiii■■■■i■■■■■ ■■ii■iii.iiii■wii■■.iii...■i■■■■.■■■■■iii.e■.■i.■■■■c.■■ii.■■■■■■ ■■■■.i■i.i■■.i■■iii■■iii■■■.■■■!■■■■ilii■ici■iiciiiii■iiii.iii■i■■ ■ii.■ii.iii■.ii.■■ii■■iii.■■■c.l�■..■■.■..■■■....■■■..■■■■■■.■■■■ ■■■■■■i■■■!■■iii■■III■■■■.■■e■■■■.■■■■...■.■■■■.iI■.i■■■c.■i■■I■■■ ■.ii■.i.■ii.■i■i.iii■■..■.■■■■...■■■■■e■■■.■■■.■■■...■■i■.■.ic..■■ ■■■■i.i■■■■■ii■i.ii■■iii■iiiiiiii■■■■■i.iii■■■■ii■i..■■■■iiiiiiii■ ■■e■I■■■i■■ii.li■■.■■.■.■.■.■....■■.■■ ■■■■■.■■.■■.■■■■■Till■■■■■■ ■■i■■ii■■iii■ilii■iiiiii■■■■.■.■�■.■.■■■■■■■..■..ii■i■ii..i■■■..■ ■iiiiiiiiii■i■iiiiiiii■iii■ii■ilii■■ii.iiiii■.iiiiiiii■iii..i■■..■ ■■■■■.■■■I■■i■ill.■■■.■■■■.■■.■■■■■■■■■.■.■■■■■i■..c.■■.■.■■■■■■■■