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P7623 Peoples Creek Rd DAVIE COUNTY HEALTH DEPARTMENT � 4o 0.0 •4 .�,j IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION t *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name Date 94 N2 6 2 Location Subdivisio-i Name Lot No. Sec. or Block No. Lot Size _ - House Mobile Home — Business -- Industry No. Bedrooms No. Baths No. in Family — Public Assembly Other Garbage Disposal YES p NO'[ Specifications for System: Auto Dish Washer 4 zi. YES :pj. NO ,Auto Wash Ma;hive YES NO ❑ 3�c, ,, k 3. ` �„ 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. 0 U f , ,. r. •�1 Improvements permit by —C�-. � *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 `� � - r� . f= r•3 C-5113 63 5 Certificate of Completion _�� Date -�� -9 "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 a.: 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 �� L 7 e Business Phone 2. Address 3. Property Owner if Different than Above Address 4..Permit To: a) Install Alter Repair b) Privy Conventional/ Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home 0' Business Industry Other b) Number of people 6. a}If house or mobile home, state size of home and number of rooms. House Dimensions 14X 7S Bed Rooms 3 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 2 showers Z washing machine Z dishwasher sinks 8. a) Type water supply: Public `� Private Community b) Has the water supply system been approved? Yes No- 9. a) Property Dimensions '_� 6 L0 X --�?— 4 D b) Land area designated to building site A� � c4� �� il�'1 D�-r . -/-v� SC__(fZrr'_j c) Sewage Disposal Contractor d.7N 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is c t to th my knowledge. to Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ' - l DCHD(6.82) �l ti DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation c c NAME NI S DATE EVALUATED ADDRESS PROPERTY SIZE (tel Cpp9- r p\ PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:l�-'ZL Auger Boring Pit Cut FACTORS I 2 3 4 Landscape position Sloe % Ss°' 3° HORIZON I DEPTH &k Texture group Consistence T Structure MineralogX 14, 1 1:\ HORIZON II DEPTH " Texture group Consistence FT F 1 Structure Mineralogy HORIZON III DEPTH Texturegroup Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS T 15 5 RESTRICTIVE HORIZON 1 SAPROLITE CLASSIFICATION S, LONG-TERM ACCEPTANCE RATEI Lj I LI 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 A _ 0- S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt p 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 ■■■■■■■■■.■■■.■■■■■■e■■■■■e■■■■■ ■.■■■■■■■eeeeeeeNe■■■■■.eee■■■� ■■■■.■■.■.■■■.■■■.■■■.■■■■■■.e■■I�■■■■■■..■.■■.■.■■.■/■■./NOON■■■ ■.■■■.■.e■■e.e■■■■Nee■Nee.■E■■■Nee■Nee■■■.Nee■■■■.ee■..■■/■..■■■.■ ■■.■.■■■■.■■E.E■■..■.■■■..■■■.■■■■..■.■■■ ■..■ ■.■....■ SONE ■■ ■.■■.■■■.■....■■■.■■■■.■■■■.■■■■■■■......C........■...........CC.■ ■.■■■.■■■.■■■■..■..................■■■.■■■........C.....■........ ■■■■..■.■.■...■■.■..■.■■■......■■■ ■..EEE...■■EE.■...a■..■i.■..■■C CCC�eiiiiiiiC�■CCI■iCCCCCCC�eCCI■iCC�CCCCCCCCCCCI■iCCCINiCCCCINiCC1EiCCC■■CCCC ■■.■...■.■■■..■.■.■eeeue■■eeeee.e■■eee■.EEE.■.e■■N.N E..eeE...■ .................................................. ............... ■...■..■■.■■..■...■■■..■..■■■..■C■■■N.■■ ■■■.■■n■■■■.■■■■■■■..■■■ �iiiC�CCCCCCI�CCCCCC�iiiiiiCl�' CCCCCC�CCCCCC C�:CCC�MENNEN ■.■�.a■.a.►\e■■r.e■.1�.■.a■►�■aa■■e.■.■.►f�,■■�i�■�t►■■��ic'■1►►■■r�■■.►�■elr`■ ��e►►��e■.��e��ee►��le■■��ee►�le��.e a fiE�►� O ��►■WR■UMMEMMEWaa CC.'-iiiiiiii�■ �■■■'aiiCliiiiiiiiC.iiisa I�iieiC.iCC ■i.■a■■■N■■IC■MEN a■■ C ICCCCCCCCCCCCCCCCCCCCCIIC�,\�CC� � "ECC:ICCCCCCCC"r CCCCCCCCCCCCCCC ■II.■■■■.■■■■■■■■■■■■■i■11■■■■■■.■■.iii■■■��.■n■■■■CN ■ .■■■ n■....■ C\CitJCCCCCCCCCCCCCCCCCCI��C�CCC�Con"PR EMEME CCCCCC No ENO ■lJf.!/n■flla■■!■�t1./■■■■■■.■l�iiv!�■■■■ ■1!■■ ■ ■■■■■.■■.■■.■..■■ ■It■�i\.. 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