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415 Comanche Dr :. ,�- r .�;....+, •• •, k.LL+!'�=.�-zr...�.._,.::..�w.,. .. ,. "-.•• .Yat-.:, ._. tax O DAVIE COUNTY HEALTH DEPARTMENT f DU. Up IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ..., *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Perm-it Number Name Roue o� Date 7 U 3 ' 9 4 N� t t nl Locations `�,.r`��•... sem. .� �- =:�;-,s,...•s. n--. �r�.-�.,��,�,�s��.L, .�.. Subdivisio Name r Lot No;` Sec. or Block No. Lot Size House Mobile Home Business Industry No. Bedrooms No. Baths —"A No. in Family) Public Assembly—" Other Garbage Disposal YES [� NO ❑ Specifications:for �System: Auto Dish Washer YES W NO F-1 - Auto Wash Ma^hine YES D,/NO ❑ W .ate ,. G� o X x Type Water Supply 'This permit Void if sew a sys desc 4bedAnIQw its not installed within 5 years from date of issue. This permit is subj to rev ation ' to plans or tded0u a change. t =ly / Q .1 }� (. Improvements permit by `� \ *Contact a representative of the Davie CountyHealthDepartment 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 . F 4 S /atisfactor q7e ? ificate o CompletionDate to' certificate shall incjic to th t t system described above has been installed in compliance with �, forth in the above rtion�i shall in NO way be taken as a guarantee that the system will function any givbn period 6f {� j 4 >< ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT "— Davie County Health Department Environmental Health Sectionit P. O. Box 665y 0 V �} 1994 Mocksville, NC 27028 1. Application/Permit Requested By o K) Mailing Address W(o-a 0 0) ryur A - --V) r- Home Phone S ler , . N C. 0-I 1>"I Business Phone f'/V 5; 3'-1,7 47 2. Name on Permit if Different than Above 3. Application for: __ ❑General Evaluation Skeptic Tank Installation Permit 4. System to Serve: GK-House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobi!e home: SubdivisionSection / Lot # / ♦1 6asement/Plumbing No.of People ❑ Basement/No Plumbing No. of Bedrooms Washing Machine No.of Bathrooms El"Dishwasher Dwelling Dimensions J3 o O arbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ❑ Public Private ❑ Community 8. Property Dimensions .__ Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ 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 revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: Al �7in o�C /� �vR� Ge o ,✓ Co ✓ z 7 C.c ��Ju/C /�.� ��o I`QF� 0 D J C=��e ( /�(' �]`QK <(.chi v L ,E e ��/-��7 c7 27� rC do AoAef This is to certify that the information provided is correct to the best of my kno ledge, and I understand I am responsible for all charges Incurred from this application. :6i ' DATE SIGNATURE CONSENT EQ$ ISIF EVALUATION TO BE DONE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. B2. I DO NOT OWN the property. If you checked Box #2,the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of th Davie County Health Dygartment to enter ponbov described property located in Davie County and owned by,Q � —ISS.— pF LTOI? to conduct all testing procedures as necessary to determine said site's su•ability for a grounder sorption sewage treatment and dispos I syst m. / 9�Z DATE AIGNATURE DCHD(1193) I i •''" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Y� NAME _ o D �� - U�S b ►� DATE EVALUATED ADDRESS S `A `fn`'Q, PROPERTY SIZES \ ' PROPOSED FACIILTY \6ys LOCATION OF SITE w kN Water Supply: On-Site Well Community Public Evaluation ByZ. L Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position S s -5- ,S' Sloe Z 11V " 5 'IS HORIZON I DEPTH Texture group Consistence Structure >� Mineralogy HORIZON II DEPTH 2" Texture group Q Consistence Y14 Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS .s S RESTRICTIVE HORIZON f SAPROLITE — CLASSIFICATION 5 5 LONG-TERM ACCEPTANCE RATE 3 SITE CLASSIFICATION: S EVALUATED BY: Co i� 019 LONG-TERM ACCEPTANCE RATE: `3 OTHER(S) PRESENT: P REMARKS: '"y^1 \*.•\ Q� 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 '.lay 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 ■■■■■■■■■..■■■■■■■■■■■■.■■■■■■■■■■■■■■■..■■.■■......■■■..■ .■■.■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■.■■■■■■■..■■■■...■..■■■■■■■■■■■......■..■....■■■■■.■■...■■■■■ ■■■..■■.....■■...■■■■■■■■..■■■■■■..■..I....i�■.■■■■■■■■■■....■■■■■ ■■■■■■■■■■■■■■■■■■........■■..�\1\CII..►\■■■■.■.%.■■■■■■■■■■..■■■■■■ ■.■....■■.■■.■.■■■■■■■■■■■i..■i.►�I►X11■■■.\i■i%1■■■..■■.■■.■■■■i■..■■ ■.■........■■■...............■■GiSil.'■1...■■..1111■.■■■.■■.■■■■■■■■■■■■ ■■■■.■■.■..■.■■....■..........\iii%I�i■I..■■...1111...■.�.■.■.■■.......■ ■■■■■■■t�■■■■■■■■■■■■►n.lt►.■■■■■■■■�11.■■■■■■.I�.....■...■........ ■■■ MIN ■......■......■■........■■...■..�■....1.11■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■■■■■■■■■■n■.I�.■■.■■■.■■■■■■■■.�■V■■■■■t■�i■■■■■■■■■■■■■■■■■■ ■...■■.■■■■.■.■.■■■IIP\1\�■■■■■■■■ ■■■..R■ ■■■■■. ■■■■.■..■■■■■.■■■ ��.iiii�iiiiii�iiiiii�iiiiiii�iiiiiii�iiiiiii iH.ii■�iiiiiii� ■..■■..■■..■■■■■■■.■.■■■■■.■■■r.■■■■■■r�■■■■■■■■■ ■�■■■■■■■■■■■■■■ ■■■■■■■....■n■■®■.■■1i1...■■■....■■..■.��.■ ■■..■■■ H.■■■■■■■■■.■■■ ■■■..■■..■■■■..■.■■■■■%.■■■■■■■■■■■■■■r ■■�i■■■■■■■ ■1O■■.■■■■■■■■■■■ ■..■■■n.■■■■■■■H■■■■.■I■■■��,�■.■■■■R ■..r ■_■■■■�i■i tl�ii� ..I.■C■■I1■■■■■■■1M ■■■.■■il•..■■H..■..■.11...1!!lri7[1J �;�■. ■■■■■II■■.■■..■■■■■■..11■.■(%'lei■■� \E■. 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