P6303 Livengood Rd l
(,u. DAVIE COUNTY HEALTH DEPARTMENT =l,//,N 10
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary SewageSystems Permit Number
Name,:22_._fJQ9z1 �`�c` y�fn7 /��� f,/rl' p —t-r',� N.0 G303
f
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size 1A?'A House Mobile Home Business Speculation
No. Bedrooms No. Baths /A No-.-' in Family
J
Garbage Disposal YES ❑ NO 12- ` Specifications for System:
Auto Dish Washer. YES NO ❑ /IUDG� , �
Auto Wash Ma.hive YES �] 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. J �1
a
L�
Improvements permit by A_? �
*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.
In Installation Diagram: System Installed b
Final s g Y Y
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. '
t
.^ APPLICATION OR SITE EVALUATION/IMPROVEMENTS PERMIT
iy a Davie County Health Department
00 I� Environmental Health Section RECEIVE
�� 011 P. O. Box 665 o CT
Mocksville N.C. 27028
/ CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED."'
J Home Phone
1. Permit Requested By Business Phone
2. Address o
3. Property Owner if Different than Above 144e%
Address s� ,�
4. Permit To: a) Install Iter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House-I—Mobile Home Business
Industry Other
b) Number of people 14/
6. a}If house or mobile home, state size of home and number of rooms.
House Dimensions
i
Bed Rooms.—Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes 2 urinals garbage disposal
lavatory showers 2 washing machine
dishwasher sinks
8. a) Type water supply: Public Private 4-� Community
b) Has the water supply system been approved? Yes P"No
9. a) Property Dimensions
b) Land area designated to building site � y4
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is o certify that the informatio is corr t to the best m c ledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE ITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
F;1-5 �� �o rYip �bt /2'/
jj/j 00� 14WZI nl/ zcl/.
DCHD(6-82)
DAVIE COUNTY HEALTH DEPARTMENT
~, Environmental Health Section
Soil/Site Evaluation
NAME �l/ ' y v/� DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY 1�/a m LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position Z .4- C.
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture group
Consistence
Structure f S6.e _r%Z2
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 RATE c'
SITE CLASSIFICATION: /' EVALUATED BY:
LANG-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-Finn 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
Mineralolzy
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
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~ Davie County Nealtfr Department
a .Morn X It A yenn d e ea Fr cy
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE,N.C. 27028
PHONE:(704)634.5985
October 25, 1990
Betty Potts Realty
P. 0. Box 2056
Advance, KC 27006
Re: Site Evaluation
American Homes of Mocksville
Livingood Road
Dear Realtor:
As requested, a representative from this office visited the aforementioned
site on October 25, 1990. The site was found provisionally suitable for the
installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
�nwa�.�✓a�l� Rs .
Robert B. Hall, Jr. , R.S.
Environmental Health Section
RH/wd
Enclosure