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235 Red Bud Ln DAVIE COUNTY HEALTH DEPARTMENT I D U IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTlsassued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name Q�� c�C. s - ota Com,.Date 'T y9� N°_ 7 3 4 7 5 - - /\� _ Location Subdivision 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 ❑ NO OR/ Specifications for System: (�, Auto Dish Washer YES NO, ❑ '° UUb ,_�Y - - - \J Auto Wash Ma sTI hine YES [� O ❑ Cw Type Water Supply A `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. v c e f, ~ i VS. Q _ F Improvements permit by w *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 4:30J5:00 P.M on day of completion.Telephone Number:704-6345985. i Final Installation Diagra :Q y System Installed by d Certificate of Completion Date *The signing of this certificate shall indicate that the system described abo a�guarantee as been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken a that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section L �j P. O. Box 665 Mocksville, NC 27028 2 6,. 1441 1. Application/Permit Requested By. Mailing Address aAl Home Phone V-S-Z 2— G! J V l LL(f Business Phone 2. Name on Permit if Different than Above S 3. Application for: ❑General Evaluation ❑Septic Tank Installation Permit 4. System to Serve: KHouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing No.of People XBasement/No Plumbing No. of Bedrooms 3 �l ashing Machine No.of Bathrooms Z' XDishwasher Dwelling Dimensions2—�2 K ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ❑ Public / Private ? ❑ Community 8. Property Dimensions S Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes JRCNo 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. Directions to Property: hr4es This is to certify that the information provided is correct tot e b t of owle ge, nd I nderstand I am responsible for all charges incurred fro this a plication. Z4 DATE SIGNATURE CONSEN FOR SITE EVALUATION!Q BED NE_QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box#2, the fest of this fol MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to fief r in s ite' suitability o grou d absorption sewage treatment and disposal syste . DATE SIGNATURE WHO"(1193) '" ► ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME F�� S\,�'c Q� \�� DATE EVALUATED l Z) ADDRESS S Q ,Q PROPERTY SIZE 15 c PROPOSED FACIILTY oy S Q-- LOCATION OF SIT Water Supply: On-Site Well Community Public Evaluation By:Cc,-L Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position .S f .S —S- Slope Z -1S v TIE- ; HORIZON I DEPTH to Texture group Consistence Structure 2 Mineralogy HORIZON II DEPTH 'A->7 2 Texture groupC Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5s 5s ss ss RESTRICTIVE HORIZON SAPROLITE — CLASSIFICATION WS V 7S 5 LONG-TERM ACCEPTANCE RATE , , SITE CLASSIFICATION: Q . 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 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■■■■....■■Ott■■■■■..■■N.E.■■e■■..../.■.■■ ■ ■/N ■ .................................................................. ........°.................. ...................................... .................................................................. ■..■e..■■e.■■■■■■■■■.■■■.■■.■■■ e.■■.eE■■■■■.■■..e..■■.■..■.SEEN ■■■........■.E..■/E..■■.eS■EEE./■.■...■■.E■e..S■■SE■■■EE■■■■■.EE■■ ................................................. ................ ................................ ................................ ■....E.S.■■■■■..E.t.Nt././■..■■■�■■■■■■■■■■°. ■E.eE....NNee...E■ ■....■...■.....■h■■E■EE■■■S.■..■■■ES■ES■E■■E�■■■S■■■t■S■■■E■.■■ iiiiii°■i�■i�■iii�iiiii�■iiiiiiiE�iiiiiii�iiiiiiiiiii■�iiiiE■iiiiiii ■■.E.S.E..E.■Ne../..NEN/.■E.■E.S ■.Ee... .e■/e■uEe■■...E/.eEEN■.■ iii i°i MiiiiiiiMEMEME ii .�MENNEN ....................... .............. ■.t■■■■r.t■■■■■■■■■■..■ ■/e.e■e■ EE.. e... 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