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1469 County Line Rd DAVIE COUNTY HEALTH DEPARTMENT -b IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION 5 *NOTEAssued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems x� �j Permit Number 6 -7 9. Location f-L,01) - ' 7o ,ZZ — ,G .l << ef,/ I, >/moi P-- 7--------------- a. Subdivision Name Lot No. Sec. or Block No. Lot Size �� House Mobile Home Business Speculation- No. peculationNo. Bedrooms No. Baths No. in Family _ ? Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer. YES ❑ NO ❑ � �� , . Auto Wash Ma^ E] E)hine YES 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. • r, Sa � n��j� `t,, �. 1� Y �y r • 0 ftnprovements permit by --� 4. *Contact a representative of the Davie County Heath Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of compl (on. T lephone Number 704-634-5985. Final Installation Diagram: System Installed,by 0 O x 4 •t i Certificate of Completion �_ \� Date 3 *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 Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1 . Application/Permit Requested By �L - Mailing Address '- /��z Home Phone92 Business Phone 2. Name on Permit if Different than Above / �a 3. Property Owner if Different than Above :7�9g/ 4. Application/Permit For: 0 General EvaluationG-1/Tank Installation 5. System to Serve: House u Mobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms J Basement/Plumbing No. of Bathrooms / Basement/No Plumbing (Mashing Machine Dishwasher 0 Garbage Disposal 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: 0 Public a--Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes i_`v 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 isorr t to the best of my knowledge, and I understand I am r .sponsibl r all charges incurred from this applicati �L v N Dat ignature Directions to Property : eL/ DCHD (10-89) ti .t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED 7-A/10' ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well �� Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS I 2 3 4 Landscape position L L _ L Slope % 1 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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 RATEy 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 - 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 ■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■Mee■■■■.■eee■.■...■.■eee.■■■ ■■■■.■■■■■■■.■■.■■■■.■■■■■■■■■■■�i■■eee■.■■■.■■■■■■■■■■.■■■■■■■e.■ ■■...■■u....■...M..■..■...■.t■■ ....■fil.■■.■.■.........■.....�■EN ■■N■■■■■■..■■■■..►dl■■.■■■.....ecce.■..■■.■■Y�1■■■.■■■■■..■■.■..■■■■■ ■■■.■■■■■■.■..■■■■.■■.■wMMM■MMMT■■■■■■■MMM\.■■..■.■■...■.■■■■■.■■■■ UNMEMME MEMEii�iiiMENNENEMEMENMENNEN ■eee...■■............■ee�le■■.■■■■■■■■■■■�.■■.eeee■■...N■■■■■■■■■■■■ iiiil�iiiiiiiiiitii.iiii.iii�iii■ ■■....■...■...■.......■......■■.................■....■.....■. 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