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748 Ridge Rd - ✓S(6 r - DAVIE COUNTY ,HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NCTE:Issued in Compliance With Article 11 of G.S.Chapter 130a ,. Sanitary Sewage Systems Permit Number Name a v �.s t' N e Date N27352' IJ3 Location Vt �.`b Lq - �c v �� 1 ZOaI —�— ` -- V\ `.os Subdivision Name of No. Sec. or Block No. //-3-73 w -- Lot Size House fMobile Home _ Business _— Industry No. Bedrooms .No. Baths No. in Family — Public Assembly Other Garbage Disposal YES p NO 8' Specifications fqr System: Auto Dish Washer YES NO p wx Auto Wash Ma^hine YES,.`Q, NO p ? 3 00' 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.` " /oe' /oto' _ y I` Ql �L M »�* Improvements permit by��`^```g� � *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 ti Certificate of Completion Date "The signing of this certificate shall indicate that the system described above has been installed in compliant 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. q� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department } � !/k �` IQ Environmental Health Section V tiw l U�� ED c P. O. Box 665 Mocksville, NC 27028 Ij)C T 1 1993 Cr 7 ------------_ '1. Application/Permit Requested By Mailing Address\ ' ` LTY a a Home Ph e6� 0 1 ,A� c Business hon "1_7�_9�g3 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation 0,Septic Tank Installation Permit 4. System to Serve: 01. House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # _$bBasement/Plumbing No.of People ❑ Basement/No Plumbing No. of Bedrooms 3 Washing Machine No. of Bathrooms lk�Dishwasher Dwelling Dimensions , ❑ 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 !SR S S1 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes X 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: �j- . �D 16 This is to certify that the information provided is correct to the;best off my knowledg and I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENTE ITE EVALUATION jQ BE DONE gN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 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 c�r�1t- �• Q_C�1Av`.s to conduct all testing procedures as necessary to determine I site's suitability for a ground absorption sewage treatment and disposal system. )9 n DATE SIGNATURE DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ) b ADDRESS 'S 1�,""Z_,\ PROPERTY SIZE PROPOSED FACIILTY \A\, LOCATION OF SITE Water Supply: On-Site Well ✓ Community Public Evaluation By:1tt,_y Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position S S -S Sloe % - ' ISS k -1'r- HORIZON 15HORIZON I DEPTH G ' Texture groupS Ct_ S L S C Consistence T Z Z Structure VZ Q�li�_ Mineralogy HORIZON II DEPTH Li Texture group C Consistence Structure t' Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS ss ss S/ .sr RESTRICTIVE HORIZON — — — SAPROLITE — — — CLASSIFICATION S �•S S S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: \ � .s��.��.g.� N?,� � �s San , 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 ■■■■■■■■■■■..■.■■■■■■■■■■.■■■■■■�■.■■■i■.■i..■■iii■ii■■■■■■■....■ ■.■■■■■■.■.■.■■i■/■.■■■■■■./..........■.............■.......■..■■ ■■i.i.■■■...■iii.■■i■i■iii■■/■■■.■■■.■./■i■i■■■■.■.■■■.■■.■■■■■■■■ ■■i■■■■.■■■.i■■■■■..i■■/■Ott■■■. ■i■i/■■■■■■■.ii■...i..■■..■■■..■ ■■■■.■iii./i■■■■■■■■i..■■.■.■■i■�■■■ii.■■.■i■.iii/..i.■■i.i■■i■■■ ........................... ................... .................. .................■.......................�......■.■...........MINN .. .................................................................. ■■.i■■■■■i.■■.■/..■■■■■.■■■.■■i ■...■■.i.i.■.■..■iii.■/■.tit■■■■ ■.■.i/.■■■■■i..■■■■i/..■..■■..■i■■■■.i.■■.■/.■.■..�...■■..■.■■... ■■■.■.iui.■.■■/i■!!J`/.■■■■i.■■ ■i■l1■®.■i i!■./a■i■i■■■■■■./ ■i■ ■■!■■.■.■alai■/i■I�..l�■Ill■\`/■■i./aa■.■\,■�L.0■.I■■i■■/■ ■...■.ilii/■.�■ ■■..■■■!■.■■■■■/■►`l.YY/!��!_/CC:CCG%1i■\i�C%■■■■■./■.■■/■.■.■■■■■/■■ ■■■■ii■■■■/■■■i/i!!■■��'!��!� 111►:�Ilr��■I.i/■■■i■i■.i.■■■■■i■.■■■■ .�.liiiiiia�■�iiiiiil■�iii.'ilii.�iiiiiii.�iiii�ii�i�iiiiiii�i=iiii�iiiiii.�.l .....■.................................... ......0 .■■■..■C........ ................■.............1■l.■si! ■.�...■■■■ .I...■.W.■■■■■■■ .........■............................�._ .■■...i Illi/■■. ■■■■.■■■ OMEN ON10111MMOMMMMOMI ■■/.■.■...i■.■....■.■..■.i....�1.■.■■■. ■.■... ■■■■■■■■■■. .a■■ smommommmoomm man MMMMMMMMMMMMM IS ■..■.■....■■.■..■.■...■.■.■■■.�I.■.■�.■It.■■u ■■■l ■■.■■.■■■■■■■.■■ ■■.■.i........■..■■......■.■■■�I.■■�!.■IONO�■■ ■ ■■■.■S■■■.■.■■ i■iil'i .�MMMMi'■■1'iMMMmiii■ ■..■.....■..■■.■...■■/■ l.■...i...■i.■■■.■■.■i.■■i.■.■■i.■..■.■■.i■llI■■■GFjmMlRmOM.' ..■■ ■ ■■ ■.■■■■■.■■■■.■ ■■ ■.■■■■.■ ■■■ ■■M ■■■■.■O..■■.■ ■..■■.■. ■■■l■■.■■...■■■■. . ■.■.■■. ■Ml.. .■.■...m.■. 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