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P6967 Gladstone Estates I/X.0 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number -F Date N2 6967 Name Al X2 Locatio Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home L< Business'--- Speculation No. Bedrooms No. Baths No. in Family 42 Garbage Disposal YES E:] NO 0' Auto Dish Washer YES NO Specifications for System: E] Auto Wash Ma shine YES NO Type Water Supply 41 *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 *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. 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. T ti DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation > J NAME / DATE EVALUATED ADDRESS )� PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE (-,/22"7f Water Supply: On-Site Well Community Public Evaluation By: Auger Boring L'111 Pit Cut FACTORS 1 2 3 4 Landscape positionSlope % HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH 11 f �t 'zit 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 RATE y� SITE CLASSIFICATION: / -� EVALUATED BY: 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 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 ■■■■■■■■■■■■■■■■■■■■.■O■■.■■■■■■■■■//■.■...■..■■■■■■■■■..■...■tit■ iiiiiiiiiiiiiiiiiiiiiiiiiii®iiiiiiiiiiiii�iiiiiiiiiii■iiiiiiiiiiiii ■■■■■.■.■■.■......■......■...........■■■■■■■■.e■.■■■.■■■.■...■I■■■ ■■ss■■■■■■■■■■■■■■■■n■■■■■■■■....■■■■■■■■n■■..■■■■■■■■■■■■■■■■■■.■ ■.■■........■■..■..■■.■■epee====:::■■....i�......■■..........■..■.■ ■.............■■........ren■......n■■.....i�■......n■....■■....■..■■ iiiiii�iiiiii�iiiiiii�■/■■/■ ■/■■■/ �■■/■■/ ■■///■�■■■■■■ moon.■ .■■■■■ ■■■■■■ .■■... ■....■ ■■■...■■■....■■■■■■■■...inn...■■■..■■■■..■■■■■■■■.■■■■■.■■■■■■■■■■■ ............................................................. mono ■■■...■■■...■■■■■■■..■■■.■.■..■n■■..■■■■■■■■■■ ■■ ■■■■■■■ ■mono■ ■ ■..■■■■■..■■■.■■■■■....■■■..■...�..■■n.■■■■■..■ ■■■■■■.■■■■■■..n■ ■■■■■■■ ONE 00 ........................................... ..................... ................................ ............................■.■■ .................................................................. .................................................................. .................................................................. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE_____ ��,r . rQp�® Davie County Health Department 1.- ItV Environmental Health Section DEC a � � P. 0. Box 665 Mockaville, NC 27028 1 . Application/Permit Requested By 96t? ev- SAna Mailing Address , , G ti b L a l - NG 2 7 o I Home Phone /d T ' < 7Business Phones 2. Name on Permit if Different than Above Jl 3. Property Owner if Different than Above c[A re-t4c e- 14 Q kJ 4. Application/Permit For: General Evaluation a,.S-/Tank Installation 5. System to Serve: :House bile Home (] Business -] ::Industry u Other 0 �Unknown 6. If house, mobile Thome: Subdivision Sec.7�T, Lot#1 No. of People Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms ?/' Basement/No Plumbing 0 Washing Machine eDishwasher 0 Garbage Disposal 7. If b ZZ r:lS othehe r: pacify type No. of People Served Z No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers A141 e, No. of Showers S. Type of water supply: C Public 94-Ir ivate (a Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? [] 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 trice best of my knowledge, and I understand I am responsible for all charges incurred from this applicat o /.2 I/r ?2— Date tignXture Directions to Property : ��S�ov� e. �6� 2►- �e.�are-- �ev,c� fie �,�t o DCHD (10-89)