217 Jim Charles Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewag�Systems PermitNumber
Name Date o 7 J N o ( 2 4
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size /. I �� House Mobile Home —� Business Speculation
_f r.1 n
No. Bedrooms r' No. Baths No. in Family —
Garbage Disposal YES [] NO ❑ Specifications for System:
Auto Dish Washer YES d NO ❑
Auto Wash Ma shine YES_\� NOO\�❑
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.
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k-1 C:G '•J 5 •n
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w
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 Numbpr 704-634-5985.
Final Installation Diagram: System Installed by
�f
J00 i
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. .
y
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT =+ �
Davie County Health Department
V
Environmental Health Section
ED
P. 0. Box 665 0 �
Mockaville, NC 27028 ,SD• � 8 x 1993
IDOr a
-------------
1 . Application/Permit Requested By T' ..S
Mailing Address
Home Phone 1 Y�Z° 1 Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation S/Tank Installation
5. System to Serve: (g House u Mobile Home 0 Business
Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lott
No. of People Z Dwelling Dimensions 40 -A 4
No. of Bedrooms — Basement/Plumbing
No. of Bathrooms 2 Basement/No Plumbing
(]''Washing Machine (YDishwasher dGarbage Disposai
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: C Public Private Q Community
9. Property Dimensions 3 0 0 )C (,S 0
10. Sewage Disposal Contractor r'�h
11 . Do you anticipate additions/expansions, of the facility this system 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.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
Signature
p -+uo- &-(-C, k •1-e�,,n r 1,yh+ o t1Lt rry Lc44 0,-\ lye,.,--¢ I
Directions to Property : o L ��,, ej o e,e,
r
DCHD (10-89)
• _ DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
M Soil/Site Evaluation h
NAME , \��C \�9 DATE EVALUATED
ADDRESS S ° PROPERTY SIZE 3 ISO
PROPOSED FACIILTYy SC) LOCATION OF SITE -- �
-1-N r�., Z a ss
Water Supply: On-Site Well Community Public
Evaluation By:Q_'� Auger Boring ✓ Pit Cut
FACTORS 1 2 3 4
Landscape position S -5
Slope % o p - v b . so C) -�
HORIZON I DEPTH s<"
Texture group S S CL—
Consistence iR 1:
Structure C, �R
Mineralogy
HORIZON II DEPTH 9D"
Texture group S C-L SCL L
Consistence T FZ -:T
Structure C,1?_
Mineralogy V.
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS 5S I ss .SS
RESTRICTIVE HORIZON
SAPROLITE —
CLASSIFICATION S S S
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: S EVALUATED BY: � n1�
LONG-TERM ACCEPTANCE RATE: L' OTHERS PRESENT: wz
REMARKS:
LEG ND
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 t
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