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1771 Cana Rd ti .. r r+ . 4�_ DAVIE COUNTY REALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Syst ms �`��' c�' ,r ,,,• Permit Number Name _, /Ji't :t /„r�. fir%4,t.•`�'pa NB 885 Location � 1:�— .� d'� / .W% /� i✓'i�J /%• Fr � •r � ��/ r()�.� fes.''.• /�f./��/�(/ r��l, i ,'ra,`Ir' jfj'”: Subdivision Name Lot No. Sec. or Block No. Lot* SizeHouse _ Mobile Home _--_ Business Industry No. Bedrooms --,,---.No. Baths —&Q-- No. in Family —2 Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES ❑ NO r, 4u,.. '' / ✓' ,r,)_ .t1�s Auto Wash Ma-hine YES Q' NO ❑ G���r� 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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. i (z f 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: 704-634-5985. Final Installation Diagram: System Installed by 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 PE Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 ENVIRONhfENTAL HEALTH DAVIE COUNTY ' 1. Application/Permit Requested By N e I 1 Mailing Address 153 JJ1A.)M0 ,0-4J I Home Phone W Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly us Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home:Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms R'Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions / ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type Of Sc b:%+Ad),vMALI 4?i2lgdhy f No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories 2 No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public R,'Private ❑ Community 8. Property Dimensions &%r755 Sewage Disposal Contractor ^_ ! 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? [IbY�v 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. Directions to Property: 04444- l- 2— 1A NOS a-(- This is to certify that the information provided is correct to the best of y knowledge and I understand I am responsible for all charges incurred from this application. C7 A DATE IGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: ❑ 1. 1 OWN the property. V2. I DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representativ of the Davi ounty Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to de ermin aid ite' uitability for a ground absorption sewage treatment system. DATE SIGNATURE DCHD(1193) c a • - . DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation JJ NAME /`" CS�(LJi h✓ DATE EVALUATED 05/.Sa ADDRESS PROPERTY SIZE �A�G PROPOSED FACIILTY x-�Ar.0" de�5 P G©l�r LOCATION OF SITE C,14AIn Water Supply: On-Site Well tl _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Q Sloe % ` HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH '' w +' Texture group CC G Consistence Structure C 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 RATE �,,�/ SITE CLASSIFICATION: /v EVALUATED BY: J*9 !