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337 Gordon DrDAVIE COUNTY HEALTH DEPARTMENT �� h," L);) IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION *NOTE:'Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems_ ` Permit Number Name h�� �" \ ,\S Date ��" N2 Location OW, , Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home — I Business Speculation No. Bedrooms No. Baths No. in Family 2 Garbage Disposal YES (B/ NO ❑ Specifications for System: Auto Dish Washer YES V NO ❑ Auto Wash Ma :hive YES ©-, NO ❑ 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. s a Improvements permit by�`K *Contact a representative of the Davie County Health Deparlie'�l for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completio Telepho a Number 704-634-598,7 M Final Installation. Diagram: o S stem�� . Installed by � s 4 Certificate of CompletionDate j "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 PERMIT f1p" Davie County Health Department Environmental Health Section P. 0. Box 665 1. Mocksville, NC 27028 RECEIVED APR 2 ! Im Application/Permit Requeste By Mailing Address L Home PhoneBusiness Phone a� 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: C) General Evaluation S/Tank Installation 5. System to Serve: House + Mobile Home 0 Business tj 0 Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No ofvPeople y Dwelling Dimensions No. of Bedrooms Basement/plumbing No"of Bathrooms �-- Basement/No Plumbi;yGarbage lashing Machine gZ/Dishwasher Disposal 7. If business, industry, other: Specify type 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: Public 0 Private Q Community 9. Property Dimensions 10. Sewage Disposal Contractor/ Ser 11. Do you anticipate addi ions/expansions of the facility this system is intended to serve? es 7 No If yes, what type? o�S! L L 1f1�3N1 Sr� *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 my knowledge, and I understand I am responsible for all charges incurred from this application. oZ Date Signature Directions to Property: 7— �L-el-��'�i'dE G6Pdo•v-d!k' r G-o�s fp-.Al JN�k�e Gl / Del% o DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME "S . V_" y \c-, DATE EVALUATED 4-Z - J ADDRESS s A �PROPERTY SIZE PROPOSED FACIILTY �, e cr.� LOCATION OF SITE G��- Water Supply: On -Site Well Community Public V Evaluation By.�_'1�11- Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S 157 Sloe 7. - (� - S6 - 325 HORIZON I DEPTH 62 Texture group Q L�- Consistence I F� P•� Structure Mineralogy 1 t t HORIZON II DEPTH Ll 3e' 36 Texture groupC C Consistence Structure AIN Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S s1Z.s RESTRICTIVE HORIZON -' SAPROLITE -- CLASSIFICATION .S S LONG-TERM ACCEPTANCE RATE 35 a SITE CLASSIFICATION: ,\ EVALUATED BY: LONG-TERM ACCEPTANCE RATE: `1� OTHER(S) PRESENT: a REMARKS:. LEGEND Landscave 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 Mi n eraloity 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