119 Canter Cricle Lot 89_ _ _ --.gag*erg,y.,a.��•y,:Y4Y"�ftij�w�''I.r'4`�F_ti,�:v.n, �.�?�f..,s.4 • `=u•i:''e*5e'ii: E'T J A _ u_ r 'rnr..�Yf '�.�Y?"'i
Y y ar V O
WE COUNTY HEALTH DEPARTMENT
4 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
Sanitary Sewage Sistems " Permit Number
Name A �,, i L ��n� �i Date NO
646.
Location
L. I ek, I—) U J 2 V\ (._. it -b",I h', — tt I Aft \ ) c. V" i n ea A kAU e
Subdivision Name Lot No. Sec. or Block No. 'z
Lot Size %% V 118 V21 xVj House Mobile Home _ Business Speculation
�T _ i• r
No. Bedrooms iNo. Baths No. in Family__
Garbage Disposal YES ❑ NO U/ Specifications for System:
Auto Dish Washer. YES, ❑ NO p' 0 o G _
Auto Wash Ma^,hine YES` p� NO ❑
Type :Water Supply;." ?a
*This,permit Void ifsewage 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.
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:
j
System Installed by �J��
F
r
V
s• Certificate of Compl4 i Date ':L`S
"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 sh#ll in NO way lie taken as a�guarantee that the system will function
satisfactorily for.any given period of -time.
V
s• Certificate of Compl4 i Date ':L`S
"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 sh#ll in NO way lie taken as a�guarantee that the system will function
satisfactorily for.any given period of -time.
_* APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT %6 S/
�- Davie County Health Department ��0
! Environmental Health Section MaY Al�'s
P. 0. Box 665 pE(, 11
Mocksville, NC 27028 TT��
1. Application/Permit Requested By
Mailing Address e C' a L? 3 1 Y`� K sc1�r L L
Home Phone %*3 q'y% I Business Phone 7 5 L D% L 7
2. Name on Permit if Different than Above �� fir+ --t
3. Property Owner if Different than Above S A IV—C
4. Application/Permit For: 0 General Evaluation P-91/Tank Installation
5. System to Serve: 21 -'House Mobile Home 0 Business
Industryu Other 0 Unknown
/a &,Z-
6. If house, mobile home: Subdivision Sec. Lott' �9 ?
No. of People Dwelling Dimensions
No. of Bedrooms Basement/Plumbing
No. of Bathrooms_ �ement/No Plumbing
ilk'^ashing Machine J Dishwasher 0 Garbage Disposai
7. If business, industry, other: Specify type gV A
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: V Public 0 Private vCommunity
9. Property Dimensions , !%� X l , l l X i 35, 15 X I q% 20
10. Sewage Disposal Contractor'F r' 0Q— 'C-il"" - 't
11. Do you anticipate additions/expgprsions of the facility this system is
intended to serve? 0 Yes o
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 they
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
P W
Date Signature
Directions to Property:
C - O (_;p q W Si
CD R
v
La� c� C C Cay ou A
� r Lal ��. S w�-� (�-0 v_e c1
CF -NJ L- Q- F � #
DCHD (10-89)
4-"e1-Q--S'S'6-t-1-V-'C- 9
�e Fi
C L.ry "
F e' 5
,-,,j 0,4k -
N e K / //1 e-r� I. 0-"f �
9 0
o�
�m
100 "C"
v
2 �o
a)
LN 52 N
f� m
N 10 - 11 (12)
i 13
14
N 15
16
17
18
19
- 20
_
=
=
_
-
= �
' 270
.,,
.,
loo
loo.
0 41
= 40
= 39
- 38
_ 37
-
= 36
= 35
= 3433
-
= 32
- 31
-
N
0 30
o
17
18
19
20
21
2 2
93
24
25
26
27
28
A loo
Jo0
Ino
100
100
100
100
too
loo
100
100
100
OAKLAND AVE.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation LL
NAME DATE EVALUATED
ADDRESS S x. tr PROPERTY SIZE X 1 9
PROPOSED FACIILTYrJ V,LOCATION OF SITE �'"� QN \\ w \ 1
Water Supply: On -Site Well Community �� Public
Evaluation By:t,,_ - Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
V\_
7
7'
Sloe
HORIZON I DEPTH
Vii''
Texture group
L
C t_
C t_
` L
Consistence
"t -C
-
=
Structure
R
C', \?
MineralogX
HORIZON II DEPTH
CA D
h"
Texture group
Consistence
Structure
Mineralogy'•
\
\
\
\'� \
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
>
.55
_5_5
RESTRICTIVE HORIZON
—
—
—
-
SAPROLITE
—
-
-
-
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
? S -
; ` - o
;?; - \\t) I
r
SITE CLASSIFICATION: i EVALUATED BY:v`
LONG-TERM ACCEPTANCE RATE: d 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 -Finn 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 watet 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