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605 or 617 Main Church Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION d *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit-Number Name ��_� � , \_ �,F't� �.. r� kA Date ' �U �0 r 26 17 Location `> ��{?r--"""tea SubdivisioCnn Name Lot No. —_ Sec. or Block No. Lot Size Cis House Mobile Home Business Speculation No. Bedrooms No. Baths j No. in Family Garbage Disposal YES ❑ NO EJ/ Specifications for System: Auto Dish Washer YES ❑ NO 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. ------------------------ 1ao , Improvements permit by *Contact a representative of the Davie Coun_tyy Health; Departme4 fo final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day'of c triplet v Talephone Number:,704-634-5985. ��._j Final Installation Diagram: S stem nstalled b t w Certificate of Completion , Date *The signing of this certificate shall indicate that the system described above has ba,_en 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 Environmental Health Section P. 0. Sox 665 RECEIVED SEP 0 7 1996 Mocksville, NC 27028 1 . Application/Permit Requested By �Gt/ I�qr Gf C eq r h %} /J Mailing Address A to DSC 4 -I� �M,,s4h-,s U /'/1-e—f Home Phone 44!� �(� ' /� Business Phone 3 966;" 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: l7 General Evaluation tIZITank Installation S. System to Serve: House �obile Home Q Business LL Industry u Other Unknown 6. If house, mobile home: Subdivision Sec. Lott No. of People Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms �_ Basement/No Plumbing 0 Washing Machine J Dishwasher 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 8. Type of water supply: V Public &1--rrivate Q Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/ex ansions of the facility this system is intended to serve? o Yes additions/expansions 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 plane 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. 'Date Signature IV A az h e r o ny er �O �j e� �J✓� Directions to Property : DCHD (10-89) 'C DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME u��R� �a���aQ.�C _ DATE EVALUATED 9 ADDRESS PROPERTY SIZE I_�,5 \\ \\ PROPOSED FACIILTY R LOCATION OF SITE %Wt t3 Water Supply: On-Site Well V Community Public Evaluation By:C. fi,L Auger Boring U Pit Cut FACTORS I 1 2 3 4 Landscape position Sloe % a • t 1a- O- Q HORIZON I DEPTH 4 11 " Texture group L I- C Consistencer-,L. VW V - Structure C. Mineralogy1 Il HORIZON II DEPTH til b Texture group Consistence 071 1 V PT V Y' Structure M Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS US VS RESTRICTIVE HORIZON _ SAPROLITE -- CLASSIFICATION U71 LONG-TERM ACCEPTANCE RATE ,S' 6 SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �. - 3 iD OTHER(S) PRESENT: REMARKS: _ - ��M -�•�� �� 3 s-� LEGEND Landscape Position t R-Ridge S-Shoulder f3--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 i DCHD(01-901 ■■■■■e■.■■■■■M.EEE.■■M■■■■■■.E■■■.:■E■■■■■.■e■.E...MM■■.■E■■■■■EE■ MEN ■■■■.■■■■.■..■■■■.■■■.■■■.■■■.■■■■■■■.■■■■■■■■■.■■.■■■.■■..■■ MEMO ■■■■■■■■ ■■■ ■■■■■■■■■■■■.■■■.■■■■■■■.E■MN.■■...■■■.■■.■■..■■■■■■■ ■.■■■■■■..■■■■.■■■■■■■■!■��zy��■■�■■■■■nil■■■■■■■■■■■■■■■■■■■■■■■■■ ■■.■■■■■■■■■■■■■■■■■.■cam-�=_■�..■e■■■..ate■■■■■■■■■■■.■■■■■■■■■■■■■■ ■■■■■■■■■!■■■■■■■■■■■■we■■■■■■■■■■■■■■..awe■■■■■N■■■.■■■■■■■■■■■NONE ■■■■■■■■■.■■...■■E■■■■■.■■■■■■■■E■■■■.■■�■■.■N.■..■.■■■■■EEE■■■■.■ ■■■■■■■■■■■■■■.■■r���]■/rN■■■■■■■ONS■■■o■■■Ori■■■■N■.N■■■■■■■■■■■■■ ■■■■ONO■■w■■■■■■■,■c-:�■■e!■eO■O■OeIO■NN!■■OOO■OOOO■■O■O■ONOOO■■NN■■■ ■■■..■■■■■■■■■■■■i■■■■.■■■■■.■■e;�■ilii■■i■N■■■■■■■■.■■■■■.■■■■■■■■■ ■■■■!■■■O!■■■■■■N■■NONO■w■ON■■N■ ■O■■■■ONO■O■■■■■O■.■■■■■■■■■■■■■ DAVIE COUNTY HEALTH DEPARTMENT r O zJd % P�i IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETIONh - Ji iac NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a 1 � Sani ary Sewage Systems Permit Number Name Date //'// i't N2 6205 Location r'`� �~ � � r a✓ �/, - / i r ,._ `l �n t-- /.. 