130 Boone Farm RdDAVIE COUNTY HEALTH DEPARTMENT
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f IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION; 4 —
* NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a -�
Sanitary Sewage Systems Permit Number
Name i 6; ,'' %� to'/� N2 6023
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House l obile Home Business Speculation
No. Bedrooms No. Baths No. in Family A.Ztzli
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO ` If
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 -- f
6
*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. "'
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Final Installation Diagram: 111Jrt
n Installed by
Certificate of Completion Date 0
"The signing of this certificate shall indicate that ike 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 PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665 R}��E�vEDJU
Mockaville, NC 27028 Os lbea
1. Application/Permit Requested By
Mailing Address 74�pf -J / /UC./}'ya
-5'1,jl/
Home Phone �- , Business Phone
2. Name on Permit if Different than Above
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3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation 0s/Tank Installation
5. System to Serve: HouseU Mobile Home Business
L Industry u Other 0 Unknown
6. If house, mobile home: Subdivision
No. of People Dwelling Dimensions
Sec. Lott
No. of Bedrooms Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
0 Washing Machine J Dishwasher 0 Garbage Disposal
7. If business, industry, other: Specify type &AP-AG�
No. of People Served
No. of Commodes
No. of Lavatories 4
No. of Showers
8. Type of water supply: 0 Public
9. Property Dimensions -2.2 424aQ
No. of Sinks
No. of Urinals
No. of Water Coolers
g.-VFivate
10. Sewage Disposal Contractor '
0 Community
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 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 tris!
best of my knowledge, and I understand I am responsible for all
charges incurred from this application. rJ
9,
Date Si nature
Directions to Property:
DCHD (10-89)
Cp
DAME COUNTY ' HEALTH DEPARTMENT
Environmental Health Section
Soil/Site 7 Evaluation
NAME DATE EVALUATED
ADDRESS �7 PROPERTY SIZE
PROPOSED FACIILTY e5� q5le4 Or LOCATION OF SITE � 6y
Water Supply: On -Site Well Community Public tI
Evaluation By: Auger Boring �,/ Pit Cut
FACTORS 1
2 3
4
Landscape position
e-- .4-
G
Sloe %
HORIZON I DEPTH
V h
a
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
-�
Texture group
Consistence
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 jt2f
SITE CLASSIFICATION: 51 EVALUATED BY: 464;a
LONG-TERM ACCEPTANCE RATE:
REMARKS:
Landscave Position
OTHER(S) PRESENT:
LEGEND
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
Mineraloity
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