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1290 Junction Rd o ,.. _r- ,+ ."F`^t •<,' ! r ,A. i}..y. -.'V 1 t' - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a S nitary Sewag Systems q ., Perml lu be Q b y Date I f �� ( G t� f��` s� `Name N2 1��-� �=�Q�� i� _'__ _ ��a 1 • �.. �� tea. Location -- Subdivision Name Lot No. Sec. or Block No. Lot Size House _ — Mobile Home Business, Speculation No. Bedrooms No. BathsNo. in Family Garbage Disposal YES ❑ NO Specifications for-System: Auto Dish Washer YES [� NO ❑ t>"c' Auto Wash Ma.hine YES p �10 ❑ Doo NY X 1-1" C)v `t.� 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 704-6.344--5985. Final Installation Diagram: System Installed by 6_ Eur- IV ,- )7 veN 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. 4 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section RECEOVED P. O. Box 665 4}��g Mocksville, NC 27028 SEP 13 1933 1. Application/Permit Requested B BOB ` -- :====J 4 Yn n Mailing Address V ,��T 'f,Q( � 7_ 1 V l 00M. N C• a7 oa 8 Home Phone 0 I- f qQ--7353 Business Phone 5AM6 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation Lam"Septic Tank Installation 4. System to Serve: El House tfYMobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 3 ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions 'a ,� L S ❑ Garbage 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: 2"ublic ❑ Private ❑ Community 8. Property Dimensions 105' X a 0-7, Sewage Disposal Contractor �� 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? El Yes L�3'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: Go Dawo VC4Lt O &aeL4 0 p l U RN d� ULCTJ0IV pc`Olio, OF 0oic- (Aius i3fias 1141% 6c0E OF PAI(. ROAW3 TA-Ck0 ) TIg.N UP &(tFtVC-J- �21 Y� j�-s�p� � v►� (MDaILL KQP51LC- HOM6 (ON T619 OF �JLL. (JILL, B6 M601L6 J-616 (0-'(6R F)PeK 401 —/o R1611JT 0Z9V6A-S- This is to certify that the information provided is correct to the best of my knowledge, and I u derstand I am responsible for all charges incurred from this application. DATE Sr6NATUbE CONSENT FOR SITE EVA66ATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative o,the Da ' C My H alth Department to enter upon above described cated in Davie County and owned by c�. N-1 N1 all testing procedures as necessary to determine said site's i abili for a gro absorption sewage treatment al system. -i843 cam• DATE SIGNAT E DCHD(12-90) F ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation G NAME �� 0 Y DATE EVALUATED ADDRESS S P PROPERTY SIZER PROPOSED FACULTY WN �\ y LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:�'� L