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P6287 Cornatzer Rd ' DAVIE COUNTY HEALTH DEPARTMENT .-";-.IMPROVEMENTS PERMIT AND .CERTIFICATE,OF COMPLETION'. ,i. *NOTE:'Issued in Compliance With Article I I of G.S.Chapter 130a r: Sanitary Sewage Systems Permit Number Name + '.�r J./, Date .2/ ' / N2 6287. Location 4'%-/- f y� /�';r> �li- _ _-; `.�?a, _l �: /f, -'� .I`,� �r,, :� ✓ �r., .a r/ r�!��.'!' der,//:✓:7`" ct°.�l4„� �� J n :r.,,� ��i��9li-:��li✓f�„�l� .� �f!� �l��ii../..'., .�i,��:. Subdivision Name Lot No. Sec. or Block No. Lot Size ,f�` P/' House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family (;2 _ Garbage Disposal YES ❑ NO Er' Specifications for System: Auto Dish Washer. YES ® NO ❑ �� Auto Wash Ma thine YES QD NO ❑ `/ 4 Type Water Supply ✓n --- ( �F *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. r Improvements permit by *Contact a representative of the Davie County Health Department for f;r�C[fid%,' �985. n of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number` Final Installation Diagram: Syst m Installed by � � i I i Certificate of Completion ` ' �Z�N 1 Date vC *.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 Department r Environmental Health Section P. 0. Box 665 REEEIkEa Mocksville, NC 27O28 FEB 1991. 1 . Application/Permit Requested By „ nepr'aO a . (,A4er ,jr. Lljn, 12 , &Lnie-f- Mailing Address P k3 BOY, 4-59 MOCK-S l eO N.C. 27089 Home Phone ,919-Qqg a`l3`j Business Phone 741-J- 3S8 4Pm-I2.prr-� 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation U S/Tank Installation S. System to Serve: House Mobile Home 0 Business Industry Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People 1�1 Dwelling Dimensions /4V )( ?a K No. of Bedrooms 91 Basement/Plumbing No. of Bathrooms �9_ Basement/No Plumbing Washing Machine J Dishwasher Garbage 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 S. Type of water supply: S Public. 0 Private 0 Community 9. Property Dimensions _k_ eco�.,s csr."I', s 10. Sewage Disposal Contractor 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 Perpi+,ts arejlsubject 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 trif best of my knowledge, and I understand I am responsible for all charges incurred from this application. a-b ,;-G1 Date Signature Directions to Property : �d m moc i s� t l ' �- her� 5u�' �-c.� � rc\ crn �e •�� �orna�-zer �- Cross � ,�-c�w.or� Cr.� Q � �ir5 houS1e. Tk, your vta oh Ltbur \p 4 Just as Ltpass ers 1r.ouse, ���s� c `t T � b� U���lC p srall Macke un� `e"�S� .Go 0.1- pu.c 1�•� 1 a �JQ-r r i S��e v� . `1 `-e•�t �u V v� d — ✓ . b' DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section all Soil/Site Evaluation NAME �`�� DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public t.--' Evaluation By: Auger Boring r/ Pit Cut FACTORS 1 2 3 4 Landscape position L L L Sloe % _ :2-. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH D (o Texture group C_ Consistence ' _r 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 RATE SITE CLASSIFICATION: AT. EVALUATED BY: '�112 T LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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 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 Mi neralolty 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 ■■....■....■......■.....■...■■■.�..........■■.....■■.■.■.■.■■ ■■■ MENNENiiiiiiiiiiiii ■iiiiiMEMNONMEMNONMENNEN ■■■■..■..■■...■.■■■■■■■■■■■■■■■■■■■■■■��■■■■■■■■■�■■■■■■■■■■■■�■■■■ iiiiiiiiiiiiiiiiiiiiiiiii�iiaiii:iiiiiiiiiiiiii=ii=iiii■ii�®iiiii�i ........................................... ..................... ........................■....... ..............................■■ ................................ ................................ ..................................................................