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724 Cherry Hill Rd V�1O DAVIE COUNTY HEALTH DEPARTMENT j �r p U IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION. �f *NOTEAssued in Compliance With Article II of G.S.Chapter 130a jSanitary Sewage Systems Pirmit Number Name } t \ �' � c �� �� �4.}S Date `� - 11 NO_ 65 77 Location C\ _mac �� ,, �=K.,`-'.;J��?`��� Q•c-. a�� V . Subdivision Name Lot No. or Block No. Lot Size House Mobile Home_ Business _�-' Speculation No. Bedrooms No. Baths, No. in Family Garbage Disposal YES p NO Er Specifications for System: Auto Dish Washer j YES. p NO ©/ Auto Wash Ma thine YES ❑ NO E], Type Water Supply *This permit Void if sewage system described below is not in talled within 5 years from date of issue. This permit is subject to revocation if site plans or the inn,, ded use change. S Ids, a j �.� U i 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. or 1:00-1:30 P.M. on day of completion..Telephone Number 704-634-5985. Final Installation Diagram: System Installed by S b W VJ Certificate of Completion - Date 9 j *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. _ Sol - &�V - APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER Davie County Health Department Environmental Health Section 1 1991 P. O. Box 665 i Mocksville, NC 27028 I' l 1. Application/Permit Requested By, t Mailing Address.OfJw Home Phone Business Aone 2. Name on Permit if Different than Above AJIM 3. Application/Permit for: ❑ General Evaluation 2.19eptic Tank Installation 4. System to Serve: El House El Mobile Home ❑ Place of Public Assembly 11� Business ❑ Industry Ih�, ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision laJ t-t Section Lot# ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ 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 51 Private ❑ Community 8. Property Dimensions 5 O.crz Sewage Disposal Contractor 7 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 02/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: )-/10-1� M 60 ' 1�Jc I�:ALvCyI • ( �7L JE 1©DO oa This is to certify that the information provided is correct t e best of my knowled e, and I understand I am responsible for all charges incurred from this application. DATE §IGNAT&JRE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. El2. 1 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: I hereby give consent to the authorized representativ, tl�e Davie County Health Department to enter upon above described property located in Davie County and owned by ,J ,p to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage' atment and disposal system. la - a �-al DATE SIGNATU DCHD(12.90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation i NAME � '�� DATE EVALUATED _ 91 ADDRESS PROPERTY SIZE PROPOSED FACIILTY ����� - S�r� LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation ByJ�1 Auger Boring V Pit Cut FACTORS 1 2 3 4 Landscape position S S S S Slope % O - 8� �" �1 - $° HORIZON I DEPTH Texture group C L S C. I_ S S Consistence it FT FT V,r- Vi= Structure R R Mineralogy HORIZON II DEPTH 14 6.1 Texture group < C Consistence r T V F T V t-v- Structure S K S 1< S Ksi�'r Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S s s s RESTRICTIVE HORIZON — _ -- - SAPROLITE — — CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,3 3 SITE CLASSIFICATION: 2 ' 's EVALUATED BY: LONG-TERM ACCEPTANCE RATE: e 3 OTHER(S) PRESENT: 'U oN REMARKS: LEGENIJ �c-�- Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Footslope 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 watef 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