P6449 County Line Rd ; ...,1J.w Sw• o- a r.. A• Y 5. • as ..4_..tix .al:.F.: f a� w..:Yr. /A'
DAVIE COUNTY HEALTH DEPARTMENT U
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION J��
*NOTEAssued in Compliance With Article 11 of G.S.Chapter 130a U
S nitary Sewage Systems Permit Number,
Name _____c•:�:� _ter, :• Date `I. N�
6 .�
Location,A\ `�C �y ''- � 3 C�n , � � ,. �`� ',- _ p Jep
37
Subdivision NameA Lot No. o.
Lot Size lo "s, House - " � Mobile Home _ Business Speculation
No. Bedrooms .No. Baths- No. in Family ° _
Garbage Disposal YES ❑ NO f Specifications for System:
Auto Dish Washer. YES ❑ NO ,❑i
Auto Wash Ma-pine YES'p/ NO=❑
Type Water Supply (, v t
*This permit Void-if sewage system described below is"hot stall within 5 years from date of issue.
This:permit is subject to revocation if site plans or the i ten ed us�change.
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Improvements permit by
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*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 byhr?/.Y/Zn
• ,rte.,,.
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Certificate of Completion1Date
*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
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mockaville, NC 27028
1 . Application/Permit Requested By 'PAU.Lr 2PtuG4 p)2
Mailing Address K�+ 4 �oX 333 moG�sv «� _ K• - L702g
Home Phone A4>4-415 5 Business Phone to 3y - A40o
2. Name on Permit if Different than Above
3. Property Owner if Different than Above SRrrNz,
4. Application/Permit For: 0 General Evaluation S/Tank Installation
5. System to Serve: House u Mobile Home O' Business
Industryu Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People 4 Dwelling Dimensions
No. of Bedrooms 3 Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
Washing Machine J Dishwasher 0 Garbage Disposai
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: XPublic 0 Private Community
9. Property Dimensions 0.5\
10. Sewage Disposal Contractor
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 Yes No
If yes, what type?
*NOTES 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 far all
charges incurred from this application.
pa" (;�
Date Signatu
Directions to Property :
1,D T ukM ON Sgu=Pi2D
-,P3 C-mux {-�( L i tobL�o(L 46
�b 1 rL c� Ll
J J
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation /
NAME Q c�a�� SK. DATE EVALUATED
ADDRESS S Z" CSL PROPERTY SIZE ! �� CII Q 1
PROPOSED FACIILTYoo S Q LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By:(-' ';-L Auger Boring 1/ Pit Cut
FACTORS 1 1 2 3 4
Landscape position
Sloe Z O- ° O -q
HORIZON I DEPTH 6" to " b"
Texture group C L C L_ C L CL
Consistence
Structure e
Mineralogy
HORIZON II DEPTH " 14:1% LA �'
Texture grouC
Consistence �-
Structure B
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS $ S S 5 S S
RESTRICTIVE HORIZON J
SAPROLITE - —
CLASSIFICATION S S
LONG-TERM ACCEPTANCE RATE -,C_ D - S - , J -- ,
SITE CLASSIFICATION: a S • EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: 5 - •4D 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 fine 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
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