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P7357 Gladstone Estates DAVIE COUNTY HEALTH DEPARTMENT 11-41F IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 1 0a nitary Sew ge Systems (12 ' ' Permit Number Name �. -� — Date ® 7357 Location Subdivision Name Lot No. Sec. or Block No. Lot Size 40 House Mobile Home —�'� Business Industry No. Bedrooms No. Baths _ No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO 0" Specifications for System: Auto Dish Washer YES NO ❑ - ' Auto Wash Ma^hine YES NO ❑ �� 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. r Li 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., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by — S /: v .—J Certificate of Completion �__¢'rL 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER Davie County Health Department tz ,: ." If Environmental Health Section P. 0. Box 665 flCj Z� i � Mockaville, NC 27028 rrr+.+w rwwwwrrwM 1 . Application/Permit Re //e��sted By (2�w' Mailing Address ' v' �0 a Home Phone O 155 Business Phone Z 2. Name on Permit if Different than Above sI 3. Property Owner if Different than Above C- 4. 4. Application/Permit For : C) General Evaluation D,-S/Tank Installation 5. System to Serve: House - h- obile Home Business L Industry u Other Unknown Ci, es �i 2 6. If house, mobile home: Subdivision Sec. ,1® ` Lota No. of People Dwelling Dimensions / ! Y CO No. of Bedrooms Basement/Plumbing Na. f Bathrooms 4. Basement/No Plumbing Cfolwashing Machine J Dishwasher 0 Garbage Dasposai 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: ublic 0 Private n i t y 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility t system is intended to serve? Yes No If yes, what type? lf�� *NOTE: Improvements Permits shall be v id for a period of 5 years from date issued. Impr ements Permits are subject to revocation, if site plan or the intended use change. Effective October 1, 1989 This is to certify that the in matron avided is correct to the best of my knowledge, and X erstand am respo ible for all charges incurred from this s plicate ` Date Sig ature J5�4-4/ Directions to Property : (3arv► [4 e.— �Y O i� P DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE (O I eZ- _10211 Water Supply: On-Site Well Community Public L--, Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH �- Texture group Consistence Structure 1 ,� 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: 7/7 l� EVALUATED BY: Q llT LONG-TERM ACCEPTANCE RATE: r 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 , m ■■■■■■/■■■/■■■■■■■■■■■■■i■■■■■■■//i/ii/i.//ilii■i/i.i.iii■ Uili i! ■i■/■Milli■i.