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1697 Hwy 64W 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 /l ..'r ! � ��i� . 'S1Date / –/E �'Za ND 6175 l:0 n ,a ttl " -77/L/r' rA�.�.�',1 ti fl�'/G� ' � �Gd � ./`l/l: Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home k—l"'* Business Speculation E No. Bedrooms No. Baths 1 No. in Family Jv Garbage Disposal YES ❑ NO ErR• ' ' Specifications for System:;-t; Auto Dish Washer YES NO ❑ ". Auto Wash Machine YES NO ❑ ��� `� Type Water Supply � �c'�/rS',k'/ ` ej *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. s� 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. a Final Installation Diagram: System Installed by 1u'W c 4 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. ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section la P. 0. Box 665 Mockaville, NC 27028 1 . Application/Permit Requested Byill E S �• 6 co/YI BfO'y Mailing Address Room' �� . V, Home Home Phone 76z- 97 Business Phone 7U10'-e q 7 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: lC) General Evaluation TIS/Tank Installation 5. System to Serve: C) House R' Mabile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms Basement/No Plumbing 0 Washing Machine 0 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: 0 Public Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/e ansions of the facility this system isintended to serve? 0 Yes Ly 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 charge's.-,incurred from this appl tion. Date Signature Directions to Property : ell' l DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED 14 ADDRESS PROPERTY SIZE /Au PROPOSED FACIILTY LOCATION OF SITE 4 w Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position < A- L Sloe % 2 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH •pilo Texture group Consistence Structure S^ ,T /� Mineralogy -/ ,i-i �;- HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION _ i, LONG-TERM ACCEPTANCE RATE ✓'- , SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: •� 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-Finn 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 ■■■.■..■■■■..■■■.■...■.■■■■■.■■■ ■......■....■■■■■■.■■■■■■■■■�■■■ ■■■■■■ ■E■■E■ ■MM■M■ ■EME■A ■■.■■■ EMMEME ■EM■■■ ■■.NE■ ■■.■■.■■■■■■■...■...■■■■chi■■/■/.■.M■■■..■/■./■■.■■■■■/■■/.■.■..■■■ •••••••......................■.■�imom SEE MMMME■E■MMEMME■EMEM■■ MEM■ .............................................................�■..■ :CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC�CCCCCCCCCCCCCCCCCCCC MENEM CCCCCCCCCCCCCCCCC::::::::::::CCCCCCCCCCCCC'CCCCCCCCCCCCCCCCC .................................................................. ■■■■■.. .■■ ■../■■■ ■.■■■■�i■■■■■■■■./.■.■■■/■■■■/.■.■.■■■■�■■■■■ ■■■OMME■ ONE ■t■/■■■■■■■■■■L7■■■■■■■..■.■.■■■■■■/■.■■■■■■■//.■///■ ...................... .................... ..................... .........■........................................................ .................................................................. .................................................................. ■■......■■■■■■.........■■■■■■■.■.■.■■■■.■.■....■■.■.■■■■■■■■■■MEMO