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P7159 Gladstone Estates DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:'Issued in Compliance With Article 11 of G.S.Chapter 130a tinitary 4 Sewage,Systems, . Permit Number AT No 7159 Name Date Location Subdivision Name A"holl"', 61112 ��Jp To—M--- Sec. or Block No. Lot Size House — Mobile Home Business Speculation No. BedroomsL>?- No. Baths — No. in Family Garbage Disposal YES ❑ NO Spe Pica ons fpr ,System: Auto Dish Washer YES NO E] Auto Wash Ma thine YES i NO E) Type Water Supply -- 16 *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 ch ane.A 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 ,0 ego ------- 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. PPICATIONFOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Sec�ion Box 665 Mockaville, NC 270281 I � .I AApliton�iormit Requested By 9 , j, Maill �dd �sa r � Hams pbo e � ���b � a��� Business ';Phone 2. Name n erq► ! t if Different than Above I I I I . Prope tyjOw or if Different than Above 4. Appligat ,on� ermit For: 0 General Evaluation �/Tank Installation ., Syste t� �ve: 0 House ,Mobile Home: 0 Business a L Industry u Other 0 Unkn wn 4. If hoilsei, mQ�ile home.: Subdivision Sec. Lotw No. o P op�e 3 Dwelling Dimensions /4j Y `7U No. o.1, Bpdrp'Qms 3 BasementA, Plumbing No. o B,thrpoms 1 Basement/No. Plumbing Was in, Mar�hine ,j,�Uishwasher 0 Garbage D13posal 71 If bu�in� lss,�I industry, other: Specify type ; i No. o, Pop�,� Served No. of Sinks No. op, Cmmpas No, of Urinals No. ovatoriesNo. of Water Coolrs No. o Show s i 1� i S. Type f Iwat�a' supply: Q Pub11c0rivate Q Community III I ; �+. PropeFtyi Di1nensi.ons 10. Sewag D,}sp �al Contractor 11 . Do yoa tiFlpate additions/ex anuions of, the facility this s stem is inten ed!toi, erve? 0 Yes If ye hattype? •N TE Improvements Permits shall be valid for a period of 5 j y9ars from date issued. Improvements Permits are subject to revocation, if site plana or the intended use c�ange. I „ ;4fective October 1, 1989. { This is tpi certify that the informatiorr provided is corrects to tri j best' of my: knowledge, and I unders and I am osponsible for; all } . ch a qe� i urred from this apple 1p'n. U ►te Signature Direction ' t r perty . • �, ;I �,LQ.t�s�v7c-C �s �t�t'to �� 7`� l�f�JLFi1 C CC�rJ j .�n.J I ACHD (10-8�) Ii j ;: I i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE DATE EVALUATED � ��� ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE 5P11 Water Supply: On-Site Well Community Public 4-- Evaluation iEvaluation By: Auger Boring tl_� Pit Cut FACTORS 1 2 3 4 Landsca e . osition 4 Slope — HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence ' j EU 7:72 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: _ 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 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■.■■■.■■.■■■■■■■■■■■■■ ■MEMO■ ■■■■■■■■■■■■■■■■■■■eee■■.■■�ie.■■■■M■■MM■..M■■■■■■M■■■■■■■■■■■e■■.■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii'M.�iiii�i�i=iiii'�iiiiiii■'�■ii iiiiiiiiiiiiiiiiiiiiiiisiaiiiii�ii=iiiiiiiiisii■iiii iiiiiiiiiii=i iiiiiiiiiiiiiiiiiiiiiii'■i�Miiiii�MMMMMMMMi'M�i�Mioiii■iiiii'Mii=SON ■■■■■■■■■■.■.■.■.■■■MEMO■■■■t■.M■M■■M■■■.■■r■/ii■■■ ■■■..■..■■.■■■■ ■■■.■■■■■/■■/.■■■■..■■.■tit■//■■ ■■■■■■■■■■.■.■■/../■■..■.■■■■■■. ■■.■■■■■■■.■■■■■■■■■■Mc....��E��■..====="��■.■...■■■ E■■■■■E■■■■■M ■■■e■■■.■■eM.■se■Me■■.■.■■.■■■■■■.■.■■■■■■��.■■■■■■■■■.■ ■■.■■■■■■�■■i■ii■i■i■i■�■■i■i■i■i■i■ir�■■i■iMiEi■i■iM�■M■■■■� e■■■■.M■ i°'s'011IMMii '■■ i/UMENNENUMENi ■ 1ME ©■.II■■■■■ ■■■■■■■■■■■■■■.■ ■■.■■■■■■■■■■.■E■■■■■■■..■■.■■E■■■■.EEu■ mom no e.■■■M■ ■■■■■■■■ ■■■■■■■.■■■■■.■■■■.■..■■,■■■■■■■■■■■��■����NI■■■.■■ MI■■■■■■■■■■■/■■ .......■........................ 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