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449 No Creek Rd (2) DAVIE COUNTY HEAl�f H'V DEPARTMENT _ =1� `IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION q 5 'NOTE:Issued in Compliance With Article II of G.S.Chapter 30a .Sanitary Sewage Systems les 3X01--4 Permit Number . 1 n o Name _ Date _ N_ 7948 948 Location �J Subdivision Name Lot No. / Sec. or Block No. Lot Size `_ —_ House _ Mobile Home ---_ Business -- Industry No. Bedrooms Baths Baths — No. in Family `— Public Assembly Other Garbage Disposal YES p� NO p/ Specifications for System: Auto Dish Washer YES p NO p Auto Wash Ma^hine 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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM', C' i� J C.f} 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., 1:00-1:3P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634.5985, Fina Installation' 'agram: System Installed by —� �� Vz)3�01yo i� Hogs r %oo f 1 Certificate of Coti \_ , vim" _ Date / �5 i4 `!— 'The signing of this certificate shall indicate that the system deSEF ed above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way e taken as'a guarantee that the system will function satisfactorily for any given period of time. - f APPLICATION FOR SITE EVALUATION/IMPROVEMENTS (� �"'"'�'" j� Davie County Health Department °� Environmental Health Section O. Box Mock 2 0230 sville, NC 27028 1. Application/Permit Requested By v � co- C, - � �- Mailing Address FO 5QX I`�'iC►l Home Phone \V UJt)—W- . .tsi .C, Z^715 Business Phone 2. Name on Permit if Different than Above �� 3. Application for: E)General Evaluation l�Septic Tank Installation Permit 4. System to Serve: Q House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 2- eBasement/No Plumbing No. of Bedrooms C7 Washing Machine No. of Bathrooms 77 Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private Community 8. Property Dimensions —7 iNCP6�2 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem 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. Directions to Property: LGIT< B I� XVG01 aJ L do evxV X17. Poll� MIA VOC aJ �� , �r"�N Flpallf t+6u5� This is to certify that the information provided is correct to the best f my knowled e, nd I un erstand I am responsible for all charges incurred fro"J this application. DATE SI NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT t Environmental Health Section Soil/Site Evaluation h p NAME c s \ ma; t�•��`' DATE EVALUATED - ADDRESS J Atcro PROPERTY SIZE PROPOSED FACIILTY �AoVSCL LOCATION OF SITE Water Supply: On-Site Well _ Community Public L Evaluation By:CV_� Ev Auger Boring 1/ Pit Cut FACTORS 1 2 3 4 Landscape position HORIZON I DEPTH Texture groupL Consistence Structure Q�' Mineralogy 1 1 HORIZON II DEPTH '' •2'' zlt Texture group Consistence lrZ Structure W__ If> IV_ 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 SITE CLASSIFICATION: .S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: 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 ;lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V+_-.-y friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Nonplastic SP-Slightly plastic P-Plastic VP-Very plastic Structure 3C--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 ■■■■■/■■■.■■■am.■•..■■sm■■M.N■.■■■..■■O■O.■C..:--.:•off■■.■■■■■.■■■■ ■MM■.■.HEMI/MM./■EMM/E■■..�■■ ■■■■.■.!�■.■■■.■..■■ ■■■■ ■■■■ MNNNMII■■ ■.■■■■.■■■■■■■■■■■■■.■..■1►I..%■■11■■..lit►/■P.:1■■■■■■�■ EINN 01 M ■■NNEN ■■■■■■■■■■■■■■/■ ■■■■.■..IIMN■MEM■EMENNE■M■■MNENM.■N■M■■■■■\\■■.■■��■�■■■■.■.■■■/�;■■ ■.■■.■..11.E■NEE■.■■■.■■.■/./■■.■.■..■/■■■■■■■■■ M■MEMM■■■■■.I■M ■.■■.■.■/t■■■■.■MM■■■.MEM■■■■■■■■E■ME N■■■�■.■.■■�MMMMMMMMMMMM.IM� ■■■■■/.■ll■.■■■■■■■■■■■■■■■■■■■■■■■�■ ■■■■■■ ■■■HMM■M■M■ M=M■.■fil mono'11'1miommoiimm:'�:■: .......n►...E■s■M■ESE■E■s/■.■■■■�IE■■■M■OH�■MEMMMMNM■■.■MMNMN mom .■........�...................... ........ .. 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