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208 McDaniel Rd Lot 1 f; DAVIE COUNTY HEALTH DEPARTMENT 1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Sl�� •NOTE:Issued in Compliance With Article II of G.S.Chapter 130a a itary Sewgg-e Systems p Permit Number Name KAt-' \ t e V •-C. 0 .SO 0 Date ` - _ No 8214 Location - �� - s _ C�U to c-,:, '� a�4 a�• (�•�y lJ-' ' v"�r��.1t. � -vS1D �L1 U CTc� �;�}�C�� R-�� CSS;7. `�li��i,'�-ht��. Subdivision Name Lot No. Sec. or Block No. Lot Size ��c ` �—_ House _ Mobile Home _ _ Business _— Industry `� • a wb No. Bedrooms -) _.No. Baths __ No. in`F.amily PublicAssembly Other Garbage Disposal YES ❑ NO 21Specifications for System: C e• Auto Dish Washer YES ❑ NO d 0 0 o Auto Wash Ma^hive, YES NO ❑--.�_ O U u ^� 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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOF MQST 5ETHIS PERMITILAYOUT BEFORE INSTALLING THIS SYSTEM. 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., 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 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. ► r "" DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION S � Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems _ Permit Number Name .. 1� " r`a^� .t- c� r t_t — Date !_ 0 8214 ,f t Location Subdivision Name �' �� v 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 0-' Specifications for System: 4� Auto Dish Washer YES ❑ NO Auto Wash Ma^hine YES d NO ❑ TYpe.Water. Supply *This pgrmit Void if sewage system described below is not installed within 5 years from date of issue. This permittis subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMITILAYOUT BEFORE INSTALLING THIS SYSTEM. w "'A �\ 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., 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 — -- i I 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 PERMI D f * s Davie County Health Department Environmental Health Section SEP 2 P. O. Box 665 Mocksville, NC 27028 PRE�vl�or�7�u 1. Application/Permit Requested By Mailing Address G Home Phone fn 2p 4G/"7/ lBusiness Phone _�4�• 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation $SepticTank Installation Permit 4. System to Serve: ❑ House Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms IR Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served —!5� No. of Sink§ 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 X Private ❑ Community 8. Property Dimensions / fg-cr2-eo Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ 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. Directions to Property: 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 incurrpprom this application /S q ! _ 12 DATE V51UNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: --;k1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box#2, the rest of this form 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 determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1/93) '. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation q�( NAMES DATE EVALUATED ADDRESS SMS , Q PROPERTY SIZE PROPOSED FACIILTY `" c `\ 9 LOCATION OF SITE tP"� Water Supply: On-Site Well _ Community Public Evaluation Byl'k,L Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z 1S ' a° CP HORIZON I DEPTH Texture groupL_ l� Consistence IF x. Structure Mineralogy � ) HORIZON II DEPTH Texture groupC. Consistence Structure TA Br, 8 Mineralogy • 1 I � HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON ^ SAPROLITE CLASSIFICATION . 3 LONG-TERM ACCEPTANCE RATE I SITE CLASSIFICATION: �" S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: "u OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Footslope 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 ;lay loam- SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vc-y friable FR-Friable FI-Finn VFI-Very fine 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 .3C--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 CCCCCCCCCCCCCCCCCCCCCCCCCCCC:CCCiCC:CCCCCCCCCCCCC=:CCCCCCCCCCCCCCC ........................... ................... .... ............. ■■■■■■■..■■O..e.■■■.■■.■M■.■M■■■■O.■E■■■ ■■■ No mom OEM ...............................■�.■■.■■■O.�■HN■■■E■■■M■■■■ME■■ CCCCCCCCC::�:�CCCCC'■CCCCC::C:CC:::�CCCCCCCC'CCCCCCC�CCCCC:�C ■■■.■■■■N■■■■■e■/.■■■■....■■..■■■■■■■■■■■■ON■■. 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