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P7558 McDaniel Rd 44W-- ZN DAVIE COUNTY HEALTH DEPARTMENT 100. 44 9-9� IMPROVEMENTS PERMIT AND .CERTIFICATE,'OF COMPLETION NOTE:Issued in Compliance With Article II of G.S.Chapter 130a S ita y Sewage Systems Permit Number 6K Name_- O,C S C� lt!_E. Date - �4 N2' 7558 ti ,U • � \t U \A.N �e \Q . 0Cl 140 Location — Subdivision Name Lot No. Sec. or Block No. Lot Sizey k o House Mobile Home Business -- Industry i.. 4 ✓ No. Bedrooms No. Baths ;"� No., in-Family 4 — . , Public Assembly Other Garbage Disposal YES ❑ NO"e w Specifications for Syste Auto Dish Washer.. YES [p/,NO Auto Wash Ma^hine YES [p/ 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. B .t 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: System Installed by "'��^ 9' s �. . - i d -+• O - 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. s APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested By Business Phone 2. Address ' d Ay 3. Property Owner if Different than Above Address 4. Permit To: a) Ir.istall Alter Repairs_ b) Privy . Conventional Other Type Ground Absorption C) s6b=ebd2i�- cc Lot No.�L- 5. System used to serve what type facility: House Mobile Home ! Business l/ Industry Other b) Number of people `t- 6. a)If house or mobile home, state size of l,i'bme and number of rooms. House Dimensions /2 Q Q Bed Rooms Bath Rooms—Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes �"' urinals garbage disposal lavatory showers �' washing machine dishwasher Z sinks 8. a) Type water supply: Public �rivate Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? A10 What type? This is to certify that the information is rre t tot of my knowled D e Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: w7h vi CdcNA-r ��r h d DCHD(8.82) i' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section w Soil/Site Evaluation NAME � �.1.. 3 - DATE EVALUATED ADDRESS a `� PROPERTY SIZE } Lk Ul 30Q PROPOSED FACIILTY ��\�6� `' LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation ByC:P,�_ Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 ' Landscape position .5 4;.S' Sloe Z O -1ko o Q _gam HORIZON I DEPTH Ia '' Texture group L L. Consistence —7007-77 9T Structure 011 Qn Mineralogy ' 1 HORIZON II DEPTH 31,11, 4'' 3 " ' Texture group Consistence IF T F Structure Q 4 k k Mineralogy ' ' 1 VA HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS Sas .S —S--P RESTRICTIVE HORIZON SAPROLITE — — CLASSIFICATION LONG-TERM ACCEPTANCE RATE C,L4 �L L SITE CLASSIFICATION: ' �' EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 1 OTHER(S) PRESENT: REMARKS: LE END 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 ■■.■■.■■■■..■....■■.....■!■.!■.■.■....■.■.■.■■.■■■■■■■■■■■ ■■Et >tr ■.■■..■..■■■..■■■■.......■....■. .■■■■.....■.■..■....■■■!lE. 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