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195 Candi Ln .i !- DAVIE COUNTY HEALTH DEPARTMENT w' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a ni ry Sewage System Permit Number i Name Date27673 Location - �C� '' i�/)9?=F � �� / , .,✓�,ct z Airm l 7 V !�`J' r \ --�-- Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home �i�. Business -- Industry No. Bedrooms —.No. Baths —�— No. in Family�_— Public Assembly Other Garbage Disposal YES ❑ NO E?- Specifications for System: Auto Dish Washer YES ❑ NO g,-' / 7�� ' %6 Auto Wash Ma thine YES 201NO ❑ C Y 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. 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., u d 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 Dov o� ,oa �J 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 R E C ENE Environmental Health Section P. O. Box 665 J u 1. 19 19Q4 Mocksville, NC 27028 1. Application/Permit Requested By _ Mailing Address /,.3 96 Home Phone?l0' /Y! a Cf'S li i�� -� 7? C G 2 Business Phone 2. Name on Permit if Different than Above �� 3. Application for: El General Evaluation ErSeptic Tank Installation Permit 4. System to Serve: ❑ House L7'ftn'obile 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 p'VPashing Machine No. of Bathrooms all ❑ Dishwasher Dwelling Dimensions Qt,4"►ae,2• ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served 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: 2( Public ►! ❑ Private ❑ Community 8. Property Dimensions q L 6t F`' Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No 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: ,I 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. 4t4A q Z C/1 0 All� DATE C711 SIG URE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: ❑ 1. 1 OWN the property. l�. 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 tie Davie Coynty Health D pa ent to enter upon abov gescribed cated in Davie County and owned by �'/L�. -Vo<q� � �P�1Za -F- r►� all testing procedures as necessary to determine said site's suitability for a ground sorption sewage treatment system. - DATE GNAT E DCHD(1/93) L . 50.5& 53 �- ,P Rp P•0 ol /N o. / z.000 Ac- co 0 N Ln o S$C.)p �3, 18�•� N/P ..V 'ry 34,4 •' � - � , . 49�•2g. 27 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME CoC3r,-1 DATE EVALUATED ADDRESS PROPERTY SIZE >L PROPOSED FACIILTY LOCATION OF SITE _�✓7 - G/5� t Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position 4- Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupe Consistence Structure h/ Mineralogy '/ /' ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 7 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 - 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