662 Cedar Creek Rd (2) ,y= , r• x1A s' a ,^-t .. 1 s £"„ -i i ,. .,-`i f 9 ~'s r s.:, s .>. r .:f (/
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
-_Name / .�G <� ����%; ff. j Date �1% l N2 6301 ,
+Locations�i��„✓�
Subdivision Name Lot No. Sec. or Block No: y
Lot Size �1' House Mobile Home Business _ Speculation
No. Bedrooms No. Baths No. in Family -22
Garbage Disposal YES ❑ NO p-''' Specifications for System:
Auto Dish Washer. YES NO ❑
Auto Wash Ma shine . YES �j NO ❑ // „ ,p '
Type Water Supply //tlO� �vn� �JA
'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'.
F
f
Ile
Improvements permit by 21,�
'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: =Sy§S J by
1
Certificate of YZ Date �1
"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 as a guarantee that the system will function
satisfactorily for any given period of time.
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME L DATE EVALUATED
ADDRESS / PROPERTY SIZE ��
PROPOSED FACULTY -fG�.�' LOCATION OF SITE ` N4��
Water Supply: On-Site Well f Community Public
Evaluation By: Auger Boring Ll_� Pit Cut
FACTORS 1 2 3 4
Landscape position
Slope % .2
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 1 '' Rte' 3p�� •�
Texture group
Consistence i"
StructureA4'e 111-7
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION S' 73
LONG-TERM ACCEPTANCE RATE v
SITE CLASSIFICATION: �P /n EVALUATED BY: Ila
LONG-TERM ACCEPTANCE RATE: �9 OTHER(S) PRESENT:
REMARKS: �rai P cP
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
SG,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
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• =� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
jr Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mockaville, NC 27028
1 . Application/Permit Requested By //f/•/�/l� �1
Mailing Address
Home Phone W---1.210 Business Phone2. Name Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation 9-15�/Tank Installation
S. System to Serve: [Mouse n Mobile Home Business
L] Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms Basement/Plumbing
No of Bathrooms / _ Basement/No Plumbing
67washing MachineDishwasher 0 Garbage Daspusai
7. If business, industry, 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
8. Type of water supply: C Public a-frivate D Community
9. Property Dimensions Zzle
10. Sewage Disposal Contractor
11 . Do you anticipate additions/expansions of the facility this system 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.
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 applicati n. �
r-�b fz!2z
2—"— X xlc
Date Signature
Directions to Property :
�a
DCHD (10-89)