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150 Daye Ln (3) r . 60 DACOUNTY HEALTH DEPARTMENT 0 .IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a anit y wag Sy ems Permit Number P� X0 � Ql��� 'f Date r'�4� 0 r� Name__ ' ___ N 7 2 0 2 Location ,C�� �t�?��'SP��9�l��L� _ �,��I� �'i�✓� �f" ,®�Ya�� /- YD i�/�lw�l r fJ ri/ t Subdivision Name Lot No./ Sec. or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms `-� No. Baths No. in Family Garbage Disposal YES ❑ NO i� Specifi ation for System: Auto Dish Washer YES NO E] � p Auto Wash Ma-.hive YES NO ❑ ����.�� � �-[JQl 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 be taken as a guarantee that the system will function satisfactorily for any given period of time.. o c;' i :.qac, �;y�S .f. ! ..r t ,�?'j ''*,i: .., 1 j.5,5._ .}4 aby zcv..r� P,, r, Y, • ._ z x. .,;K.�;.s-< <�,.� • i 6' DAVIE COUNTY HEALTH DEPARTMENT " IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a anit e a Sy lem Permit Number Name �.- Date —� 7202 .} 411 11 NO Location Subdivision Name Lot No. Sec. or Block No. Lot Size /f/ House—�— Mobile Home _ Business Speculation No. Bedrooms .No. BathsNo. in Family _ Garbage Disposal YES ❑ NO ❑ Sp ci(�'catio fo�System: Auto Dish Washer YES NO ❑ %e . Auto Wash Ma-.hive YES NO ❑ fee/r;!X/� 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 I— _ 'Contact a representative of the Davie Coupty 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. �. s�/1� • 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[L� 1. Permit Reques d By k&t4 Business Phone 991;L/DO 2. Address JJ il/ l 0�70 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair _ b) Privy ConventionalOther Type- Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: HouseMobile Home Business IndustryOther b) Number of people 6. ap If house or mobile home, state size of home and number of rooms. House Dimensions /V'x _;: D Bed Rooms --5' 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 showers Z washing machine dishwasher sinks l 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes 'No 9. a) Property Dimensions 1-:1114f, b) Land area designated to building siteT� c).Sewage Disposal Contractor zy ��-�- 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/- y3 Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: J o0 � - C� V1 DCHD(6-82) Q h ' ~ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Son/Site Evaluation NAME o I/ DATE EVALUATED —S��/ ADDRESS PROPERTY SIZE - 1 PROPOSED FACIILTY ,�� LOCATION OF SITE Water Supply: On-Site Well / Community Public-P-11, Evaluation By: Auger Boring t/ Pit Cut FACTORS 1 2 3 4 Landscape position Sloe %. HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group /'_1L' Consistence Structure S S 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: EVALUATED BY: LANG-TERM ACCEPTANCE RATE: I 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 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 watef 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 CC:CCCC::CCCCCCCCCCCCCCCCCCC:CCCCCCCCCCCC'CCCCCC'CCCCCCCCCCCCC"CC ■./.■■/..■■.■.■/.■■■■■■■.■■.■■■■.■■.■■■..■.■■.....■.■ ■■■..■...._■ ■■■■.■■■■..■■■■.N..■.t'..■■■....■■■....■.■..1■■■■■.■.■.■....■.■.■ ■■.■■.■■■■..■■■...■■■■■■.....■..■ ■■■EMM. .■..��■N■■■■■■■.■■■■■■■■■ CCCCCC=CCC CCCCCCCCCiCCiiiC� ■..■■....■.....■■.■.■..��..■■■......■...■■...�i.■. ...■■■.!■.■.■■■!■ ■.■........■■.......■.....■...�i.C::i:ii� summonu■!■.. ■■■■■■■■ ...................................... ..E.■■■■E ■l■M.■■■.E..■.■. ......■■■■...H..■.■..■■....■■..■.■.■■ ■■■■■ . .■...■■■■■.... ........E■...■N■■■....■■■...E■■...... . ... . .. . .. ..MEMS ................................ .... .....C.. 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