P7127 Gladstone Estates , , �--;:. _.'iq.t 3 y�t�' Si�-.at �; '1f..,.:"sf -'�<,.r- .-. ...� •l.r*, _y :.._i r..:..,�. ,ry�Y r.:{`. b� ..=:;f 1.1, ,�".y- -. ,-:r�. ° /.`i�� r j.,;r ... -.1 .
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Se-wage Systems ,, Perm! umber O
27
Name r! / Date N2
Location
/y %o+ f'r'— �' r' /lid: C1.✓ :j/ C , f� / f'� G- j j�...
Gl. s7anl� � .
Subdivision Name 't_'t5t�7o. Sec. or Block No.
Lot Size House Mobile Home — Business _— Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES,❑ NO ❑ �C�C " f �'
Auto Wash Ma shine 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.
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 704-634-59855..
Final Installation Diagram: System Installed b
9 y —�
U
r
Certificate of Completion ley �� Date J `f
'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.
1
.i
i
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PEEQ ' ED
Davie County Health Department
Environmental Health Section pa
143 P3
P. 0. Box 665
Mockaville, NC 27026
li
1 . Application/Permit Requested By
Mailing Address �G_/J ;� [�'QI.GG`�C:Ge/ 2.7,0i� Ij 11
i y IP I
Home Phonle �7de( Business Phone
2. Name on Permit if. Dif f e'rer t than Above I ( 1
1 3. Property Owner if Different than Above
i
4. Application/Permit For: General Evaluation /Tai�k'' Itsstllllation '
1
5. System to Serve: House l 2--M'abile Home 0 Eih'sirifr3s�l
Industry u Other 0 dn1knoWn
i
'
6. If house,' mobile home: . S�Ibdivi ion i :; Sec.� L� to
iI Ili
! No. of People _ D.we]:linq Dimensions ✓��91d � '�!I � �(
i No. of Bedrooms ~ Basement/Plumbing
No. of Baithrooms i ` Basement/No Plumbing i
eWashing' Machine j r Dishwasher 0 G
�ba a ispvsai
7. If business, industry, other: Specify type Jfyj II
No. of People Served i Nd. of' Sinks ('
No. of Commodes No. of', Urinal II II
No. of Lavatories No. of' Water d olers
No. of Showers
S. Type of grater supply: !
yp pp y: � ublic � Private ' j�, C mmunir.y
i
9. Property Dimensions �`i9 G'�� 74
10. Sewage Dilsposal Contractot1 _
I, � I 1
1 L;
J11 . Do you anticipate addit'ior s/expansions of the facility thsi s�'sm is
intended ito serve? 0 Yes I VNo I i
I'• I I
If yes, what type? iI
1 i
•NOTE:j Improvements Permits .shall be valid forea perk-dc o� 5I
j years from date issued. Improvements Permits Are ! 'ect
to revocation, 'if site plans or the intended uie chane.
Effective October 1, 1989.
This is to certify tn'at ithe information provided is corz'6ct 'toth(!
best ofj my knowledge, •arid I underst I am responsible t'or �al
charges incurred from' tHis applic on. ill
Date j ignature fid
Directions to Property:
CS'{CLQ s • „ + ;
xo—
i
I jl;j I Ii
led c/0
s I i I I: i 1 i ii i
� i Ilii I li' I
-8
D
CHD (10 9)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation -/
NAME DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring ✓ Pit Cut
FACTORS 1 2 3 4
Landscape position .Z Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 145"
Texture group
Consistence 01s
Structure S'
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON ry
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
Mineralotty
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
■■■■■■■..■■.■■■■■.■■■■■■■■■■■■■■�i■■■.■EMs.■■.ss■.E■..■.E.■s■.■Mi■
■■■■■■.■■..■■■.■■.■■■■■■■■■ ■■■■■■■■■■■■■.■...■M.■.Ee.■.s.■■Nes..■
iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiO■i�i�iMiiiiii�iiiiiiMMii
■■OO■MO■.■■MO■viii■..ei.■■■.■■.■■.■■■■Ee■�EOO■M■�■M■M■■eMM.MMM�M�iM■
■■..■.■■■■■■■■■.■i..■.■■■■■E...■E.■NOON.■.e■.■■■■■.■■■■./■.■E.■■.■
NONE 0
�■ii�iiiiiiiiiiiiiiiii�isiii
■......■....../■.■■■■N■.■....■...■N..e.■/.■i.MM.■■. ■Me■MME.■MEN
■■..■.■■.■■t■■■■ei.■.■■.E■■..■.■■...■Il......ee..■■.■.�■.■■■■■...�■
...............................■...■M■MMM■e■■MM■M■.......■.■......
■.■e■..E■.M..■e..e.■■.■e��M.����i�i/..■■..11.■.■...■■i ...■ ■.MOON■
iis:i®Mieiiiii EMMOMMMEMMEME
■■■■..■.■..■..es■■■.■.s■■s.s.ie■se■.eM.■Moi■.O.eM ■■ ■■.■..■.■■.■.■
■.■■e.......E..OM■OOe■.■MMEOEOO.00■OEOMOMiOEM■O■S ■NOME■■ ■■■■O■■■
■■■■■.■■m■.m■■■s■■■■m■■a..■i■■■■■■.■■. �i.■■■■■ .■�■■.■■.■■■■■■■■
i . iMii �ii�
MEMMEMMEMEMEM
■■■OE■MO■MOOOOeO■eeO.O�s•EEOMEMOiO■�icE ■�iMO •4■O E■■u■■ ■.■MOO ■
■■MMM.MMMEM■MMOMe■s�M�M�����o.EMMEMM►iM■i M►� MM■u ■ ■■ ■■ H■MMEOE
on ME
... . . . ............
iiiiiii��i�iii�ii�=ii�:iiiiiiiiiiiiii�iiiii� ■■■=■M■■■o■M=■i■�■■
___'" MMM ■M■MMM�i■MM■ ■NM■M■■OM■
........■■■■■■■■■■.■■■■■■■■■■■■■■■■EIA
MENONES
.....■................�......... wMMMMM=MMM..■■.Ns■■■■■s■o moms
ss.■...■■.e..s.E..■.■msO•■es■��■ Eo■E■EE ■■■■■H■■..■■M■■■Es■■NEM
MENEM
■■■■■■■■■..■■■.■.■■.■■.m■■H■■■■■.■■■■■.. ..■. ■..■em.■.■ ■■■MOON
.................... .............................................
■.■■■■■■..■■■■■■................ ■■■EN■■MM■MENMEN M.■MMEMMEMMMMEM■
...................................... ...........................
.............■....................................................