P7783 J & L Farm Ln DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE:Issued in Compliance With Article.I I of G.S.Chapter 130a
anitary Sewage Systems . Permit Number
Name Pr //��i; l� �a � �� / Date '2 V'Z/ n HN2 7 18 3
Location /rte/wr>•,1r1
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business -- Industry
No. Bedrooms No. Baths --a'2 No. in Family o'22257 Public Assembly Other
Garbage Disposal YES ❑ NO [q.- Specifications for System:
Auto Dish Washer YES NO ❑ /T/CU fug
Auto Wash Ma thine 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.
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
0
0
S •rte
0
Certificate of Completion, Date 11-17-a' _
'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.
SITE VALUATION/IMPROVEMENTS PE M i ' `
yz�n�ICATION FOR I E F>f � �,. .-
• i Davin County Health Department
I � _ it ♦'1
'� • i Environmental Health Section iul•
,
P. 0. Box 665 �I l
Moc.'kovillR NC 27028
_ � I
1 . Ap ication/Permit Requested By , f- I �
I /�
MIlling Address ib I
•V 'I
Home Phones /�T n i / ( Business Phones !
2. Name on Permit if Different than Above ( 11 ;
3. Property Owner if Different than Above
4. Applicatilon/Permit For: 0 General Evaluation . /Tari 1114!Irlbtllatia�
S. System tol Serve: 0 Houseobile Home I (� litibs�t '
I l7 Industry u Other 0 Oh'knd6n'
.0
I
6. If house, mobile home: Subdivision Seca i� L to
' � ,,�ice ', {
No. of People Dwelling Dimensions .! 5J01 - I
No. of Bedrooms .3 Ra-q '^' tubing ;p
No. of Bathrooms 2 Plumbing
0 Washing' Machine r isPosad
7. If business, industry, other: Specify type
No. of PeiCommodes ople Served No. of Sinks I 1i'i ! I'
No. of No. of! Urinali
No. of Lalvatories No. of ;,Water 'd ol 'rs
No. of Showers j
8. Type of ester supply: Public rivato i; ' C 'mmunit
9. Property (Dimensions
i iI � r �
r j
10. Sewage Disposal Contractor @� i
11 . Do you anticipate additions/expo' nsions of the facility thli s�Ist�"m s
. intended Ito serve? 0 Yes `: ;Flo M i'
If yes, what type?
*NOTE:i Improvements Pdrmite shall be valid for a peri8J o � 51:
years from date issued. Improvements Permits 'ai�e ilIubject
to revocation, if site plana or the intended %44 chlan'4e.
Effective October 1, 1989.
This is' to certify that the informatio p ovided' is or oct itu� tnE:
best of my knowledge, acid I uridersta d am respo ble �al
charges incurred from this applicat o ;
Date Sigh tura I, i
Directions to' Property :
I
lam ' I ,
—Ci I V%
Ir n
,i
0CAI
�1 i I !
Ij
DCHD 9)
�c 'DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME ��`�oo/zp� DATE EVALUATED
ADDRESS PROPERTY SIZE �Q_.� r. �� �i�fC
PROPOSED FACIILTY /W LOCATION OF SITE ��4 ✓7 ;O,&
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position G
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTHl
Texture groupL' L'
Consistence r i
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 , V
SITE CLASSIFICATION: N EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: 1 / 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
1p"• M-Massive CR-Crumb GR-Granular ABK-Angular blocky
locky PL-Platy PR-Prismatic
ies
:s
hickness and inches from land surface
U(unsuitable)
rom land surface to free water or inches from land surface to soil colors
ble), PS(provisionally suitable), U(unsuitable)
.eptance rate - gal/day/ftz
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