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586 Main Church Rd (2) :.rte DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name -Date Ll ! U N� G 1 5 1 Location +S , n o "7 ,�'�\ _ nt "- �`` ^. �: �.C, �...�.y��\1:.1�_�c.� .;GTx?., � �< Subdivision'Name �.� " ,-ti s� Lot n `! {� Sec. or Block No. Lot Size (L: House Mobile Home _ - Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO E�/ Specifications for System: Auto Dish Washer YES ❑ NO ❑p� Auto Wash Machine 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. _., l -r ----------- '. o ` Improvements permit b `� P P Y ` *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. Final Installation Diagram: System Installed by �� <` ( 0 c Certificate of Completion Date / The signing of this certificate shall indicate that the system d scribed above has been installed in compliance with the standards set forth in the above regulation, but shall in 1�0 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 • Environmental Health Section P. 0. Box 665 RECEtVEO SEP 21 Mocksville, NC 27028 1 . Application/Permit Requested By _ - �ZL Mailing Address b V� C,/"� 1 1 �i ep Home Phone ��7"` -�Z. Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation S/Tank Installation S. System to Serve: House Mobile Home 0 Business Industry u Other 0 Unknown l /-////S /, '8� /fly 6. If house, mobile home: Subdivision d kN.re� Ff/ S Sec. Leo p No'. of People Dwelling Dimensions it / No. of Bedrooms Z Basement/Plumbing No. of Bathrooms Z Basement/No Plumbing Washing Machine J Dishwasher 0 Garbage Dispusai 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 8. Type of water supply: / Public 0 Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor c$7/a1-fl4 d?,(1 rNAf ee cj2�WJ'kr //f/ 1,91-2 11 . Do you anticipate additions/expansi.ons ,of the facility this system is intended to serve? 0 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. 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. A?a w "O�Xflzm� Date Signature Directions to Property / �CkJ (p Q� /�D/"y � /0 ,44r 6V>vq r r e: a N i it/sN it/ex os', e, o/V a� 0rev/AJ /o � / , /Z, d � 10-V X�n� . �'�-� r sed / 'p ties Ae— C,/90 r14 rly' )If�, .A , ire erre DCHD (10-89) •. � � N � �• ' w f��Ar tsr s 4w, •. r Y1 �� 1 �, � a%,.°w� Wl- so Ow 00 Homes 1 � n A O • •• v M I ``Y+�4 +� h AvItHu q At M wJ.,�a F w •�a wlJl ♦ n ,� •• • 0 •, : 0• 1i •• N y J► Jfw 14 . r • DRIVCAe ,��jr sy --•r � • ` r,, v 14 e DAVIE.C..IY.C. HILLS �03 SDG � O Oct. - :•`i� •y� .fes ....H._�r., DAVIE COUNTY HEALTH DEPARTMENT -' Environmental Health Section Soil/Site Evaluation NAME �� `\,\c I /3 0 DATE EVALUATED ADDRESS fl Y11 2 PROPERTY SIZE 6o , X a PROPOSED FACIILTY c,b 1e H 0 YI^�41. LOCATION OF SITE �AhI V� Water Supply: On-Site Well Community Public L/ Evaluation By: c`'L Auger Boring 1/ Pit Cut TS\no FACTORS 1 2 3 4 Landscape position 5 -S S SlopeF!- HORIZON I DEPTH Texture group L G C. Consistence Z I Structure Mineralogy1 1 HORIZON II DEPTH L4 6 Texture group C_ 5 C. Consistence am, Structure C, PC C Mineralogy ' I 1 `. ► I 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS .55 55 155 _15:S RESTRICTIVE HORIZON -- — �- SAPROLITE -- CLASSIFICATION S 5 LONG-TERM ACCEPTANCE RATE D 0 �, - . 0 i` q0 I SITE CLASSIFICATION: S . EVALUATED BY: �� LONG-TERM ACCEPTANCE RATE: 3 .8' - 4- 0 OTHER(S) PRESENT: N of�2 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 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 ■■■■■■.■.■..■■■■■.■..■..■■.■■..■■■■■■■..■.■...■■■..■■■■■.■■■.■!■.� ■■.■■■■n■..e■....■■■....■.■■e■■ ■e■.■■■.■■■■■■■■.■■■■....... ■■■ ■■..■■■■■■■.■■■■■■■■■■■.■■■■■!r!Ia■.1�■..■.■.■■■■■.■.■■■■■.■■■■■■■■son " MEMNONiiiiiiMENNE UNMEME MENNEN MUMMEM"iiiiii� ■..■■■.■■■■.■..■■■...■■■e■■ ■■.■.■..■■■■■■■.■■.■■■■■■...■..■■■■e■■ ■■■■■■■iia■..■■■■■■■■�..�_==t:�■■�-_�■■..■■■■■■■..■.■ ■.■■ ■■...a■ ■■.■■■■��tii■.■■■■■■■■■��■■■■I�..r.r6,S�SR7■■■■..■■■■.■■■■■■.■■■.■■■�■■■■ iiiii=ii�ii■iiiiiiiiiiiiiiiiiiiiiiiii■iiiiiiiiii=iiiiiii�iiiiiiii= ■■■..■�I�J■L..iii'��■.�.L!i�i��:i�C�!iCCiiO■■.■.■■■■■■■■■■■■. .■■■■ sommommo SEE ME ■■ecce■■eeeee■■■eeeeeeeee■■e■■eeeeeeeeeee■■eeeeee■eeee■■eeeeeeeee■