1760 Junction Rd DAVIE COUNTY HEALTH DEPARTMENT 1E
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION C1 .1 �
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems _ Permit Number
Name Date N2 6106
Location ,'�� �� c•X lC)
; l..�at�`.- c'`!�1hJS^+ ceµ.�..�, S.J.f= . _ .�- �f..Y:�S�. �%--,. ..�.,,,�5-"-.•�``f� .`�.,,,'•�,,,},,,',�-� .:�..:.'-.+.r�1�..a,
Subdivision Name �1 `� ` `' Lot No. — _ Sec. or Block No.
Lot Size -3 ice., House Mobile Home —A"/ — Business Speculation
No, Bedrooms { j �'q.\Baths No. in Family
Garbage Disposal i YES ❑ NO [QJ Specifications for System:
Auto,Dish Washer YES ❑ NO p, G Ul:.�
Auto Wash Machine YES 03 NO ❑ 7>'
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.
00
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 11\1WIN's,�111_
J
1
! j
Certificate of Completion Date 9 `� g
*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
Environmental Health Section
P. 0. Box 665
Mocksville, NC 27028 D AUS � �
RECEIVE
1 . Application/Permit Requested By0c' ✓'�
Mailing Address f ? &)A V 7 6
Home Phone 2 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 ii/S/Tank Installation
5. System to Serve: Nouse J Mobile Home Business
Industry u Other Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms � 3 - Basement/Plumbing
No. of Bathrooms %zr ` Basement/No Plumbing
® Washing Machine J 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
8. Type of water supply: Public 0 Private a Community
9. Property Dimensions -3117/_?4L=
10. Sewage Disposal Contractor f�/✓,� 1/lam ffi
11 . Do you anticipate additions/expansions of the facility this system 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.
This is to certify that the information provided is correct to triE
best of my knowledge, and I understand I am responsib a for all
charges incurred from this applicat
.Date Signature
Directions to Property :
Al JI
'
I ✓ /
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation �(
NAME
d F�� L � 17 3 �SU� DATE EVALUATED ` ^ l - 70
.ADDRESS
'S r PROPERTY SIZE :
PROPOSED FACIILTY NS �r LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By: 1,Auger Boring Pit Cut
FACTORSwr- p.,L
2 3 4
Landscape position
Slope % 2" v -2, o-
HORIZON I DEPTH Texture rou S c L $' cL. S CZ,
ConsistenceQ
Structure CID R
MineralogX 11.1
HORIZON II DEPTH :0 AAi 4
Texture group C
Consistence
StructureA 9 k
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON --
SAPROLITE --
CLASSIFICATION S
LONG-TERM ACCEPTANCE RATE 5-yl) 3.5` e 35-14()
SITE CLASSIFICATION: • EVALUATED BY: �,
LONG-TERM ACCEPTANCE RATE: 4' V OTHER(S) PRESENT:
REMARKS: CX -
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
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