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185 Legion Hut Rd Lot 11 " ". ,-.. i.. .�.. .,�.- � y•.a ..k qr'• f t +,,. r1. �, p _. �. a e 5 "r,". 'r ,. . =- ,-- �^ DAVIE COUNTY HEALTH DEPARTMENT ` IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:'Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name � ?% �i � ;: �ii�/ ��� /i ; r Date — ' -. NO 16333 Location Aa Subdivision Name .�i; ef!Y • Lot No. Sec. or Block No. Lot Size ,10r`)I-S'�C House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family _? Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES , NO ❑ Auto Wash Ma thine YES NO ❑ ������" Type Water Supply 65 *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. rT--- 1� Improvements permit byL *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 j y s 110 1 i Certificate of Completion /GDate *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 CQ P. 0. Box 665 RECEK ' Mock,oville, NC 27028 2 1 . Application/Permit Requested By R R Mailing Address . � r +' Ae - Home Phone c��_9/ T / Business Phone 26 T d-5��_ 2. Name on Permit if Different than Above L -e' P "944, lVi6sn 3. Property Owner if Different than Above .z 4. Application/Permit For: 0 General Evaluation S/Tank Installation S. System to Serve: House bile Home 0 Business L Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lott No. of People J Dwelling Dimensions No. of Bedroom— 7 Basement/Plumbing No. of Bathrooms ` Basement/No Plumbing 0 Washing Machine J 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 S. Type of water supply: V Public 9-15rivate a Community 9. Property Dimensio s 10. Sewage Disposal Contractor- 11 . ontractor11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Yes rE, 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 understan I am respon ble for all charges incurred from this applicati � LY ate Sig ore Directions to Property : DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / Soil/Site Evaluation / NAME / DATE EVALUATED ADDRESS PROPERTY SIZE Z45 1a'� PROPOSED FACIILTY A0 LOCATION OF SITE Water Supply: On-Site Well Community Public_ Evaluation By: Auger Boring 4� Pit Cut FACTORS 1 2 3 4 Landscape position •L Slope % 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 RATE SITE CLASSIFICATION: EVALUATED BY: , x4 LONG-TERM ACCEPTANCE RATE: 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 Mineralo[ty 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(01-9ot ■■■..■.■......■■■.■■■■■.■.■ww.....■.....■.■■■■■e■■■■■■■■■■■■■■■■■■ ■■■■.■■N■■■.■■■■■■■■■.■■■..■■■■ :''>1■■■■■■■111..■■1./■■■■■■■■■■■.e■�■■■ ■..■...■..■■..■...■■e..■.■.■■■■■ t.■■ew...L�■www■■.■■eew■■■■■■ee■■ ...■........................■....■..■e■■■■■■.■ell■■ee■.■■.■■■■OEM C. .................................................................. ■■.■■■■■■■.■■■■■■■■.■.cell■■■■..■■■■.e.■■.■■■.■I■■■■■■■■.■■■■■■.■■■■ ■■������■■iiiiii■��������■iii■i�eiiiiii�i■iiiie■iiiiii■������■■ .■■.■■ ■.e■■■ ■■■e.■' we■■■.Be■■■■. ■■.Nle.Mi■■■e■■ MEN on ■■■■■.■■■■■■■.■■.■.■.■■■11■■.■.i��_����:�i��.�■�.■■■■ ■■...■.■....■■ ■■..e■..■■w..■ee.....■..L��il:..e■..■■..e■.■■■■ee.ee ■e■e■■e.■ee.■■ ..................................■.■■■■■■■..■u■.■■C■.■■M■■■■■■■� ■■■■■...■ew■■■■...■ewwe■e.e..ee. ■e■N■.■■e.■e■..■■..■■■.ee.■�■■■■ ■■■.■■■■■.■■■■■■■■■■■■...u.■■■■■■■■■■..■■■■..�■■■■■■u.■I■■NONE ■ ■■.■■■..■■■■■■.■■e.e.ee.eee.e■.e■■■■■■■■■e■■e■ ■■ ■■■■■.. ■■■■■■ ■ ...........................................�......C.........■.MEMO ...............................■........... ■■.■■■.■.■■..■■■e�■e■ ................................ ........................... .... ■.■■..■...■■...■.■■■■■e■.■■■..■...■e.■■e..e.■■w■■■■■.■..eNe.■wee. ■..■■■.ee■■■...■■.ee■wee.■.■.■.■�..■■..■..e■■.■e.■■e■e■■.e.■■e..■ ■■■■.■■■■.■■■■■■.■...■■■■e■.■■■■■e■....e■■■■e■■.