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709 Cana Rd (2) DAVIE COUNTY HEALTH- DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapler 130a Sanitary Sewage Systems 6� oJC �a-��`�'ytock5✓/��,.� Permit Number Name �.r ^� � � Date Z�2.` �-}''� tra �7 �� . 7382 Location /lv 1' !!� ,�.- / �/ ✓�� i'�y_.e �� i'i/.-��r%j Subdivision Name Lot No. Sec. or Block No. Lot Size -- House Mobile Home Business -- Industry No. Bedrooms No. Baths — No. in Family_ _ Public Assembly Other Garbage Disposal YES ❑ NO Ql Specifications for System: Auto Dish Washer YES NO ❑ Z-%,�,, Auto Wash Ma thine YES NO ❑ _ Type Water Supply _ .�1,'iI°� _— *This per. it Void if sewage system described bel i not installed within 5 years from date of issue. This erit,is subject to revocation if site plans o th i tended use change. V 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., 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 ��Zal � � 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: APPLICATIO O SITE EVALUATION/IMPROVEMENTS PERMIT , Davie County Health DepartmentIi V- �, v� Enviro mental Health Section \ °3 a � . O. Box 665 Nov 2 2 1993 tp� sville, NC 27028 � �� of 1. Application/Permit Requested By �" et25, , AND L&,L&A Mailing Address EL-774A De-• Home Phone �,(�1 �•g �}� NC c2�106 Business Phone 1!2) 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation 916eptic Tank Installation Permit 4. System to Serve: ❑ House VeMobile 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 ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions � /X J ❑ 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: ❑ Public 0110rivate ❑ Community � r 8. Property Dimensions 96 x 9D O Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes V/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: 601 No r4,h 4o Co*-ic- Rpt Ya hy1..t, on (a-�+1 e We WOU& t:kms- -4-0 bA- w -� y01-k comp- Qw+ , Please cc,-u -�-\o Y- o- conv�e 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. 11� c9— - 9-5 DATE t SI A CONSEN FOR SITE EVALUATION TQ BE DONE QIN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 Q IN the property. V2. I DO NOT OWN the property. If you checked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner: 1 hereby give consent to the authorized representative of the Davie County Hr th epartment to enteron above escribed property located in Davie County and owned by I /19.,5 Co � /LE, g � to conduct all testing procedures as necessary to determine said site's suit bility f r a ground absorption sewage treatment and disposal/system.q 02l DATE SIGNATURE DCHD(1193) y Si DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED Z' ADDRESS PROPERTY SIZE PROPOSED FACIILTY ,�L, LOCATION OF SITE Water Supply: On-Site Well Community Public wgiw Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4- Landscape position .4 Sloe % HORIZON I DEPTH Gr a <• 'e lfl Texture groupS'G Consistence Structure Mineralogy HORIZON II DEPTH .3 Texture group 'CAI 1 el 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: 8&4 '� EVALUATED BY: ,A/ �! LONG-TERM ACCEPTANCE RATE: C_�_) .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 Mineraloity 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 ■■■.■r�■..■■■■■■■■■■■.....t.■.■■.■■■■■■�■■.e.ee■■eeee■■■■eeeeeeee■e■ ■/■■.■II■.■■■.■..■■.■...■■.■■■..■■■..■.//■.rte■■■■e■ .■■.■..■■■./e.■� ■■■...■n..i.ii■■■■■ii��...�u■��■■■■/■i.1■■.e..li■■■.Ili/.■■.. ■■■ ■■■.■.■■■■■e■...iii■■.■■.s.ia.i.■�:::�.■..e....■.■■■.■!�.�.■■e■■■.■ iiiiiieiiiiiiiiiiiiiii�■iiiiiiii, iiiiiiii�ii�aiiiiiiiiiiiiaiiiii ■■...■.■■....■.■■u.■■........■.■I■■....■..■.■■i�P■■■■■■.■■■■■■.mom �iiiiiiMiiiiiieiiiiii�iiiiiii�iii■siii�iiiiii■�MEN iiin ■■■e■..■■■■■■.■■■■■■..e■e■e■■■■■e■ieeee■■ee■■■eea e■eeeeeeeee■e■ee■ ■■■■.■■.■■■■e.e■.■■■■■e..Iti•.......rJ.■. ■■ mom MEN ■ ■■■■■..■■■.■■■ .................■.............. .... .... .■ .. . ■■ ■■■■■e■ ....■............■.............■ ■■■.+�n■..■u■ ..■■........ .... ..........■■■........I.1....■■■..■\!■.... ........�IMMMEMMUMMMME ■■■■■■■■.■■�■■■■ .....................�.........■.■.■..■■.■■■' i ._ ■■■emom C■■■■■■'E■ ■■.■■e■■■■ee■■.■ee■■■■..�e■.■.■■■■e■•.■.■■u=■. .■■e.r,�.e■ ■ e■ ■ ■ ■e n■■■■■■ .........................................�.�■... 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