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150 Daye Ln (2) ss*�—....irw gy��:.+r4.lS''� xW^r.rwu.,".o.-w;�y, � s+..v- *r;R'—..arm w•r. _ -uwsz �1�c+F+ey�at r � Ftp-.,�.yjpr".:r�wr•�,yrswr+yew��.'..`'`�.aabTvti+^'�"""'w" �„"�ybrt�t+'a��svrori"U`�r`t,:v,"+.'m*..a'we"!+'-.:. e ,:.W 4. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS 'PERMIT AND CERTIFICATE OF`COMPLETION *NOYE:Issued in Compliance With Article II of G.S.Chapter 130a Hite Sewage Systems / Permit Number Name 41t/S ��0115�// l�l� l��'r Date f� N2 7201 Location � ' !/ df' D� Ohi ll��/.�� ✓-'✓l pry �-- � 117;,7 Mal ef e5r Subdivision Name Lot No. Sec. or,Block No. Lot Size � � House Mobile Home _v Business Speculation No. BedroomsNo. Baths '�- No. in Family Garbage Disposal YES p NO Specifications for System: Auto Dish Washer YES L� �NO ❑ ,� ox--er.1I/a � Auto Wash Ma shine YES [Fj 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. : Improvements permit by -- w6 / *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 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. t s' ' y ,1, - .., •t' t-' vs" C`, :� Yr v }'t�. 'C. yip. .a�`+... 1^y a ,i. .. .. _ !Or DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a a�na Pita Swge Systems Permit Number Name �� '�'�;GS'// ,2 Date NO_ 7201 -- Location — Subdivision Name Lot No. Sec. or Block No. 7 _ Lot Size / House Mobile Home _v— Business Speculation No. Bedrooms `" No. Baths No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications Jor ystem: Auto Dish Washer YES ryj', NO ❑ �/�j� C/ Auto Wash Ma^hine YES [3, NO ❑ ^4 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. Ila 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 — 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 betaken as a guarantee that the system will function satisfactorily for any given period of time. y r.. ♦v APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone(/f/ 1. Permit Requested By Business Phone 04f) 2. Address ✓ 7ad 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type— Ground ype 0 7— Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business Industry Other b) Number of people 6. al If house or mobile home, state size of home and number of rooms. House Dimensions 141X _70 Bed Rooms_ Bath Rooms Z 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 Z urinals garbage disposal lavatory Z showers Z washing machine dishwasher / sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes o 9. a) Property Dimensions � 141e"b) Land area designated to building site c).Sewage Disposal Contractor eff oVL'- 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? yy What type? This is to certify that the information is correct to the best of my knowledge. -s= o2L/- 9.3 '744Z�� Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: J 00 .A DCHD(8.82) Q ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS // PROPERTY SIZE PROPOSED FACIILTY kll' LOCATION OF SITE .("�✓�9 �� Water Supply: On-Site Well Community Public L/ Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 21<1 Texture groupe Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 7273 LONG-TERM ACCEPTANCE RATE k_77_ _ 7 77 SITE CLASSIFICATION: S 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-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 wateil 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 SSSSSuuuuiuuuuuuuuiiiuuuiiuuuuuiuuuu�■uuu'Suuuui i SuuuuuuuS'ii'SS ■■...■■■■.■■■■■■■■■■■■■■■.■.... ■.■......■..■...■■■■■ee.■■i■■ee■ ■.■.....■■/■■■..e■■....■..e■.■■..■ ■...■■.■..H■.■■.E....■...■MEMO �SSSSSS■�=iiuuuuul■�;i'■uuuuS■�iuSSSS■■��iuuuuuS=i�iiuuuuuS�SuuuuSr■�iuuuuiS� ■■■e■.■■■■■■■■■■■■■■.■■■■r�■■■■■■■■■■■■ ■■ ■■■■■■■ ■ ■■■■■.■■■.■.■■ .■■■■■■■■.■...■■■.■.■■■.■►�.�■..====son M=S■.■■. ■■■■e■■■■■■■■■ ■.■..■■...H.......■... 30 ME ■■■. ■■ ■ ■■ .■■..■ ................................ ...�■■....■. ■■S■.■S.■■S■.■S■■■S..■S.■.i■.■■'.■u.■■uE■■u■.■u■■■u.■■u■.■u..■u■■■u■■uu.■u■..u■.■u■■■S.■■■i..■■.■S■.■S■■■■■■■■■..■.■■■■■■.■■■■■■■■■■■■■■■■■uS■■e■ �■■ EEu■■u.u.'■u' ■. ■■E ■ ■R■■ ■ ■1i Suaiu�■ SiEMMMMuiuuuEEMENOMONEE Samsun ri■nu UM■ uM ■ S ■ ■■■ ■■■■■■■E ■...■■..■■..■.■■■�..■■..■■...■■. 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