■■.e■■■■■e.■■■NEON 1� * 41APPLICATION FOR SITE EVALUATION/IMPROVEMENTS"PERMIT 'Ak ►' , `. Davie County Health Department Environmental Health Section ";_la� 9•` r ` P. O. Box 665 I r4- Mocksville, N.C. 27028 �- ��� • }• CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. c Home Phone 1. Permit Reque ted B _ f �I�, Business PhoneU 2. Address Vmss' _-C"O_Q4 - -�- ------- - k, 3. Property Owner if Different than Above Address - --__-- ---._._ _ --- - -- -- _ _ -_ - . --,- - __ �► �. 4. Permit Tp: a)Install.- . Alter.. . . Repair b)frivy_-Conventional____. Other Type._ Ground Absorption c) Sub-Divisioh�2La� ��-�LL+%Eec6 Lot No. — 5. System psed to serve what type facility: House—Mobile Home Business iv Industry—Other b) Number of Peoplq 6. a)If house or mobile home, state size of home and number of rooms. House Dimensions — -- ----- Bed R-ooms_'__S_ `Bath Rooms_s�_. __Den w/Closet.-.__.. b) If Business.,Industry or Other. State: Number of persons served _..._. What typo business,etc. Estimate amount of waste daily (24 hours)_-.—_ �. 7. Number and type of water-using fixtures: commodes 2 urinals ___._____ garbage disposal lavatory showers — washing machine dishwasher sinks S. a) Type water supply: Public Private Community b) Has the water supply system been approved?Yes No_ 9. a) Property Dimensions b) Land area designated to building site C) Sewage Disposal Contractor 10. Do you anticipate any addldoos;or expansions of the,,0011ty this sewage system I*I to fie&e? What type _�_.---- - --- - --- -- - This is to certify that the information�Iss correct the best of IKngw ge. Date Owner gnature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directlons to property: ii / li ! DCHD(6.82) { . DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section // Soil/Site Evaluation / NAME _/)%l/,17 A90 DATE EVALUATED ADDRESS �J PROPERTY SIZE PROPOSED FACIILTY �/ /y' LOCATION OF SITE Water Supply: On-Site Well Community Public / Evaluation By: Auger Boring Pit Cut FACTORS 1 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group J Consistence r' r r- Structure Mineralogy HORIZON II DEPTH Texture groupi C G 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 RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: e Y 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 Mineraloizy 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■■....■■.■.■..■■■■.e.■..■■...■.....■■...■■eee■■■■ee■■■■■ ■..■■■■■■■■■■...■■■■■eee■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■ee■■■■ ■■■■■■■.■■■■■.■■..■■■■■.■■■.■■...■■■■■■■■■■■a.■■■■■■■■■■■■■■■■■owl ■.■■...■■■■■■■■■■■■■■■■■.e■e■■.■■■■■■■■■■■■■■■■■■■.■■■..■■ecce■■■ ■...■■.n........■...■■.....■.■. e....■■■■■.■■■■■.■.■.■■■■.e■ ■■■ ■■...■■■.■...■.■■■..■.■.....■... .■.■■.■c■■■■..■■■.■.■.■■.■.c..■■ ■.........■■........�.�.iia.■■...■■■■.a..e.®..��..■■.....■■.....■■.■ ■■■.■■■■■.■■■■■■.■■■■■■■■■.■■■■■■■■■■■.■■■■■■II■■■■■■■■■■■■■■■■■■■■ iiiiir■iiiiiii iiiiiiMIMNMMIMMiiiiiEN MEMiii ■■■■■■■■■■.■■■■■■■■■■■■■■��■■■■■■■■■■■■■■■■■■oe■■■■■�■■■■■■■■■■■■■■ ................................ ■■■■■■■■■■r■■■■�■■C■■■■ ■■■■.■. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■_■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ iiiiiii■ iii iiiiiii iiiiii■�iiiiiiiiiiiiioiiiiiiiiiiiiiiiii iiiii ■NOMMEN ■■■�it■■■■■■_■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■N■��i■■.■■ ................................ ........................... .... .................................................................. .................................................................. .................... ............................................. ■..■..■■e.■.■■...■■.C........... ................................ ■....■.........■..■.■...■....■.■ .....■.....■■.n..■■e......■■..■