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225 Wing Haven Ln (3) ,. ,....,.... .,--..,c .w,......c:,-`.r ,.�..". %.rS;w' .�.^�:>�ii:....,✓ ".uat n:!No.ae.!�-i+.r. ;. .. v.�,y.,w. s. � ,-• -.. .. _-. .-, -^- .� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c _• Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number _ Name i r r),;% �y: �.::.,7 Date Location/ Subdivision Name Lot No. Sec. or Block No. Lot Size ,f �_ % , House ! Mobile Home _ Business__ Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ !� Auto Wash Machine YES NO ❑ �� `� ` `1 /`� Type Water Supply "This permit Void if sewage system describe ed"b o'T w is not installed within 36 months from date of issue. 69 1 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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by 1 Certificate of Completion . Z,Z 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. Z'h DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number NameCe i �� ' ?. ,/�r Date "" NO ' 64'3 � Location 'r-'//�/-- .• ! ( '.� o,� . '�/ — �:I,-1,1�cX `�J .;e i Y ate,'...;/� . . Subdivision Name Lot No. Sec. or Block No. Lot Size � �'-'''�1`l House Mobile Home _/e!!!� Business Speculation No. Bedrooms No. Baths - No. in Family -2- _ Garbage Disposal YES ❑ NO 2- Specifications for System: Auto Dish Washer YES EP NO ❑ ! Auto Wash Ma shine YES p NO El 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. Improvements permit by / /a Z/� *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 l�t� V`" Certificate of Completion iL 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. r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 404 64' l -f 2-✓ DATE EVALUATED 45r_-Z' f ADDRESS PROPERTY SIZE 1 to C PROPOSED FACIILTY LOCATION OF SITE V A e1/ A f_- Water Supply: On-Site Well / Community Public Evaluation By: Auger Boringy Pit Cut FACTORS 1 2 3 4 Landscape Rosition Z_ L. L . G Slope % -2- HORIZON HORIZON I DEPTH G oma` o" a•� Texture groupG Consistence Structure /� •t /� ��/�.. / Mineralogy HORIZON II DEPTH 40 Texture group eG' Consistence i 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 1 1 ,y SITE CLASSIFICATION: � EVALUATED BY: SIR/f LONG-TERM ACCEPTANCE RATE: - r 1Z 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 ■..■..■■■.......■■...■.■....■■..■..■....■.■■..■..■...■.■■■ ■■■t■w■ ■■■■■■■■.■■■■..■■■■■■■■■■■■.■■■■■./■■.■■■..■■...■e.e..■■.■■■■■■e.■ ■■■■■■■■■■■■■■.■■■■■■■■e■.■■.■■■■.■■■ecce■.■■■.■■■ eee.■.■■■■.■■.■ ■■■■■■■n■■■..■.■■■■.....■e■■... ■■..e■e..■■■■■■■■■..■■.■■■■.=■■e .................................................................. MEMNON MEEMEN mosomm MEMNON ummommPlummommummmommom ■/.■■/■■■■■■■■.■■■■■.G■..e/!C:iii/e.■.��i:\.e■■.■ee■..e.■.e..■■■■■■ ■■■■..■■..■■e■■■■■e■..e.■ee.■■.■■■■■■.e■■e.■.ee■■e■.e■.■■■.ee�■■■■ ::::iiE MENCiiiiiii=::::::'.::::::: ::::::'.::':: ' :'.::::'. :: ................................ ................................ .................................................................. .................................................................. ■■■.■■..........■■....■■ecce■■.■■e■■....................■....e.te■ ■■■.ee.eeee.e.ee.eeeeeeeeeeeeeee.ecce.eee.e.e..eee.e.eee.eeeee.ee■ ................................ ................................ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section 4 P. 0. Box 665 Mocksville, NC 27028 1 . Application/Permit Requested By 7�tCf+td�2� �. ��cJ��2Sd _ Mailing Address KT box 36 7 -2702-k Home Phone q9Q- 75 7 9 Business Phone 22 7a7 9 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation S/Tank Installation 5. System to Serve: 0 House Mobile Home 0 Business L] Industryu Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Z Dwelling Dimensions IV4 '< '70 No. of Bedroomsy Basement/Plumbing No. of Bathrooms Basement/No Plumbing Washing Machine X Dishwasher 0 Garbage D:isposai 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: 0 Public 'Private 0 Community 9. Property Dimensions 114C2E 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes Vo 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. 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 apple on. 6- 7 9l a":ec� Date Signature Directions to Property : DCHD (10-89)