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328 Cornatzer Rd Lot 2 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Fssued in Compliance With Article I I of G.S.Chapter 130a ,i anitary/Sewage Systems Permit Number Name j��('l�Fr�1 .�.��tY^7LA rk 1 �-,�7� Date """'.J7-9d N2 61io • Location _ Subdivision Name r �'r� r �^ Lot No. Sec. or Block No. Lot SizeHouse ✓� Mobile Home _ Business __ Speculation No. Bedrooms _ No. Baths C No. in Family Garbage Disposal YES ❑ NO [ ' Specifications for System: , Auto Dish Washer YES NO ❑ /7j Auto Wash Machine YES NO ❑ ®� l 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 A2 / i *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 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section =� P. 0. Box 665 Mocksville, NC 27028 AUG ' Q 1 . Application/Permit Requested By Mailing Address 0. A1C -76 ` I > /"loJ:fSV� Home Phone y - 7 7 Y -2--- Business Phone 9 / F- 2. Name on Permit if Different than Above /` C �) �,nr'� L ii�_S�drn /Y6yYlE=$ 3. Property Owner if Different than Above 4.. Application/Permit For : General Evaluation /Tank Installation 5. System to Serves ouse u Mobile Home 0 Business Industryu Other DD r 0 Unknown 6. If house, mobile home: Subdivision bitG,S/G�2 644feS Sec. Lot* �- No. of People Dwelling Dimensions _,51y' x /716 No. of Bedrooms Z Basement/Plumbing No. of Bathrooms " Basement/No Plumbing 8--Washing Machine b-luishwasher 0 Garbage Disposal 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 S. Type of water supply: V Public Private ommuni.ty 9. Property Dimensions 10. Sewage Disposal Contractor "2)a'tJN1 La'1ce 11 . Do you anticipate additions/ex�pa ions of the facility this system is intended to serve? G Yes & 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. thf best of my knowledge, and I understand I am rosponsi.ble for all charges incurred from tl•iis ap Vate Signature Directiona to Property : -47 ��fy DCHD (10-89) ,y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation �J NAME iS/-� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY fP LOCATION OF SITE 1 e'w Water Supply: On-Site Well Community Public Evaluation By: Auger Boring_L/ Pit Cut FACTORS 1 1 2 3 4 Landscape Rosition Slope % e�2 119— HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupL' Consistence - Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATEI WS I � SITE CLASSIFICATION: Dr EVALUATED BY: Ay ' LONG-TERM ACCEPTANCE RATE: _ 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 ■.■■■■■■■■■■■■■■■■e■.■■.■■epi■■e■_.w■.:■■■.■■■■■■■■!■■■■■■■■■■■.■■■ ■■■.■■■■■■■■■■■■.■■■■■■■■■■.■■■■■■■■..■■■■■■■■■■■■■■■■■■■■■.■■ ■■■ .....■.........................■...■.........■........... ■.■■■■.■ i�NNNNNNU, ::::::�3NNNNNNr::: :: ::NNNN�lMENNENNNNNNN"NNNNNNiN ■■■■■.■■■i]■■■■■■■■■■■■■■I■.■■■■■.■■■■■■■■I■.■■■■■■■■■■■■■■■■■■■!■■■ ■■■...■■■..■s■..[�7�'■■....1...■..������.�11�■■■■... 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