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226 S Angell Rd Lot 5 • .�.ti/ DAVIE COUNTY HEALTH DEPARTMENT: I IMPROVEMENTS PERMIT AND .CERTIFICATE 'OF'*COMPLETION *NOT'E:Issued in Compliance With Article II of G.S.Chapter 130a Sa itary Sewage Systems 'PermitNumber C„Name if Date f Location Subdivision Name �� Lot No. -Sec. or':Block No. Lot Size �, >��' House Mobile Home _.z,� Business Speculation, ­. ;No:B.pdrooms -_ No. Baths' No. in Family ----« } �t arb•aa,Ga Disposal YES ' NO Specifications..for System` t , ;Auto Dish Washer :YES NO ❑ ���� �' r Auto Wash Machine YES NO ❑ V -,, �� Type:Water. Supply' /�, ,,This permit Void if.sewage system described below is not installed within 5 years from date of issue # 7 ' Thin mit subject to revocation if site lans or"he intended use change. k P Pi. 1 f1Jit ( k 7 . 'Improvements permit by. •Contact a representative or the Davie County Hea Chep .ment for 'fin inspection of this;system between 8-30-' 9.30 A.M. or 1:00-1.30 P.M. on clay of c pletioon Tete �dne Numba . 04-634-5985. ; Final Installation Diagram: . Syst Instal d by *" � 7 d� 1 rr � �.''` r {i . . '1. r• ( , t s(i i,” �L�w -' � tivf i t ' i } r 1 ; 77777 5 _ i t l ti t f _ Certificate of Completion : Date $ t ; he 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 fur:ct �n satisfactorily for any given period of time. Yr. �., _ �, r a..:..w E*w c .4F•q vs...a �+1'+"-r'.�y' i r ..i _ s r DAVIE COUNTY HEALTH DEPARTMENT; IMPROVEMENTS PERMIT AND CERTIFICATE 'OF' COMPLETION *NOT Issued in Compliance With Article 11 of G.S.Chapter 13oa - Saitary Sewage Systems Permit Number. Name Date /—/ / ► i N22 5 6._. Location �r •, 4J 9.. `Subdivisiori Name i/�� Lot N777 o. Sec. or Block No. Lot Size' �,7�/" House Mobile Home Business Speculation No Bedrooms _ No. Baths 2 No. in Family 4<229 NOGarbageDisposa Specifications .for System , Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO ❑ Typed Water Supply 1/0 f Thls permit Void if;sewage system described below is not installed within 5 year's from date of issue....: 4 , This permit is subject to revocation if site plans or"he intended use change. "�• t L � , ty f �2 _ f Improvements permit by *Contact a representative of the,Qavie County Hea pptment for #in t��dspection of this system betweEr. �3 30 71 is 9:30 A.M. or 1:00-1:30 P.M. oK day of c pletio ne Numb 04-634-5985 Final Installation Diagram: . G -Syst Instal d by . t _ r Certificate of Completion ` 'Date t 1 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 PERMICCT Davie County Health Department RC1VG� Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1 . Application/Permit Requested By Mailing Address >— Home Phone Y ;` / -3� Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4.. Application/Permit For: yk General Evaluation 0 S/Tank Installation 5. System to Serve: 0 House J Mobile HomePunknown usiness � 0 Industry Other 6. If house, mobile home: Subdivision 1JL6& Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms Basement/No Plumbing 0 Washing MachineDishwasher 0 Garbage Disposal 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 : g,-PubI.ic 0 Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes 0 No If yes, what type? *NOTES 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. Ua YIB Signature Directions to Property: r , = DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation p p NAME Gi!/G'/�� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH �d Texture group Consistence Structure 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 RATEI V 1 , SITE CLASSIFICATION: i f_ IEVALUATED 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 watef 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 ■■■■■■■.■■.■..■■■■.■.■■■■..■■.■■.■.■.■■■■■.■■■■.■..■.■■■■■.■■■_■■■ ■■■■■■■■■■.■.■■■■■....■..■■■■■■■■■■u■■■■M■tttMM■■■tttt■tt■■■■Ott■ s■■■■■■t■■t■■■■■■■■■■■■■■■M■■■■M■tt■■■t■■■■■t■ttttt■■tttttt■■■■■■■ MMMMMM"MMMMMMuMMMMMM MENNEN MEMNONMENNEN iMEMEMEMEMEME ■..■■■...■.■■■■■■■■■■■■■■■■■.■■■■■■■..■■■Ott■■■■■■■■■■■■■■■■■.■.■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■ ■■■■■■■ ■..■■■■■■■.■■■■■■■■..■.■■■■■..■■t■■■O■ttt■■Ott■t.E■O■■■..■■■■ MEMO ■■MEMO■ ■MEMO■.■ ■.■■■■.■■■■■ttst■■t■■■■■■■M■■tt■■■■ttt■t■■ttt■=■.■■t■ne■Ct■■■■tt■ ■.■■.....■■M■.■....■■■■....■■■■■■■■■..■■■■■■■■ ■■= ■■tttMttttt■■■■tttttttt■■■■tttttettttt■■tttt■ttttt■t■tt■■■tttttt■ MEMMEMEM M■■■■■V■■■...■■■■■■■■■■■■.■.■■■ �■...■■■■■■■.■ ■...■■■...■■■■■■■ ■■■■t■■■tt■■■■■■ttt■■■■■■t■■■t■ttt■tt■■■■tt■t■tt■ttt■■■tttt■■■■t■■ ■■■■■■■■■■■■■■■■■■t■ ■■■■tt.■■■■■■t■■■■■ttttt■tt■tt■■■■■■■■■ ■Ott■ ■■■■■■.■Ot■■■■■■Ot■■■■ ■DODO■MEQ■■■tttOtt■■ ■■■■OOttt■Ot■■.■■■■■O■ ..................................................................