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772 Pudding Ridge Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit Number ~tib �:� �� Name ii �i �.c; f ! l,_, Date N65,90O Location Z _,/=l r '/ � Subdivision Name Lot No. Sec. or Block No. Lot Size �-�' /1 G- House Mobile Home Business _— Speculation No. Bedrooms ._T .No. Baths --.:2 No. in Family Garbage Disposal YES ❑, NO 2-" Specifications for System: Auto Dish Washer YES NO _❑ Auto Wash Ma shine YES NO ❑ oc��.,/ �/ �///4�Z .,�[/0, ..I !'IGS 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. f � 3 . Improvements permit b — � �- *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 �">2_ Q�J�Of /0GU17/ { Certificate of Completion �f�3 l/ 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 n f Environmental Health Section rCD.►!�!" `� 2 P. O. Box 665 RG ' Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERM,I�HAS BEEN IS UED. J� ,� ,�,9ry— 1/�l 'F /�'y �9 � �'I� �(!`G�P� a a27�a F�ome Phone 1. Permit Requested By Business Phone 2. Address 3. Property Owner if Different than Above 6fre e Address 4. Permit To: a) Install `�Alter Repairer �� b) Privy �Conventional Other Type Ground Absorption c) Sub-Division Sec Lot No. 5. System used to serve what type facility: House�ome Business c1 IndustryOther b) Number of people 3 6. ar If house or mobile home, state size of home and number of rooms. House Dimensions 16-M -M 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 showers washing machine dishwasher sinks 8. a) Type water supply: Public Private t`lu Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions b) Land area designated to building site ►^� c) Sewage Disposal Contractor o/b/N r 10. Do you anticipate any additions or expansions of the facility this sew%e system is intended to serve? What type? This is to certify that the information is corr ct to the b st of m owledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANC WITH ALL STATE AND LOCAL LAWS Allow 5 days for pro ssing Directions to property: D / �uJ �� l is ),!�v— I D M - DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section i r-- Soil/Site Evaluation NAME ( DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE !s c� �'� �ef Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe %. o� HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 6 'y Texture group Consistence Structure .r / Mineralogy 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 /� < 7 SITE CLASSIFICATION: U% ; EVALUATED BY: /`1')a 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-Film 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 ■..■.■■aa■■aa��rla�1��7/1��.■...■..■...i■..........■■t■■■■■■■■■■■■■■■■■■ ■■■■■■■■aaaa■Iia■M■a■1/....■...■II■�.■aaaa.■■..■■..■■.■.■■1m■■..■■■■ ■....Emma...■I■.■�Li..'/■......■.I/■ ■..■..■■■..■■......■t..l'.■i■.■■■ ■■■■■■■■■■■■■ate■■./i..■■■.■..rim.■■....■.■��...►�e■■■■...■�a...■t.e■ ■■■.....■■■.e■w_==■■..■■.■.■■Iia■a■.a■■.■/►r�•E■n.■a■aai..mr�aa■.a...� ■■maa..aaaa.iia■.■.■■■.......aria■■a.■a.■■r►,:�r�,�et.......■.■rr■■■.■■■■ ■■......L`.............■..■..t1■.. ■■■■■■■■.....■■.■.■■■■.....■ ONE ■■ss.■..■■■■■■■■■■■■■■■■■■■a■■■■■■■■■■■■■■■■■■■■■■.■■■■.■..■.■■■■■ ■.Emma ■.■■.v ■.Emma ■..�.� �--------- ------ ...... ■Emma■ mama■■ , ....■.�■.■■■■ ■■.■■■.:iiae■■ ■■..■■ ME■a■. ■■■■a■ a■■■■■ Emma .......................■..i.........ria■.....i.........C....�■.......■� ■■.....■..........■■...../��.�...a.====��t■..eM.■■■ ■.MEMO■ ■.....■...■■■......■tM■■..■■■..■i��aO.a..a....a.ae.■■aa..EM■. ■■m■ ■..■a..■■■■..■■■■■M.■■■■■■■..■■■■■■■.am■■■a.■■■■....amt■■■.a.�■■■■ .....................M.aaa■ma..a■a..t■aO.■Oma■ m■mm■■m■■■ ■m■m■E■■ .................................................................. ::::: mmommmom MENC::::CCC=::::::CC:::::C ................................ ................................ .........■........................................................ ■■■...■....■■■.....■■t.■■a.■..■eaO■..a...■.mala■■■aa■tO..aa.■■a.■■ ■■aO■■a.■■t■■...■■....■■■■■■■■..■■■e...E■■.E...E■■....■■.NEE■■..■ ■■cc■■ec■■cceccce■■eecececcee■ee■ce■■■■■e��e■■ee■ec■■■■■■cc■■c■■■■ ■■a■.■■■■■..■■■■s■■.■■■■■■■■■■■e■■■mama.■■.E■.■■...■ea.m.a..■■a■■■