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172 Joe Myers Rd DAVIE COUNTY HEALTH DEPARTMENT = IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Namet, J Dater l- Np 6 4 2 Location l� ' ►- c i f t� _e'�^ilc�—.Sl��,. s. 1���~a �. 4S *.Cly ��`c ;S•�, .:�'J•.ts'�.� ��-�`�.�`.s-c'1 ^r+�_.A,,, v�3'•' :aV.t�` `�.� �J S":`-n.� 'l 1. '� �ir.S�'• .. ." Subdivision fame `' Lot No. •Sec. or Block No. Lot Size rte °s- House ✓ Mobile Home _ Business Speculation No. Bedrooms f Li No. Baths No. in Family__ Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES NO Auto Wash Machine YES NO ❑ r ► t, Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subjedto revocation if site plans or the intended use change. v -)w \ KA 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 ��' Certificate`of Completion 0 Date " _ I y /U es '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 vVay be taken as a guarantee that the system will function satisfactorily for any given period of time. , k ti r APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT `Y Davie County Health Department PIS Z a Environmental Health Section Cn P. 0. Box 665 R�C�IV� Mockoville, NC 27028 1 . Application/Permit Requested By I `S Mailing Address 2 ���x ['� A)Lla4s.In�l ' y'(fr Home Phone , ,a 9/ Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation S/Tank Installation 5. System to Serve: House u Mobile Home 0 Business Industry u Other Unknown 6. If house, mobile home: Subdivision 11;""-) o Sec. Lot# No. of People -2 Dwelling Dimensions Sgi�a ��- No. of Bedrooms Z_ - Basement/Plumbing No. of Bathrooms © ` Basement/No Plumbing (� Washing Machine (J' Dishwasher C] 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: G Public Private D Community 9. Property Dimensions 10. Sewage Disposal Contractor— ealyh 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Yes Wo 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 tree best of my knowledge, and I understand I am responsible for all charges incurred from this application. —Z 7- If r.N ��. Date S gnature Directions to Property : q S(Z C t) n dl �ac V euJ e NAof9 J1 C -E CRoss ���� a C�fs ��ia7L C6eRa �1° c�i'sViLL-� DCO (10-89) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME \ J+ DATE EVALUATED ADDRESS \�A PROPERTY SIZE 13 PROPOSED FACIILTY ' � LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation ByC.4*0n-Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe 7. - o ' V'w" �» G HORIZON I DEPTH �• '' La'' to Texturerou C L C 1- C L �- Consistence F T F-T FT Structure 4p-, C C Mineralogy ') .11 ' HORIZON II DEPTH Ij a, Ltz_" I JL Texture groupit �- Consistence Structure A Mineralogy : ) • � HORIZON III DEPTH Texture group ` Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S s s s S s s RESTRICTIVE HORIZON �- SAPROLITE -• CLASSIFICATION p S LONG-TERM ACCEPTANCE RATE b ,V �,�• ,v D -k V SITE CLASSIFICATION: EVALUATED BY: � LONG-TERM ACCEPTANCE RATE: S "�O OTHER(S) PRESENT: REMARKS: , I 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 Mi neralogy 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