7 } Subdivision Name Lot No. Sec. or Block No. -Lot Size �j!<y' House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES ❑ NO p- Specifications for System: Auto Dish Washer YES [ NO ❑ Auto Wash Machine YES [ NO ❑ Type Water Supply A' *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. t If i 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. Final Installation Diagram: System Installed by p0 C 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. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section s � 1 tet, Soil/Site Evaluation NAME /�l.l /1/ rI/ DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY �� f✓ LOCATION OF SITE Water Supply: On-Site Well ,/ Community Public Evaluation By: Auger Boring L/ Pit Cut FACTORS 1 2 3 4 Landscape position 41 L 4� Sloe %. Y G HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Tn 74P G Texture group ConsistenceA_ Structure !� /t b� k1 Mineralogy ,'ve - e 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 I , l SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 4 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 ■■..■.■.■■■■■■.■...■■■■■...■...■.■■.■........■■■■■■■■■■■■■ ■■..ME■ ■.......■■■■■■■■■..■■■■■■■■...■■.■■.�■■■■■■■■t■■■■■■■■■■.■■mom■O■■ ■■■...■........■........■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■.■■■■■Ott■ ■.■■■■.■■■■■.■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■Ott■■■■■■■■■■■■■■■t■■■ ■■■.■■■■■■■■■■■■■■■■■■■■■■.00■■■L■■■■■t■.■■■■■■■■■■■■Ott■■■■■■■■■■ ■....■■N..■c► ■■■........■......�.........■■■■■■e...■■■■■■■■. ■■■ .............................................................mom�■ ...■........................................■................... . ................................................ ................. ................................ ................................ ■■■■■.ttO■■■■.■■■■■■■Int■■■■■■tt■.■■■..t■■■■tt11■t■■.t■■■■t■■■t■■t■■ MENNEN EMEMEM"EiiiiiiMMEMEMiMEMEME� ■■■■■t■■■■■■■■■■■t■/■It■■■■ttt■■.■■■Ott■■■t.t■11■■■tN■t■■■■■■■/t■■■ ■...■....■....■■■■...��■■.■■■..■■ ■■■.e■■...■1/■w. ■■ MEMO ■■■■■■■ ■..■■■..■■■■■■■■■...■► ■.■■■■.■..�■t.MM■■e■■■f.■t.■■■t■t.■■■■■ ■■■■ ■■.■■■■■■■■■■■■■■■■■■■►tet.■■■■..w...=====tatty t■■■.tue■ ■.t■■■ ■ ...................■.....e....................�.■ Ott■■■tCME■■■■ ■ ................................................. ................ ................................ ................................ ■■w■■■■ ■■■I■O■MME■ ■■■■■...................■..............�..�.. ■O■EMMEt ME■ ■■■■■■■■■■.tt■■t■■...............■E■■OttOtt■vt■■■ ■■ ................................�........................... MOE■ ................................ ................................ .........■........................................................ .................................................................. .................................................................. ■....O.NOM..■■0....■...■..■.■t■..■...........■■.■■■■...■■.■..E■.■ ■...■■■..■...M..■■■...■..■...0.■ ■OMM■M■■..■■.■.■.■.■■..■.■...E■■ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mockoville, NC 27028 1 . Application/Permit Requested By ,�dw4,- Mailing Address M G G V yr/'I 1-e Home Phone l.� Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: C) General Evaluation 0--S/Tank Installation 5. System to Serve: House g,-Kobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms J Basement/Plumbing No. of Bathrooms I 7 Basement/No Plumbing 0 Washing Machine rj Dishwasher 0 Garbage Disposai 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: V Public a-'�Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor -�1 -1- Q/ l�i �L it 11 . Do you anticipate additions/e��xp �si.ons of the facility this system is intended to serve? 0 Yes L "o 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. Date Signature 1�8 `t"o d>'I ��� � ���� �� L•e7Gfi )y �/�l -Ps � c1-6SS Directions to Property : J- Th DCHD (10-89)