/ LONG-TERM ACCEPTANCE RATE- HER(S)0. PRESENT: REMARKS: -- i�lSir+� o/l(Z//: w LEGEND 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 :lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V<---y 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 DCHD(01-901 ■■■■■■■■.■.■■■MMMe■■■■MM■■■.■■■■ ■■.■.■ee■M ■e■■■■■eE■■eMeee■e■■■ ■■..■■.■.■..■Me■■■■■■.■■■■M.M■M■M■■■M■■MMMMMGMMM■MM.MM■■.M■MM■eM.■ ■..■.■.■■■■■e■■M■■■■■■■■■.M.■e.M.■■■.M■.■ee.■e■e■eee■■■■.ee■ee■■M■ .......................................... ........ ............. ■■■e■■■■■■■■E■■■■■■■■■e..MMM■■■.■.■eee■■■■■■e■ ■■eME■E■ ■EM■MM■EM■ ■/■■■■■■e■Mee■■■■■.■■■■■■/■■■■■■/■■■■Mee■ ee■ ■ ■ ■M■ ■■■O■■ no ■■■■■■e.■■■■■■■■■■.■.■.■■■■■■■■■■■■■■■■■■S■■■G MSG G■■■Gmonsoon e�i■■ ■■..■■■Me■eMMMM■■eMMMMMM■■e■eM■■ ■■MeEEE/e■EE■■■E■■Eee■■■■■■■■E■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.�■■■■■■■N■■■■■■■■■■■■■■■■■E■MEMO ■..■■■M■■M■eMM■■■■eM.M■■■■■■■■■■■■ee■e■e■■■■■eEG.■.e■■Ee.e■■s■■E■■ ■.■■■■■■...Mee■....■■.....■■■.MMM.e■ ■H■e■ ■E■■OE ■■■e■ ■E■eee■■ ■E■■E■■EEE■■■■■■■■■■■■■■■E■■E■.■E■G.G■■E■■■Ge■■H■■e■■■■G■=■■■■■ ■■e■ ■ _'� ■..MM..■M■■a■■■■Eee■■ee■.■■M.■■eE■ e■/■■EEO■EH/■■■EGEO/■O G ■.■e■■■■■eeeee■■■■■e■■e■■e■M■■e■■■■■■■■ee■e.e■e■e■M■ Ee■■■■■■■ ■■ ■MMe■e■M.ee■■e■■■■■■.■MMM.■■■■■M�e■eeeOEN�OO■■■O■eOOO■■■e■eeG■■■ ■■eMM■Me■■■M■■■■■eO■■■■MMMeeee■■ MMe■■e■■ ■■ Ne■■.■■■M■■■■■■M. ■■■Ee■■■■■e■■eE■■■■■■N■■■■eO■■■■■■e■■Eee■■■■EGG�ii■■EE=EEe■■E■eN■■G ■■■■■■■eMee■Mee■e■■■e■H■e■■eeee■eEO■■e■fie■.eee■ Mee ■■■ ■■■■E■ ........NOee.■■EO■eee■■■■■■■■■■■.■■■e■O�i■O■N■eeG ENE■GME■■ME� ..............■.............. �..........■..■..•GG �'G=■eGeeee■■■■.0 ■■■■■N■■■EEE■■■■■■■E■■■■■EE■■■■■.■■■Ee■■ ■■E■■EE ■■ ■■■■� ■■■/■■■ ■■M■e■esN■■■MMeeee■■■OeOMHMe.eHM■E■EeM■e■eM■e■e.■■■■■O■�i1eeeeMee■.■■eee■■■eiG�Oueeen�ie■■■■■E■e MEMO OM GME ■ ONE ■M■■■■■■M■■■■■■■eMee■e NHe■■!:!.��� ..ale ■E E■■. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�� MEE ■M■■GMEE N n■■ ■ ■OMEMEMG .■MM ■ SOMMEMM■■■■ ■■■■■e■■■■N■■■■■■■■.■N■eME UMMEAME G■■■■li■■■■■■� ■ ■■e ■■■e■■ ■Mee■e■■eee■e.■e■■■■■eeeN■e■ee�ie■■■■■� ■MEG■■■ ■■■M■■e■ ■■■■■e■■■■■eH■eEEE■eE■■E■eee■eMee=eek e■ ■■■■■■■■ ■■eeMM■■■■eeee■e■e■ee■ee■e■ OEM ■ e■ ■H■. ■■ ■■■■■■■eEEEUN■■e■ee■eEE■.GGuG.■eu■ ee eeaE■G■■ ■■■e■■ ■■eee■H■e■.e■ eee e■ ■ ■ ■ ■■e■■ M■MM■MSG■■NHO■■N■■■G '=E'HH■EO . ■CCGE■OE■�� ■MMMMMeeMMM■■eeMMEMMHee■eeeeeee ■e■■■e■■ MMe """"""'Smmummo GSGGGGGG ■■ "GG u::G'G ■e■■■■■■e■■■■ H■u■■■■ MOMMENUMME N No MENN'EN ■Mee■e■e■ee■ee■■e■e■■Eee■■■■e.eN■ ■ � �■■e■■M ■■■■eeeee■e■e■e■ee.eeeee■Meeeee■e■ ■_ ���iu'iSSSG ■MMM■MH.eM■.■eNeMM..ee..Me.■.■ ee ■MONO RE NONE O■O■■EEE■O■E ommm'■iGGGGGGGGG �0 lMMMMMlMMMMMlMM H■Gnu'GGG ■O■O■■■ GGG'GGGGGGGGEN ROME goom e MEMS sS ■eeG■M■eee./euOOee■OO■■/ ME u■G■ e■■■..............■■.■■■■O■■■■■■■■ e■ MM■M■ S .... . . ..O MEN' GGCG:GG:GG:::CSC::CGSC:000SGG' CGCG' ""' .......... on SSGGGG�"■iGSSGGoGGGGGSGm'■GSS■mo ■ iGie'ii GSSG GGMEMMO■eM■M■ MMMMM■ U ■MMM■MM■MM ... 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