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P7060 Gladstone Estates 0S. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued In Compliance With Article 11 of G.S.Chapter130a $a—hitary Sewage,Systems . Permit usilm�er Name Date N2,- 776 `7 '4,�e, Location Subdivision Name §—t No. Sec. or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES C] NO ❑ Specifications f6r System: Auto Dish Washer YES (b NO 0 Auto Wash Ma shine YES b-, NO C] 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. T 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 C) rjv" Certificate of Completion Date "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. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME /��// DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY d" ✓/��< � LOCATION OF SITE Water Supply: On-Site Well Community Public )� Evaluation By: Auger Boring Pit 11__� Cut FACTORS 1 2 3 4 Landscape position ,L, L- L- L Slope 7. — _ HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH f f 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 c/ SITE CLASSIFICATION: PSS EVALUATED BY: - 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-Finn 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 ■■■■...■■w■..■■■...■■■.■■.■■..■■ .■■■■■■■■■■■■■■■.■■■■.■■.■■■■■■■ ........................... ............................■......... .................................................................. .................................................................. ■■...■■H■..■w.w..■.ww■■n■■.■■■■�.wwna■.■.■..■■.■■..■.....■.. ■■■ ■■■■.■■■■■■.■■.■.■■■■■■t'Il.■w■...■■■hill■■■■■.■■N■■..■■■e■■■■.■■■■ UMMMMMM"MMMMMM":::C:: :: :::_ eammmm omm::: :::::C MONSON ■■■■■■■.■■■■■..■■■■■■..■■■■.■■.■Gi■■■e■■■ ■■■.■■■■H■■■■■.■■■■■■■■ .........................................C■■.■..■■■■W.■■..■■■■.■■.. ■■■■■.■■...■■■■■■■■.■..■■■■■.■■■�imom.'■■.■■■■.■■■■■■■■■■■■■■_■■■■ iiiiiiii■iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii=ii=iii■iii�MEMO Mei ■■■■■■■■ .■■..■■■■■. ■■■■■■.■■■■■■■■■■.■■■■■■a■■■■■■■■■■..■. .■■■■ ................................ .■■w.■■..■■■■.■.■■■■.■■.■■■e■.■■ .................................................................. .................................................................. .........................................■...............�......■■ ■■■■■■■■..■■.■■■■■■■.■..■..w...■ .■■■w..■.■.■...■....■.■■...■■■■■ ��w■��iO��ENE APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT •' Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1 . Application/Permit Recuiested By er =a / YYI 01 Y7 T. 0 3 Pi Mailing Address (� Home Phone = 1 D 7`�'//7 Business Phone O �S 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: General Evaluation 41-15�/Tank Installation 5. System to Serve: House u Mobile Home 0 Business L Industry u Other Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People - Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms _ Basement/No Plumbing 0 Washing Machine J Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type No. of People Ser No. of Sinks No. of Commod No. of Urinals No. of Lav ories No. of Water Coolers No. of owers S. Type of water supply: C Public 0 Private Q 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 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,arevocation, if site plans or the intended use change . Ef ,ective October 1, 1989. This is to certify that the information provided i correct to the best of my knowledge, and I understan am resp o Bible for all charges incurred from this applicati -,3 - 5--93 Date 9/.nature Directions to Property : �6'13 ons `�� G ,'S` � � f�C qJ , J DCHD (10-89)