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169 Merry Lane Lot 1 -" ."' �► , DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE!•Iss,6ed in Compliance With Article 11 of G.S.Chapter 130a �anftary Sewage Syst ms � Permit Number Name �.. \ R ¢�, Date r NO 6968 Location - w Subdivision Name Z@�- °o� SIM Lot No. Sec. or Block No. Lot Size House Mobile Home __ Business Speculation No. Bedrooms 3 �No. Baths No. in Family Garbage Disposal YES e NO ❑ S ecifications for System: Auto Dish Washer YES if NO p Tz�- �t Auto Wash Ma shine YES ©' NO E] 30� � ' � ` ►" 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 than e. CO 1� a ` C� Improvements permit by 'Contact a representative of the Davie County ealth Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of comple ion. Telepho1.ne Number 704-634-5985. Final Installation Diagram: System Install 11 b k M 1 d us4k Certificate of Completion '�- Date _ 14 "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 IT Davie County Health Department ' � C E-U VE D Environmental Health Section P. O. Box 665 N 0 V 17 1992 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Gr � � Home Phone q 1. Permit Re uested B Business Phone 2. Address F �, r �-7� A -©•f-'. 'S'7 �t,� G 6. 3. Property Owner if Different than Above Address /�.P`� Uc�j �f// U��c- �t/Lf T�C04 4. Permit To: a) Instal1_1f�-_'Alter Repair b) Privy Conventional-if'-"Other Type Ground Absorption c) Sub-DivisioJF1'�-'y��s��tL�'��-t-� 1 Sec. ile HLot No. 5. System used to serve what type facility: House obome Business Industry Other b) Number of people 6. aj If house or mobile home, state size of home and number of rooms. House Dimensions Anna g?r Bed Rooms_—Bath Rooms A Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes ;2- urinals garbage disposal lavatory 3 showers washing machine / dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes ✓No � �i 9. a) Property Dimensions 2L/,, .S Y X %0.3• X 3�zs�S' �{�'02.��x b) Land area designated to building site -S 3.5 SJ Ae- c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowled e. QQ 11&3 Da e owner Signatur G O 2 OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: • ,c-�,.�.�ua��` /tea f DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT x Environmental Health Section ' l Soil/Site Evaluation NAME ^�*\ DATE EVALUATED 12 7 c/ ADDRESS 5 'o \� PROPERTY SIZE 3 5 PROPOSED FACIILTY `sem LOCATION OF SITE Water Supply: On-Site Well Community Public tJ Evaluation By: C Cl- Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S Sloe % HORIZON I DEPTH Texture group L_ 5CL Consistence r �F a Structure Q C_ Z Mineralogy 1'• HORIZON II DEPTH p' o`` 4D` yd Texture groupG �- �- Consistence — Y Structure q- G Mineralogy1'• 1 \'.1 I 1 •1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S _5& RESTRICTIVE HORIZON — SAPROLITE r — — CLASSIFICATION LONG-TERM ACCEPTANCE RATEJ , SITE CLASSIFICATION: Q� EVALUATED BY: LONG-TERM ACCEPTANCE RATE: '4 OTHER(S) PRESENT: REMARKS: \ •\ C ''�' s�^+ �. -'`! '� 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 ■■.■....■■■.■.■■■■.■■■■■■ilii.■■■■■■■■■.■■■■■■■■■■■■■■.■■■ ■■■ ■'\i ■■■■l■■■■■■■■■■Ii■■■■li■■■■■■■■■�■■■Il■■■■■t■■■■.■■■■■■.Ill■■■■■■ ■ill■■.illll■■■■lull■.■.■I■I■■■■11■■il■■■Ill.■■ii■■■■■■■■■■■■■■■■ ■t■■■■■■■■■■IIII■■■■■■■■Illi■■■l�■■■l■■■■■■■■■■■■■IIIIIIIIIi■■■■■ ■■■■■■l..■■.■■■■Il■■VIII■Ill■.■■■■l■■■■Ill■■■il.l..I.I.iilli■III■ ■.■.■■■■.■■■..■■■■■■■■.■■■■■■■■■ .■■.■■■■■■■■■.■■■■■■■■.■■■■■�■■■ ■■■■■■■l■IIII.ii■■■■■■■Ill■■■I■■ ■■■■■e■■■Il■■■l■l.■■■■I..■■II■I■ ■■■■■■■■■■...■■■■■■I■■.■.ill■1■■■■■■■■Ill...l..Il...el�I■■■■■.l■■■■ ■.■■■■■■■■■■■■■st.■r�.0■■■■r�■■.■.■■■■■■.■■rye.■■■■.■■■■■■ta■■■■■■■■■ ■■■■■■■■■■.■■■■w■■■■III/i■i■■■■■■■■■�■���a■■■ee�■■.■■■..■■■w■_..■■■■■■■■■ 00ngMSm®HAniiEMEMSMvam\M,rUMENoNollNooMENoNamME0MEasMEMEIFINENNMNIIIUEmom NEON MEMO U ■It■■®■■I■■t■■1/■■■■■■■■■■■■■■■I/....■■■■■■■1�■t■■■■SIJ■■■■■■■■■■■■■■.■ ■It■■l.l[ItGi■■■I■■■■1..111..1.1■■■■■■■■■■■■■■\Gsi.:iil."�i!!�l■l■■■■■.■ ■iG!■t•■1.■l■t/,■■■■■e■■■■■■■■■■■■■ ■■■■■■■■[1■■■■w!■.I. 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