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1802 Junction Rd FAr .:`,y r 5i '.. > r '.; ','y4 r.F't it' a""':.� ',i.'"it v`t'wii r"i .7 Sli.. ,.,. f . ., -fi ..P' � �✓ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION i *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a x,92 Sanit rx SewageSystems ` _ �� i� _ Permit..�I lqq er u166� Name — Date N2 Location �� U I `� - 1 (�� "'' � �� ,�GSA meq, `.�::�i, �`, cry. ...1 U.x�`�.�.i:+:. �� •.;?.�`,. Subdivision Name Lot No. Sec. or Block No. I :.:) K I ;) V Lot Size House Mobile Home _ Business, Speculation No. Bedrooms No'Baths �— No. in Family _ Garbage Disposal YESNO ❑ Q/ Specimations-J S stem: Auto Dish Washer YES p NO E] ` ��'` Auto Wash Ma shine YES K] NOo "` Utj \ Type Water Supply / *This perAt 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. 1 /t - `^••\ f Improvements-permit - *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:0.0-1:30.-P.M. on day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System.lnstalled by._ �'a of .00 Certificate of Completion Date 9 - 7 "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 P IL Davie County Health Department '!c! Environmental Health Section P. O. Box 665 AUG 2 0 37.tt�e 7 Mocksville, NC 27028 1. Application/Permit Re ed By �/ Mailing Address 00eh, �? 0 Home Phone �- V_ Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation eptic Tank Installation Zo4. System to Serve: ❑ Housebile Home ❑ Place of Public Assembly ❑ Business ❑ Industry j=1 Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing No. of People 41— ❑ Basement/No Plumbing No. of Bedrooms__ =ishwasher achine No. of Bathrooms 2== Dwelling Dimensions___ 1,2= 1; ❑ 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: ublic ❑ Private ❑ Community 8. Property Dimensions l50 Z t 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: � a / ,�� o V>-L �d� ( FZctc 1° This is to certify that the information provided is correct to best o my knowled nd I understand I a esponsible for all charges incurred from this application DATE SIGNATI! E CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: 1. I 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 he Davie Co ty He Depa o ent r pon ove described cated in Davie County and owned by ' all testing procedures as necessary to d rmi said site s suit =_Ws'o swage treatment system. DATE SIGNATUR DCHD(12-90) . r# - ;r.:,� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �V1� 1-� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY � LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation ByCl I- Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S S -s -S Sloe Z o -rsb O -cu 0 -g Cy HORIZON I DEPTH Texture group CL CL_ C �- Consistence V !'-t 1-� T_ Structure C R �Q Mineralogy1 1 11 ) 1 HORIZON II DEPTH 1 `l Texture group e- Z-1 Consistence Structure Mineralogy1 1 •'1 = 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texturegroup Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE �- — CLASSIFICATION S 3 LONG-TERM ACCEPTANCE RATE N SITE CLASSIFICATION: V 6-5 EVALUATED BY: e LONG-TERM ACCEPTANCE RATE: t OTHER(S) PRESENT: N V NQ 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 ■■■■■■■■■■■■■■.■■■■■/■■■■■■■■■■■■■■■■■■■■..■■/.e.■..e.■.■■ ..■iLl�e! ■61■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■.■■..e..e.....e.■■ie..■■■.■ mommom ........1 .��,............... ■■■■...■...■...■■.. ..■.■■..■■..■.■..■ ■. .■..■i■■e►rle■ !!Q./!7.■.■■...■■■■.■■e..■..■..e.e..■ .e■....■..■.■■ ■■��■..■■1...■c■.11siull�.■..e■■■■.■.■■ ■■..■.... .e..n......e..e..�■.. ■.■.r...■e.....■iee■.s�r�.e■/■es.•....e■..■.iiri..n....■....■.■i■..■■ ■.■...e.....G...eee>z..rrr..ewe..■..>r■.......■u.e■.■........ 1...■...■ ■....■.■..�.■..ei��e�ee►i.e.rl�►�,►lt...a�.e.�n...e�e...e.■.. e..■ ■..e..■ ■....■e..G..e...�.'�II.....ell.llls■./ii`.iY1�►��.■■......■■�.........e..■ ■.e.....I/.■.......i�.ir,.......■./.......e .■..■.n...■■..■..■...■.. ■......13...........e.■I.......�.Ilii....■/.�'■ii............�.........■ .......1....Il..........................n. ...■■.. 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