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P7426 Lakewood Dr DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Eompliance With Article 11 of G.S.Chapter 130a unitary Sewage Systems Permit Number Name , `, Date 4 N2 174 G Location CA v ^.d - Subdivision Name Lot No. Sec. or Block No. Lot .Size X ,0� House Mobile Home _ Business -- Industry No. Bedrooms No. Baths 1 - No. in Family _ Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer . YES ❑ NO �]/ )U)e3 , , Auto Wash Ma^hine YES NO ❑ U� �' J 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. 4 • i 1 r.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., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by r l� ADO n f 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. =mss APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT �;. Davie County Health Department Environmental Health Section ' P.O. Box 665 } - 1 1994Mocksville, NC 27028 1. Application/Permit Requested By !-Y`a� �G�L v,y 1 I Mailing Address 17S Home Phone V-'n c-c 1�5 y Q Business Phone, (o 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation 3 Septic Tank Installation Permit 4. System to Serve: ❑ House B�Mobile 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 3 ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions - ❑ 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: ❑ Publicsrivate ❑ Community 8. Property Dimensions /S b Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 0-110 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: do"3 r\ 5e COR C� dr; c o A 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BED NE,_N ABOVE DESCRIBED PROPERTY [and ECK ONE: ❑ 1. 1 OWN the property. ( 2. l DO NOT OW]treatment ked Box#2, the rest of this forrrl MUST be completed by the owner or a person authorized by the ve consent to the authorized representative of the ave County ealtt�,Department to enter upon a cated in Davie County and owned by ,I,J(,l - // ,177a 7A all testing procedures as necessary to determine said s suitability for a ground absorption se al system. DATE C7 SIGNATURE DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section (r'1� Soil/Site Evaluation NAME P� V, V DATE EVALUATED ADDRESS S 41hc.`~ PROPERTY SIZE 5 1 oOl PROPOSED FACIILTY U• \�oyt'sz LOCATION OF SITE�A�o wpa 1J� Water Supply: On-Site Well >� Community Public Evaluation By:CE-- Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position f -S 1.5 s Slope Z `6 -1.30 HORIZON I DEPTH Texture group C 1- C L_ Consistence Y=Z F Z V'L Structure C R IRZ Mineralogy \ '. } ; 1 1 r1 HORIZON II DEPTH '' e,I Z`• 112'' �o" Texture groupC C t Consistence = L F -5- Structure Structure `� k Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS 55 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION @,S. ,S S LONG-TERM ACCEPTANCE RATE tl SITE CLASSIFICATION: V. EVALUATED BY: A� 3JJJ�a� LONG-TERM�CETA CE RATE: —� OTHER(S) PRESENT: No N e REMARKS: 1l- �an� - 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-Nonplastic SP-Slightly plastic P-Plastic VP-Very plastic Structure ;3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloey 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 ■■■■■■■■.■■■.i■■a■■■■■■■■■..■.■■■■■.i■..■..■.■.i■.ee..le..ele■■.■■ ■...■■.■e..l.■s.l..i■■■■■■■■.■.■.■■■..■■■■.■.e■ee.eeeee.e.■e■e.■e■ ■.■■■.■■■■■■■■■.■■.■■■■■.■■■■■.■■■e■.■e..■ee.■■eleee■eese■.e■eeee ■l■■.■.■i■■...■■■..i■■.■l.i.■..■..■e.■.■..■e■■e■.■i.e■.ice.■■■■■■■ ■■..■■ee.■■..■le■■.i■e.■■!■■ee■.�.■.■e..■.eee■■e.ee■.■■■..■eee■■. ........................... ...................................... ..le■leleeeeeeeeele.e..11.e■lee.l............. ........ .......... ......................................... ■■■.C■■■■■e■■CMEN■■■ ■■ .................................................................. .........■...................... ................................ ■■■■e■e.■.■■■■■■e..■■■.■..■■.■■.�■..■.e.■..■lei..■■...■■.■■i.■■.■ ■■l■el.■■l■.■■■■■e....11l■■■.■■el.■■■...■■.e■e.e.ee.leel.eeeeeeee■ ■■ee■ee.■■e■e■■.■■■■le■al■.e.e■■..l■.■■e■e.■■■■..■ ■.ee■.e■.■e■..■ CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC� ■■■■...■■■■■■■.■■■.■■■■■.■.i■■■■ ■■l■■.■■. ee■....ee■■■e■■..e e■■ ■.■e■l..ee.e■■eeele.■ee■■.■e■■e.'�..e■le.e■C■...sle■.■■■■■.■e■■■■■ ■■■■■■■■......■■■.■.■.e.■.■.■l.el■...1■.lel■ie.■el■eeC■■!!e■e■■■=l ...............................■I�il■ee■e■lMireeee■.......■...■■... eeeeee.eeeeeleeeNleeeeeeeee.ee.e.ee.ever.►..>,�e ,`.,.�►�eeeeeeeeeeeellee■ ■.■.■■■e.■ele.ee.ee.■e.eeeeeeele.el■eeee.t,�r�.elcelee■ee■■�■e.■.■■ CCCCC�CCCCCCI CCCCCCCCCCCCCCCCC�CCCCCCC�CCiiiiiiCCCCCCeeiiiiiiC ■e..e■eee.ee■■ell■■■eee.ee■■!el■ ■eee■■■ ■■.■■.■■!■ee■■■!■.■e■ll.■ ■l.■■■ee■ee.■■e■■el■e■e.lee.■e.l■eeeeeeeee■.e.ee.eeee.eee.■elee■.e■ CCCCCC�CCCCCC�CCCCCC�CCCCCC ICCCCCiSCCCCCC CCCCCimmosomC ■■eeeee■■ecce!■ele.eeee.eeeeeee■el�.�eeeeeele.leee eeeeleee.e..lea ■ ..........................■.1....IGr......J..MEMO.e■■■!■l!C■e■lee.. ■e...ee■eee!■le�.eele.e.■■er�e■■./ei■ee.■�ie i.e■eeu�Moe■■e e■l■■e■■ ■■.■e■■■■.■■■e:��a■..■..e.■■��.■e■l.■■■.■■l.CSEEM e■ ■Ioe.eo■■■ee■.■■■ ■li..■■■.■a■.Itl/.!■■..■■.i....lea■I��le■.. ■eeee`�■.� ■ ■el►.e..l.e■.■ ■■■■e.■l.eN.■tL►.1�e11e.M1.■l/I■..�.■ lJYli ■e.l N ..5,]■ .■\\ ■■■■■■ ■.■■.■■..■i■.ie�iellln■Ir�■■.r�..■■.!�■■. 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