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296 Legion Hut Rd O r 41 DAV'IE COUNTY HEALTH DEPARTMENT 4 IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTEAisued in Compliance With Article 11 of G.S.Chapter�130a SanitarySewage Systems ��;lF�-.;�rc Permit Number .�" Name 4gy)"-__T- V)0 n/1 /i f e,-a Pd�h4 ',Z Date 2" _ 0Z-7—0 _ X461 �. Location %fir • T Subdivision Name Lot No. Sec. or Block No. Lot Size ���� ;- House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family��_ Garbage Disposal\ YES ❑ NO Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma.hine YES �i NO ❑ ` , 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. I 0 -3112 - C I1 Cvti�- l ts -------------- .� 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. s} Final Installation Diagram: °t System Installed by RR<- C r-rsZ . t r { 10a' 1' L?ArM Certificate.of'Completion ��!' Date �� - L\ - 9 2 "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 LEIVED Environmental Health Section P. 0. Box 665Mockaville, NC 27028 1 1991 1 . Application/Permit Requested By - - Y Mailing Address Home Phone &u,) a�(n Business Phone 0041' i 52- s (00t1i 2. Name on Permit if Different than Above nS RPI Q; 3. Property Owner if Different than Above 4. Application/Permit For: 1C) General Evaluation S/Tank Installation 5. System to Serve: House Mobile Home 0 Business LL Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot#( No. of People I' Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms _ Basement/No Plumbing Washing Machine lJ Dishwasher 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: Public Private Q Community 9. Property Dimensions —_I carcu 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Yes No 01 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 ttie best of my knowledge, and I understand I am responsible for all charges incurred from this application. Date Nk,�-� S gn tur &�Tloo--rvos+ �n-/) (-I)AA D • rections to Pt : o F _fhroper� ro�ot , as q,a M r►'►of��r— or M.Na DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �i So.✓ DATE EVALUATED 7(52-el ADDRESS PROPERTY SIZE sT r!j PROPOSED FACIILTY ,� LOCATION OF SITE "C-afQA) J/w e Water Supply: On-Site Well Community Public L/ Evaluation By: Auger Boring i / Pit Cut FACTORS 1 2 3 4 Landscape position L L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC e 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 _ 717 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: f- 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 watef 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 ■MOON.EEE..■■■■...N....■...■......■..................■.■■■....■..■ ■■■■..........■■■..■■...■......../..■■.NEON/..■ELS+!!■■■■■.■■■■■■■■■■ ■■■....n■■■■■...■■■■■■.■■■■.■..�■■.■■■NNe■■■■.■■..N■.■■■■■■■ ■■■ ■.ss......EEE....M.M.MESE.EE■■...E■.■.......■■■....■■■.....■■■■..■ ■.........■.........■■.....■..■. .■......■.■......■■■../.■■■■■■■■ ■E.E.MUEEE■E.EEEE■■.■MOON■MOON■ ■......����■■...■....■■■■■.....■ MENNEN Emmons MEMEME EiiiiiMOMMEN��iiiii�iiiiiii�iiiiii� ■■.■■■■■...■.......■..NI�..ON.E.■■�����■��■e.M.■.. 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