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178 Juney Beauchamp Rd (2) DAVIE COUNTY HEALTH DEPARTMENT r, '�,� IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permli Number Name l 'r=' "7 // �Date –,,/ / NO 6 2 Location V n ✓ Z,_42a,"zU Z22- ,21.1al, :�2r ! ' b division Name Lot No. Sec. or Block No.l Lot Size A House Mobile Home _ Business Speculation I No. Bedrooms .No. Baths No. in Family ::2 — Garbage Disposal YES ❑ NO lam` ,., Specifications for System: A@0 Dish Washer YES NO ❑ Auto Wash Ma.hine YES NO ❑ Type Water-Supply �,. _-- ��'9��'�/� *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 us Wan ge. i 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 704-634-5985. Final Installation Diagram: System Installed by Certificate of Com letion < < este *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. r 1 1 j APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 RECEIVED FEB 14 1" Mocksville, NC 27028 1 . Application/Permit Requested By �c-W°l.� l ('_� • �t��n Mailing Address" �i Q�� for 4 MVwte tic, c�-?Zw Home Phone �'I_� -`'/ � `7�U Business Phone 2. Name on Permit if Different than 'Above 3. Property Owner if Different than Above tAJ ( • 4. Application/Permit For: C) General Eva1 tion V g/Tank Installation 5. System to Serve: House Mobile Home 0 Business Industryu Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot-# No. of People Dwelling Dimensions f �2 k �36— No. of Bedrooms ��_ Basement/Plumbing No. of Bathrooms / ` Basement/No Plumbing 0 Washing Machine G Dishwasher, , 0 Garbage 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: �bllc Private Community 9. Property: Dimensions _ 10. Sewage Disposal ContrI actor —tin 11 . Do you anticipate additions/exp Bions of the facility this system isintended to serve? 0 Yes o If eyes, 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 trig best of my knowledge, and I understand I am responsible for all charges incurred from this application. Date gnature Directions to Property : Zoe%��• ;s f./�� o a. �/ wily, ��. - pd /Y- �� 512 RP rap � 0 rd � r ANSE 6Aj rk DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section j� l Soil/Site Evaluation /� NAME DATE DATE EVALUATED �% `�/ ADDRESS PROPERTY SIZE 5?:I ' D PROPOSED FACULTY LOCATION OF SITE J s /,/u.� C.'n Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L -L Sloe % ''- HORIZON I DEPTH Texture group Consistence Structure .Mineralogy HORIZON II DEPTH Texture group- C Consistence ; Structureiz ,&, --.f,A � Mineralogy /"/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION %f LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE R TE: C 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 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 ■....■■■■■■■■■■■■■■■■■.■■■■■■■■MAW■■n■...............■..■■■......■ ■■■■.■.■■■■...■■■..■■■ee.■■..s.■■■■c!ern■■■■e■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■.u..■■■■..■■■■.■■■■■■■■■■�■■...■......■■..■■■.■■.■.... ■■. ■■■.■.■..■■■■■■■■■■e■■■■■ire■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ iiiiiiMENNEN��iMENNEN iiiiiiM MMMMMM%MMiiiii"iiiiii ■■.■./■■■■■../.■..■■.....��:/■■/..■■.■■. ■.■■■■■■■I■■■■■■.■■■■.■■ ................................�....A.....■...■ No NONE ..■ w■■ ■■■.......■■...■..■.........../■ ■.■u.■.w.....e■...■.......�■■.■ ■■.■■.■■..e■.■■.....e■■■■.e■■■■■e.■■■■e■■■■.■■ ■e=■■■■■■■ ■■■■■■ ■ ■■...■■■■■■■■■■■NOON■■■■■■e■■■■■■■■■■■■■■■■■■■. ■■■■■■■■ ■■■■■■■■ ■.........■.......■.....■....■■■■■.■■..■.■..■.■■.■■■■■.■.■■..■■■■■ iiiiiii MEN�iNo