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251 Lydia Ln 14, DAVIE COUNTY HEALTH DEPARTMENT lr . - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a - Sanitary Sewage Systems Permit Number Name _ fi -". 1 .° r `_. t:_ s _ s � _ Date �' — 16 r Location +�'`� ',_•\ �.,\ �, �L,� � _Y� Com. � �. ";+,�.`y-�.;}� �`':�s �� Tc� Cl:.r, 1-� — � (it. - y r��.r..` Subdivision Name Lot No. Sec. or Block No. Lote Size . �? -�r"`— House — �Z !`Mobile Home ---_ Business Industry No. Bedrooms ---.No, Baths �_�?_ No. in Family Public Assembly Other -Ga L o Dish Washer rbage Disposal YES E NO p Specifications for System: AuYES 0 NO Auto Wash Ma^hine YES d NO [) ' a ll I Type Water Supply •This perrriit.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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMITILAYOUT BEFORE INSTALLING THIS SYSTEM. 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 / ?1212M. &-Z� 1 1� Certificate of Completion c/� __ 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 � EIV p � Environmental Health Section q ' li P. O. Box 665 JAPE � 3 �99� Mocksville, NC 27028 1. Application/Permit R quested By Mailing Address C 1A Home Phone 3 A61 O �9106 C /�,, BusinesssPl�� 3 � -o 2. Name on Permit if Different than Above )-h S�'-.S . - Y��`0— IP 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: cl!�House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Y1 Section Lot # ❑ Basement/Plumbing No.of People G*asement/No Plumbing No. of Bedrooms Washing Machine No. of Bathrooms 2 ► j— Dishwasher Dwelling Dimensions Ito `p Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type YlA?►- 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: ❑ Public �brivate ❑ Community 8. Property Dimensions .4 X,ss��C y`P S Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No 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: �j S� 1�3 f+ �✓�✓' 1'P VJ L s � � L, L�/ 1 p ,;mss-�- G r'Prvel r OA o r L� _ 6Y-�crr,C� � t blo vr,, s4&,k eq 6 �.r IAY-ds +b roy-4V, Pmg $ Geo r-j p� 7 This is to certify that the information provided is correct to the est of m knowledge, and I understand I am responsible for all charges incurred from this application. DATE IGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 62. 1 DO NOT OWN the property. If you checked Box#2,the rest of this form MUST be completed by the owner or a person thorized by the owner: I hereby give consent to the authorized representat&&of the Davie Cou ty He Depart nt enter upon above described property located in Davie County and owned by U kms to conduct all testing procedures as necessary to determine said s'ite'd suitabili y for a gr and absorption sewa treatment and I disposal system. DAT15 S GNATURE DCHD(1/93) zt 'lilt 2�3, QX TM c F 6-5;&A 1;,Vwx I 71 25 VZ11 tg'A� VAL F*J mi A "-t� 'V T ., go, 11,-- --� - � -nv L XX w A VF o tN �7 —03 Af 5M 452 .`8 2 Ac Nq al '�p Fv, kN 'N 4 "4 OR J�u 20 t �Mtri�ll 19 PHOTOGRAPHY ' BY 1 - 7 -ERVICE ALSTER & ASSOCIATES, INC. K—7 09 COLUMBIA., SOUTH CAROLINA )Ll'-NA 29720 DAT E OF PHOTOGRAPHY: MARCH 28, 1976 L -7 " DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation p NAME YR 9.1� DATE EVALUATED 2s 1 ADDRESS S `E> mac.@ PROPERTY SIZE I.4- pS CD,y_pyls� PROPOSED FACIILTY Q J S'Q LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:t;_ Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope p- � p_ v d _ o HORIZON I DEPTH I ' �' 17< Texture group �-- Consistence Structure Mineralogyo d HORIZON II DEPTH b ' 0 0 a - Texture group C C Consistence — '- - Structure tZ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 S S RESTRICTIVE HORIZON r -- SAPROLITE -- CLASSIFICATION .S. •S LONG-TERM ACCEPTANCE RATE 1 SITE CLASSIFICATION: ` - EVALUATED BY: LONG-TERM ACCEPTANCE RATE: .k OTHER(S) PRESENT: 9 REMARKS: -' a\ - LEGE 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:i, 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 ■■.■■...■......■.■...../■■.■...■■■■■■■..■.■..■e■.■■■e....■■■■■ ■■■ iiiiiii■iiiiiiiiiiiiiiiiiiiiiiii�iiiiiiiii��iiiiiiiiiiiiiiii■i■iii ■.■.■■.■.../..■../■...■■■.■...■■.■.....■■./■.■.n.■e■ Omni .................................................................. �� ■iii�ii��iii�' Isiiiii Wiiiiiiiii=i■i �iiiiii .■■.■■.....■u...■...■./..1.■/■�l .../ .... .. 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