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304 Deadmon Road Lot 8P C 2 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: g'760 Final Installation Diagram: ' r _ 0, "--<SV tem Installed by C Sn p �I k 5� a,r Ile `CertiticNele qf"C 'The signing of this certificate shall indicate tha the sl the standards set forth in the above regulation, but shat satisfactorily for any given period'of time. lion '�•• _ Date �_ described above has been installed in compliance with )way be taken as a guarantee that the system will function "DAVIE_3�&JN� �IEAC�TN DEPARTMENT ! Sb.OQ I IMPROVEMENTS PERMIT AND CERTIFICATE .OF COMPLETION � 3v 'NOTE: Issued In Compliance With Article I I of G.S. Chapter 130a Sanitary Sewage Systems G Permit Number rJ Name _' _4 \... --- Date ' �_ I N2 888 Location / loly � t \ c r1r <C s %? .� �� n a" . _ Subdivision Name ��=��0\= Z- Lot No. Sec. or Block No. � Lot Size `�— -= E1 — House Mobile Home Business °_ Industry No. Bedrooms —:No.. Baths —— No. in Family — Public Assembly Other Garbage Disposal YES [3 NO p/ Specifications for System: Auto Dish Washer YES I& NO ❑1Z 0 Auto Wash Maohine YES D/ NO L]o0 I Type Water Supply ---- X '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 gechange ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM, " a , P C 2 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: g'760 Final Installation Diagram: ' r _ 0, "--<SV tem Installed by C Sn p �I k 5� a,r Ile `CertiticNele qf"C 'The signing of this certificate shall indicate tha the sl the standards set forth in the above regulation, but shat satisfactorily for any given period'of time. lion '�•• _ Date �_ described above has been installed in compliance with )way be taken as a guarantee that the system will function A APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER h_'�_ Davie County Health Department Environmental Health Section P. O. Box 665 FEB 2 21995 Mocksville, NC 27028 Application/Permit Requested By Mailing AddressghAt� Cf Home Phone Business Phone9- 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation 4. System to Serve: fJ House it7SepticTank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry / ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision iJww 1!�IYJ41Y Section Lot # g No. of People SP�c No. of Bedrooms 3 No. of Bathrooms ..I Dwelling Dimensions 6A ( fr� 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: Public ❑ Private 8. Property Dimensions %-440 " X Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? ❑ Basement/Plumbing ❑ Basement/No Plumbing Washing Machine 1shwasher ❑ Garbage Disposal C"No ❑ Community -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: "o% S -�o 0ea r[ r This is to certify that the information provided is correct to the est of my knowledge, incurred from this application. - DATE I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: V 1. 1 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 DOM'(1193i APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department (� I� ��r- Environmental Health Section s D I� IG P. o. Box 665 N 0 V 2 8 1994 Mocksville, NC 27028 ;i --------------- 1.Y Applicatlon/PermitRequestedBy �� /CP Mailing Address �'. ,�✓ `r,� Home Phone MCC, U/��r Business Phone 7d ft"- � ZZZZ 2. Name on Permit If Different than Above 3. Application for: Ial Evaluation Ell Septic Tank Installation Permit4. System to Serve: use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision SOUS Q r�,Q1 Section Lot # No. of People No, of Bedrooms No. of Bathrooms Dwelling Dimensions �4_Amllr• - 6. If business, Industry, place of public assembly, other: Specify type No. of People Served 1441,± No, of Commodes No. of Sinks No. of Urinals ❑ Basement/Plumbing ❑ Basement/No Plumbing ashing Machine Dishwasher ❑ Garbage Disposal No, of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property DimensionsSewage 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. This is to certify that the Information provided is correct to the best of Incurred from this �app'catio . AT I am responsible for all charges CONSENT FOR SITE EVALUATION IQ BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1, 1 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 DcnD'plast DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section " h Soil/Site Evaluation 1 NAME I' IVO J Q S W 1 (Z' a 0 0 0 DATE EVALUATED ADDRESS PROPERTY SIZE ! _ 'A a.')aR 02%, U � PROPOSED FACIII.TY LOCATION OF SITE Water Supply: On -Site Well - Community - Public Evaluation By: Auger Boring - - - - Pit V Cut FACTORS 1 2 3 4 Landscape position Slope Z O -S'o 0-8v HORIZON I DEPTH b- ] 11 1' = Texture group Q'L_ C L Consistence F --T Structure Mineralogy4) HORIZON II DEPTH 3 Texture group Consistence Structure C Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH ,Texture group Consistence Structure Mineralogy SOIL WETNESS 55 s RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: -S - EVALUATED BY: LONG-TERM ACCEPTANCE RATE: A OTHER(S) PRESENT: REMARKS: 1%x 1%x q LEGIRND (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 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 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