■■iii■.■/■■■■.■IEEE■■■iNMii■iliM.iM■i.iiiM.i../iM.�i■ ■ii■■Mi.iiiiMiiM/iiM■//ii/i■iii///iii■iiMii.■i.Mii.i■i.i.iNM..iii■ ■/■■M■■.i■■M.■ilii/■■■i//■■■//■■■■■■i/Mi.Eli■iiMMlE.iiii.MMMiiM/i■ ■■■■E■■liiiiiii■i/M.//■■iM■■./■/■■■.ilii■i.■■M..■M■■i■M■iE.iMMMM■■ ■ii/iMiliiiiiii■iii.ilii/ilii■.■■■■■..i.Mil�■i■MMi■M..■■.iM■..iiM■ ■M■■Mi/■iii.■■■iiiMil■■■■■iliiii■■■■MM..iM■iMU..IM.iMM■.■■MMM..E■ ■■//■■■.iii/M/■■i■i/MM■M/MM■■Mi■ ■■ii■iiiMNM■MMMMEMi.iMM■MNUMUIi■ ■i/i■M.l■■■i■■iii■■■■■■■■■■■■■■i�■MMiiMMME.M■.■..■UME■El■.EM.EIM■ ■iii■..0■.i.ii■iii■■M■■iiiMilii■iiiM■MMMMEU.E.■EE■EUE■UE■E.EEU.i.■ ■iiEMMM■■iM■M.li./iMNM/Miii1M/■ilii■iiiUM■M.ii.■U■EE.MEEi■■MMMEUi. ■i...M.li.i.iMiiiiMM.M■ii■iiM■iiiiiii.N■.iM...iNEM..M■.M■E.i.■.UE■ ■i..EE.M.■NEME.N■■■iii■.■■■■UU■�.■■.EE.EUE.EE.■UEEEEUEUEEE■EEEE■ ■■■/.Mi■■■/■■/M■//■//■///.//M/i /.■■/.■/M/ilii////.■MMM/■iiMMl/■ ■.iMi.NM■iU.N■...Mii..iMM..iM■iii.MM...0■■EM.M■.EUC.E■EEU■■U■..Ei :CCCCCC:CCCCCCCCCCCCCCCCCCCCCCC�3CCCCCCCCCCi �CCCCCCCCCCCCC=CCC MOMEMMEM OEM No ■/././.MN.MN■ii/■■/■MM/././■[i■/./.MM////MNMNMi/.ilii. .■Mil/iii■ CCCCCC'iiiiiiiiiiiiiiiiiiiiiii '�iiniiiiiiiiiiiiiiiiii�i■iiiiiiiiii'i�i ■.MMM■.MiiEN.MM.N.EMMMMMN.iiM■Mali■�i�tMMMMM.MM.■M..E.■.E■■..UiiUi■ 'CCCCCCCCCCCCCCCCCCCCs.siiiiiiiCEECCCCCCCCCCCC■iii■CCCCCCCCCCCCCCC ■.ME■■.UNM....E.0■■■EN..EEUU■■MMU■M..EE■E.EEUE.EEUEUE.UU.�E■.■.EU MEMOno No ■.■■■.■■■■■■■.■■■■..■■■.■ ■■■■■■■■■.■.■■■■.■■.■■ ■■■■.■■■■■■■■■■■ �CCCCCC�CCCN�C'�CCCCCC�'I�iCCCCCC�CCCCCCCCCCCCCC =CCC�CCCCCC� ■■■■■■■■.■■■■■■.■■■■■■■■■��■■■■■■■■■■■....■■■.■.. �■ ■.EE■.UMEMEElwo No 0 ME MR OEM .■ Sol MMINIMMUMN OMNI CCCCCCCCCCCCCCCCCCCC�CC:CCCCCCCiiCCC'E'M"•CCCi.CC'iMMMUMM CMMUMM _:' a M Monsoon UM EMMEM ..................................CCC: ^� MMENMMUMMEN CC.N No'CCC�CC0 NONEMMMMCNONE MC0 ::::::CCCCC:CCCCCC=CCC:CCC:CCCCCCCCC ::::' .:"_::::::: ::�:: ................................■E■EMHMU■CCCCCCC■ CCCCCCCC�"::' MEMMOME ■■■■■■■■iMHN..i■iMi■■■MNMlNM■MMMMMM■MMMT MENUMEMMUMMOMMEMMEMEMMEM MEM.NUMM■MMM/MMEMEMM/mom ■.MMMMMM■MMM.MMMM.MM.iiMMMHMi.MM■MMMMMMi MMMMMMMMMMMMMMMMlM/.MEN ■.MME.EM....EEEM■.MM EM.M■■Mi■.ai■ICM.■M.M.■i.E..EEE.E.■.EiiMNMM.■ ■iMMMMM.M■MMMMNNNNM/i/iMMM/Mi/MM CMMMEMEMMNM■NNMEN MMM■M■■M/Mi//M/M ■EUEE■ENE■EEM■■■■EMMEME■■MM.■H■■■■EE.■EEEEEEEEEUE...EEM.H.E.■EU■ Noun ■.ME..■EMUEME.EMEN■MM.MM.■EEE■■■U■■■E■.EEUE.EEEE■■EEEEE000■E■E.■E■ ■iii.■■MMMMM!■iiM/MMI.MMIC■/M■M■Mi■i/iMNMMM.ii■iMME■NM■Mi■M.iEMMEM ■■.■=■EE■aEE.EEM■■M■■■■MMi■■MEi■■■■■■M..E■E.M.N■MMEi..MMM.i.EMMM.■ ■.Mil.■■i■i■■■ii■■M///■M■■M■■/■i�M■//! ■■/■/■/////■■■■■M■/■M/■■/// ■iMN■■■■■■■MiIMNNUNM■■NNNEMMMMMH.M■MMMT ■■■■EM.■■■.EMME■■.MEM.M■■