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P7784 J & L Farm Ln ! - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a San'tary Sewage Systems Permit Number Name f;/ G ?fiJ ��Date N°_ 1AA7784 Location ra i.; f�.ryc dd .�- ✓y Ac Subdivision Name Lot No. Sec. or Block No. Lot Size ���C House Mobile Home . Business —_ Industry No. Bedrooms No. Baths — -� No. in Family Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES NO ❑ ���� / �, / - Auto Wash Ma^hine 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. !' 1 i1, H 0 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 F z. ty _ M_Jq� Certificate of Co�ipletion � � r� -a�� ate ` -�y '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. i ! IPkP ' ICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County, Health Department I` Epvironmental Health Section ! P. 0. Box 665 � I Mocksvillp, NC 27028 ! oC 1 251994 ^AJ .� Appliat ' on ermit a ues d By ki Mailig ddr!! sar� cis/ `�/. ! _ Home ho a !!' 'eq'�1'-�0 `z v� `7 Business Phone 17zJ =,,g- 2: . Nam® I n ern_' t if Diff arent than Above Prope ty (Owni r if Different than Above I ,.-,d. .Appli at. on arm F'or ; 0 General Evaluatio>� S/Tank Installation I ' � 5: Syste ' t S ve: D 'House Mobile Hgme 0 Busipesx II i 0 Industry C Other 0 Unkn wn 6. If ho' seal mppile home': Subdivision Sec. Late ! i No. o ` P�op1T -- Dwelling Dimensions ; Bdrlopms C Basement/Plumbing No. o Bath ems 7 Basement/No Plumbing F!. HiQ 0 Was in M bineJ Dishwasher 0 Garbage .Dxspc,sa.t i 7: If buI in ss� industry, other: Specify ',type �— I No. o , P,�op�1g Served No. of Sinks I No. o , Cgmmo;jas No. : of Urinals No. og, L;�valtQrias No. of Water Coolers No. to SI owp a Ii I! ? + Type at supplyv Public private P Community 9. Prope tyj�Dim rasions i :a Sewag D spl al ContractorD 11 . Do yo a ti -( pate additions/expansions of the facility this s, stem is intenpd to I erve? 0 Ye�No (y If ye I, hA � type? •NITER Xpprovements Permits shall be valid for a period of 5 y.gars from date issued. Improvements Permits are subject I to revocation, if site plans or the intended use change. i j E�fective October 1, 1989. I i Thi i; t certify that the informati provide is correct to to beg o m knowledge, and I understa I am r�. ons ' a far all cha gel if�urred from this applicat on. Ic ® ' E: to ignature i Direction ; tiq Pry perty L , ;I ii DCHD (10-1�) .1 .' : DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation a l NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well /f Community Public Evaluation By: Auger Boring e/ Pit Cut FACTORS 1 2 3 4 Landscape position e_ ,L L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence r Structure Mineralogy ; / /."/ 47 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: 1e5rEVALUATED BY: fYGi LONG-TERM ACCEPTANCE RATE: • c/ 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 3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloizy 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 watet' 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 ■■■■■..■■■......■.■..■......■■.■ ■..■■.■■...■■..■■■■.'../.■■■■■■■ ■■■■■.■■...■..■■■.■■■■■■■■■■■■!�■ ■■..■.■.. ..■■.■...........■ ONE ■■..■....■■......■.....■.......■..■N....■.■...nM.E.�....■..■■■.■ ■.■........■..■...■....llrrr■i.....�........1�..■n■....■...■....MEMO ■■■■■■■■■■■■■M■■■E■...■SIM.■.E■■.■■.E...■.■I�...M..■■■....i�..M.... 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