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156 M & D Ln ok Qi,�, - DAVIE COUNTY HEALTH DEPARTMENT %:+' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION /D-ID'�I� -�-'•NOTE:Issued in Compliance With Article II of G.S.Chapter 130a nitary Sewage Systems ) �Cp�;�,�/f a PermitNumber N2 773Name Location �� /_j-' �f / Al -/ G,-- ✓// �� aL r ' .^© vry=) ✓,'� � FJur J N„ Subdivision Name Lot No. Sec. or Block No. Lot Size House — Mobile Home Business -- Industry No. Bedrooms --?-.No. Bath's _ No. in Family _— Public Assembly Other Garbage Disposal YES p NO Specifications for System: Auto Dish Washer YES p NO Auto Wash Ma^hine YES Efr–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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT 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: Sys m stalled by — - f _ I ' Certificate of Completion __ Date 1A F 'The signing of this certificate shall indicate that the system described above as 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. yf,�,� S 6Y / ,�/ �....�� •- -��y♦� '�- xO I A t = DAVIE COUNTY HEALTH DEPARTMENT s ,`IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a ' Sanitary Sewage Systems Permit Number .Name Date �` `- sNB 7953 �r-- �; Location <J /_ ._ `'S �` fr/�� /`,'/ ✓ (% �i/r tet. r�✓ �;�3 �.�'f� .r-, ;: — ��r. Subdivision Name Lot No. Sec. or Block No. Lot Size 1l — House — Mobile Home c — Business -- Industry No. Bedrooms —.No. Baths — — No. in Family ' — Public Assembly Other Garbage Disposal YES p NO p'" Auto Dish Washer YES p NO Specifications for tem: Auto Wash Ma^hine YES pNO ❑ �.{' f 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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. .. r v� L;`s, ,J f, `'t� 4 ►• ' '� t$...A4:7 ,.' \LCY flL r ' Improveme ts,perrnMbyc:— J *Contact a representative of the Davie County Health�Department Jor;final Inspecti no of"this system betweenTO.9:3Q A-M., 1:00-1:30 P.M.or 4:30-5:00 P.M- day of compfetion.Telephone N- ber. 704-634.5985. W Final Installation Diagram: Sys m stalled by — Al r i f Completion �1� S Certificate Date o p � _ �1� The signing of this certificate shall indicate that the system described above 'has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P i Davie County Health Department Environmental Health Section �D P. O. Box 665 Z 3 Mocksville, NC 27028 1. Application/Permit Requested ByI(1 c -'C Mailing Address tl'b �t` ' � Q-k 4��n e Home Phone �$�` � b � `f iyq ee—me ° ✓ c ' D Business Phone (0-7 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House $obile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 2 ❑ Basement/No Plumbing No. of Bedrooms "J PI ashing 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: ❑ /Public El Private �ommuni� 8. Property Dimensions I//CZ -�? ?��L Sewage Disposal Contractor C 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: � � ae� �ew�.� ��-57�e �� 1� n�C �'e,�e�. 90 � e✓�cQ o� �,2;�e `meg-`{ A-0 ft'`- iLf- P-)A11VZ6 1 A v\Ct `� `g 1)4Ae AIS i-�V1► cIC a1� rt qfl� : n' A46 841ft4t ►• a ove I4%*t 4 -V �� &;*% its . !�+ 1a!' 0*got 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 thi appli ion. B —t nQA DATE SIGNATURE CONSENT FOR SITE EVALVATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: of,. I OWN the property. ❑ 2. 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 authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary t e e e s 'd site's suitabilityfo ground absorption sewage treatment and disposal system. DATE S G TORE DCHD(1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation ' NAME C�O�� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY ,/� �y1 e f LOCATION OF SITE Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L L 4- Slope -Slo e Z HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH '` ^ Texture group Consistence Structure /l ' MineralogyJ.' i /•' 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 K I , V I y // SITE CLASSIFICATION: EVALUATED BY: LANG-TERM ACCEPTANCE RATE: / OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Footslope 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 .lay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V+..ry 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 3C--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 !1 ■■/■/N■■■■■■■■■////■/■■■■N/ ■///■■■//■///■■■/■/ ■MEN MMwa=a1MMM■■■ MEN i''=iniiiiiiiMiii ■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■E MMMM■M■■■MM■N■■M ■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■ ■■■■■■/N■■■�►■�eg=ai IN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■N■■Nil■■■■■■HM■M■M■M■ iEiiiiiiii■iiii iiiiiCNNE'01i :::'::NOMMEN: NE ...............■■■■■■N■■■■■/■■■■O■■■■■■O■■■■■N wN■■ ■■O■■■ISO■■■ ............................................■..■ ■. 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