Auger Boring l/ Pit Cut FACTORS 1 2 3 4 Landscape position S S � Slope Z St /5° HORIZON I DEPTH Texturegroup C L_ C L L C�- Consistence Structure Q' P P P- Mineralogy 1 I I ; I HORIZON II DEPTH _'' 1 2 ' 2 Texture group k1_1 . Consistence - -rrT_ Structure e �' Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON — SAPROLITE -- -- - CLASSIFICATION 7 LONG-TERM ACCEPTANCE RATE Ll (� SITE CLASSIFICATION: V'S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: L OTHER(S) PRESENT: REMARKS: nA, - � � L GEND 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.■■■■■■■.■■■■.■■■.■■■.■■■t.o■ ■■■■■■■■■■■■■■.■■■■■.■.■■■■■■■■■■■■■.■■.■ ■.■■Gm■■m■■m■G■■■■■■ ■■ ■■■■■■.■■■■■■■■■■■■■/■■■m■.■■■.■ ■■■■e■■■■■■■..m■■■.s■..■.■■.■■■■ ::GGGGGGC:;GGCGCGGGGGGGCGGCGGGGGGGGG:GGGGGCGGGGGCCC:G�CGG:GGG.0 ■■■■m■m■■■■e■■■■■.■.■■■.■.■■■■■■ ■■■■mew■e.■■■■■■■■■■■■■.■■■■■■■. ■■■.■■■.■■■■■■■■see.■■.■■■m■m■■m..�e��a:�.im otm■■■N■■■■■m.t■■.■■■■.■ ■■GGG�■G■■GGGGGG■iCG�■GG■■GGGGGG■■iiiii!;■simi'iGGGGG"�G:'.GGG■■■■■■■■t■ ■■■■■■�■■■■■■�■■■■■■�■■■.■■ ■■wry■a�i■■m■�. summom■■GGGGGG■■ ■..■.■■.■■■.■■■■■■.■.■■■.■■■■■■■■■m■■a■n.■i�■. •_■ ■■.■■■■■■■.mmmmmm■mmmmmmmmmmo■om.ommEmm■a IL'li�,l'�MEN mm■om■■ ■■■.moss ......................................lim MEN...re . ■mm■■ ■■mm■■■■ WOMME................................ mmommom ■■■e ■■LINE u ■s ■ on ..see.. ■■■..■■e■■■■■■a■■■■■■■■■■■■■■■■s�■■■■IWu.ma■.. ,. memm■mmuom mm■m GGGGGGGGGGGGGGGGGI'GGGGGGGGGGGGGGGGGGGGGGm•''-ttmm��Smmt■.■■■■m.G■■.■ ■■■■■■m■mmmm.m..mm■.■.■t■■...■■..■■=■■■.m■.i■.�r� n'„ ' ■■■m.■mC■■.■■■ ■ nommommosommomm ■■■■.■■■mm■ammmmmtmmmm..mmm■m■m■r:�ls'�mmGm c�mmmm ■ MEN ONNNEENE ■■■■m■mm■mmmmmmmmtm■mm..■■mem■em t�:.�■ mm mmmmmm■.mmm■m■ we■s■■t■em.■..m.■m■■■■■■■r�■■■.m■■■.■_.■.■ r�. i ■.Cm■■.■■■■■■■.■■ ■■■m■■�� GCCmeiGmiiiGGGm■GGCeGmmiiiiiiimiGmG�i ■ 0 moMONGCGCGGMENG i[°iCCGGii ■■■G■■■■■■■■.■■■■e■■■.■■■.■■■.G■■■. 0■o ■■e■m■■m■■■mG.■ tmmmmm'■■omm■■mmmmommm■■■m■■■■■mmmmmmmNmmm■ '�0 MECC■m■m ■■memo■m■m .1!■4!■►.le■■■■■■e..■■■■■■■/1■■■■■■!■■■.u■■■.ruE■■■■.■■■mm■Gm■mn m■m aoo.■.m■.■■■■■■■■■■■m!.■..■.■■■m�■■.e.■■GU■■■■n..■.■■■■■..■■.■■■ ■■■■■■■■■■■■■i■■■■■■■Ir,■■■_=ea-.■■u��m■■m■■ ■■m■■N■■■■u■■■■■■■■■■■ ■■■.■■■..■um■.■e■m■r�■■m■m■■■■■■■la.■.■■■ u■■■n.■t■■■■■■ee■■■■■■ ■.■.■e■■■..■SI■OL:N:�■■■[/■■■■■u■■■■■■.■■■.■. ■■m■ m.■■■■■■■■ ■■.■■e■■ ■■■■■■■N■.m.l■/lC,■■■!�■■■■ ■■..■■t■■■■■.■■ .NmGNso■■.■emG■■n■■■■ G��G��G�G�G��I��GI%G:�I�GGG�GG�G::��GG�GGG�GGGGGGG�GGG�GGGG�:GGGGC�GG ■■■.■■t.■■.■�i■■■gra■■■■■■■■■■■■.■■■■■■es■■■■■■■■■■■■u■■e■.e■■.■■■■ onsommoommmmommoon GNEMESES GG:Guy■G.�G000�.GG'.GGGG�.GGGGG�.GGCGGG wt��