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111 Barnhardt Ln. 4'..,! �'+ry.-a.,,.� i �.... .3.�f y'tK'rt''Wf Y•KW'Aa. .yyWF 1..' Y FPY"tY `•y . ,1,. y .._"Cw -'- f .. ' DAVIE COUNTY HEALTH DEPARTMENT /ei• oU IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION t �. • 0 ti ~*NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a Sanitary Sewage Systems r. Permit Number Name Vec�.1�c� c�'`" '�- — Dates 2 -7 N2 1 f 18 Location ��YY�J Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business -- Industry No. Bedrooms . No:' Baths No. in Family — Public Assembly Other Garbage Auto Dis Disposal YES ❑ NO n Specifications for System: obO V) Auto Wash Ma^hive YES 4>Rrw NO p_; Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. Tl.in .,e....i♦ is cf ikicnf fn rcunrnfinn if cita'•nianc nr thei intanrlari M ma rhanna ' niNivvciiicino Nciini,uy -- — "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 dayof coQ ri mpletion. Telephone Number: 704-634-5985. _ %Zl TIl Fin stallation Diagram: System Installed by ..th r L .. i r V EN Certificate of Completion Date '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 Davie County Health DepartmentE s E 1v RE D Environmental Health Section P. O. Box 665 Mocksville, NC 27028 S.EP.. - S. iciq� 1. Application/Permit Requested By ` Mailing Address 2. Name on Permit if Different than 3. Application for: 4. System to Serve: IN House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision Home Phone (7dq-r) 6 33 -6 D 27 Business Phone [Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown No. of People 1 No. of Bedrooms 52 No. of Bathrooms J Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Sinks No. of Urinals Section Lot # ❑ Basement/Plumbing 0 Basement/No Plumbing ® Washing Machine ❑ Dishwasher ❑ Garbage Disposal No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public W Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If vac what tvna9 ❑ 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}(, J� Z 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: IR 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 disposals stem. �� DATE 04 SIGNATURE DOW (1193) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 'V� .fit N\A �os�@R ADDRESS S A�mj PROPOSED FACIILTY DATE EVALUATED - 94 PROPERTY SIZE 16 ( LOCATION OF SITE 9'a 1 4' R a� k0 Water Supply: On -Site Well l/ Community Public Evaluation By:C tZL" Auger Boring 1% Pit Cut FACTORS 1 2 3 4 Landscape position S S Sloe % g—IG° HORIZON I DEPTH Q t'. Texture group CL. i- L C L Consistence F —J� '� F Structure Mineralogy HORIZON II DEPTH 10 le Texture group Consistence FYFtl Structure k V4 Q Mineralogy ;1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS Ss ys s RESTRICTIVE HORIZON — — — SAPROLITE -- — — — CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �y "S' LONG-TERM ACCEPTANCE RATE: 1 Li REMARKS: LEG DCHD(01-901 EVALUATED BY: \ OTHER(S) PRESENT: 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 ,3C -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 ■■■■■■■M..■■.M.■■■■■ee■M■■■■e.e■■■M■■■■.eeeee.e..M..eM.■.■ ■MM■/�! ■■eee■■M..Mc.Me■eeeeeeeee■eeeeeM■ecce■e■■Mee■eeeeee.ee.■..eM■eeee■ ■e■ee.e■ee■eee.■■■■e■■■■e.M■e.■eee.■e■■e■e.eeeeeee■eseeeceseceeee■ ■■eee■■MM..eeeeee■■eeeeeeeeeee■■■eee■■.■Me■.■■..■■■..■■■.....■...■ ■■■■■.■...■■■■■■M..M■M■MMM■■..eee...■■■■■............■■■■■■■■■..■ ■■■eee■■■■■■Meeeeeee■eee■■■..eeeee■■.eee■■e■■■...■■.MMeeeeee■Mee■ ■ee■eeee■e■eee■e.eee■■eeeee■.cee�■■eee.■■..■............■eee■..e. ■■■....■■■■■M...e.M.M■■..etc.■.■ ■■M..■MM■■■■■.■..■M.■■■■■■...■■■ ...............e■■eee..eee■C■ecce.■.............■................. ■M.■■.■■ =ii■■i'�iiiiiiNii ■■..■■..■.■■MMMe■■.■■..Mc..e...M....MM.■ ■■■■.MM..■■■■■■ ■..eee.■..eeMM■■..■eeMM■■eee..■ ■■■■..M..MeMeee.MMM......M.MM■.■ ■■.MMM■■■■■MM..■.■..■M■a■■.M■■e.■M■.eM.M.M..M.M..■=■■..■.■..■■■■■■ ■.■.■...■■.....■.....eM....e.....■■..■■■■■■■■■■■■■■. ■■.M.M.■■�■■■ ■■■ceeOHeee■e.M■■e■M■eee■ecce■O�ee■eM■.M.�M.e.M.eMeeMeOeeee. 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All data Is compiled from recorded deeds, .plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be Consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or implied, in fact or In law, Including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website.please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet[View.aspx?prid=1530353 8/25/2016