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438 Pineville Rd • .: DAVIE COUNTY. HEALTH DEPARTMENT ' IMPROVEMENTS PERMIT AND CERTIFICATE OF-COMPLETION �Q *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a S�nita Sewage Systems Permit Number Name �,i�. i �r, '��!.,, i7F' /� %4' i/ Date /!- v N2 / G a Location Sr S�� - /.,r ✓ /,1 -f .f' r — i��/ �< i� C'c� ,,� 1�;% : �,r<`. r Subdivision Name Lot No. Seca or Block No. Lot Sizef �4r- House Mobile Home Business -- Speculation No. Bedrooms No. Baths — No. in Family — Garbage Disposal YES ❑ NO p , Specifications, for System: Auto Dish Washer YES NO ❑ �� /' �' Auto Wash Machine YES NO ❑ �` i« Type Water Supply *This permit Void if sewage system described below is not installed within 5years from date of issue. This permit is subject to revocation if site plans or the intended use change. 1 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,! r 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department J Environmental Health SectionCE�V P. 0. Box 665 EQN J Mock$ville, NC 27028 oyo, 1 . Application/Permit Requested By C1'0 t J/4orcl A yo G n Q Mailing Address k I-1n��-7aW 1 n , r1 1� �12- �G'. � d•S5- Home Phone �� Q� '7�0 a7oA Business Phone (9�4� 99 -g-5 2. Name on Permit if Different than Above S Gj✓L � 3. Property Owner if Different than Above .Sa rh -�e— 4. Application/Permit For: 0 General Evaluation S/Tank Installation 5. System to Serve: House Mobile Home Business Industryu Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions G 6, atsz _ No. of Bedrooms Basement/Plumbing No. of Bathrooms Basement/No Plumbing Washing Machine J Dishwasher 0 Garbage D:isposai 7. If business, industry, 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 8. Type of water supply: 0 Public 0 Private 0 Community 9. Property Dimensions '46 a—e- s 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 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. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. A-Zr /q�d Date 81 gnat e Directions to Property : DCHD (10-89) } } DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Son/Site Evaluation NAME vi Gl jl DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public ? !Evaluation By: Auger Boring Pit Cut FACTORS all 2 3 4 Landscape position Slo e %C ON I DEPTH re roustenceture alo HORIZON II DEPTH Texture group Consistence Structure Mineralogy -/ T/ 77-77 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION _ LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 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-Finn 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 Mi neraloiry 1:1, 2:1, Mixed Notes Horizon depth - 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