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312 Deadmon Road Lot 9�1 DAVIE COUNTY HEALTH DEPARTMENT— (` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION IL00 'NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a ritarry ewage Systems y Permit Number Name ��irl�a� WWII �� ate 3 '� N2 7907 Location _o0 �S /KOL),-"��SUIIt�2N�Y- Sec. or Block Lot Size hU U _-nli 00 _ House 'V Mobile Home ___ Business ___ Industry No. Bedrooms No. Baths _ No. in Family 2 _ Public Assembly Other_ Garbage Disposal YES NO Z- Specilicalions for System: /� Auto Dish Washer PES O p `L o - `I✓ —(30'X Auto Wash Machine YES NO ❑ ,� �W"�' Type Water Supply _ u nyyy""" ��'. 3,06 12� '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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEETHIS PERMITILAYOUT BEFORE INSTALLING THIS SYSTEM. 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: 704-634-59%.Y140 Final Installation Diagram: Syslem Installed by -D '-r rtif tale of Completion Date 'The signing of this certificate shall indic le t at the system described above has been installed in compliance with the standards set forth in the above regul ion, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. ✓xo 3 /7- Dead& /21 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OFrr COMPLETION ; Q v •NOTf1s'suednCompliance With Article II of G.S. Chapter 130a c3�2 )lyQr�l�l on �SanitarySe Systems Permit Number Name \Atarrn=�toc-Date r NG 790 Location Subdivision Name Lot No. Sec. or Block No. Lot Size�'"_its v — House — V Mobile Home ---_ Business —__ Industry r No. Bedrooms 3 .No. Baths _—�— No. in Family 7 _ Public Assembly Other Garbage Disposal YES ❑ NO [y Specifications for System: Auto Dish Washer YES p' NO ❑ Auto Wash Ma^hine YES p' NO ❑ Type Water Supply C *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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM, 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: 704.634.598b:g?lop Final Installation Diagram: System Installed by D 0 D 'The signing of this certificate shall indie the standards set forth in the above regu satisfactorily for any given period of time WI �` O t a tit cate of Completion _�— ��' ^ —Date S- OvJ— t at the system described above has been installed in compliance with m, but shall in NO way be taken as a guarantee that the system will function -i r, 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: 704.634.598b:g?lop Final Installation Diagram: System Installed by D 0 D 'The signing of this certificate shall indie the standards set forth in the above regu satisfactorily for any given period of time WI �` O t a tit cate of Completion _�— ��' ^ —Date S- OvJ— t at the system described above has been installed in compliance with m, but shall in NO way be taken as a guarantee that the system will function APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 Application/Permit Requested By Mailing Address 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation Tank Installation Permit 4. System to Serve: U3 Htouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If house, mobile home: Subdivision No. of People rl— No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions &r< x / 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures. 7. Type of water supply: 9'Public ❑ Private 8. Property Dimensions 'lee " X _3 ae Sewage Disposal Contractor ❑ Place of Public Assembly ❑ Unknown Section Lot # 47 ❑ Basement/Plumbing ❑ Basement/No Plumbing ET"Washing Machine O'Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes eNo If yes, what type? ❑ 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: aGl e � e aWki o t^ l 4 This is to certify that the information provided is correct to a best of my knowledge, and I understand I am responsible for all charges Incurred from this application. 636 DATE SIGNATURE CONSENT FOR SITE EVALUATION TO 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. SIGNATURE DCHD (1)83) 1 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department IrUIL bt��1G® Environmental Health Section b P. 0. Box 665 Mocksville, NC' 27028 N O V 2 8 1994 �J - �l/ l (�: P�ae� Application/Permit Requested By, � � Mailing Address> S • ;V .rlA,�l Home Phone 3 oweA I WC, Business Phone %D f/ -/,/Z5-'2 7-9 Z2 2. Name on Permit if Different than Above 3. Application for. P§ rneral Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: 0*66se ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry / ❑ Other ❑ Unknown S. If house, mobile home: Subdivision SOU`i-rn Section _ Lot # 9 ❑ Basement/Plumbing No, of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions AQP41r• 6. If business, Industry, place of public assembly, other: Specify type No. of People Served 144A No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers ❑ Basement/No Plumbing ashing Machine Dishwasher ❑ Garbage Disposal No. of Showers Water Usage Figures 7. Type of water supply: Public.,, �II ❑ Private ❑ Community 8. Property Dimensions �!.( /r�a�% Sewage Disposal Contractor 9. Do you anticipate additions/expahsion 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. Directions to Property: This is to certify that the information provided is correct to the best of Incurred from thnis�appjita�tio%. ��• G7 / 7'S` t AT I am responsible for all charges CONSENT FOR SITE EVALUATION IQ PE DONE QNN 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 DCHD M93) 1P11= DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site . Evaluation NAME -��V. l @c v 1C S O a d� DATE EVALUATED ADDRESS d AMQ PROPERTY SIZE3(��Otp PROPOSED FACIILTY vg Q- LOCATION OF SITE � S �"u� �`Oo Water Supply: On -Site Well - - Communit Publicy Evaluation By: Auger Boring Pit - 'Cut - FACTORS 1 2 3 4 Landscape position Slope X' o HORIZON I DEPTH &'121' i Texture groupC �- Consistence _ Structure C� C Mineralogy1 HORIZON II DEPTH y 6 Texture group Consistence Structure Z Mineralogy1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S SS RESTRICTIVE HORIZON — SAPROLITE i— — CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATE En�I1 SITE CLASSIFICATION: Q .S . EVALUATED BY: L-3� apt LONG-TERM ACCEPTANCE RATE: 1 OTHER(S) PRESENT: REMARKS: END 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