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183 Mullins Rd F �s DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a S�anitary,Sewage Systems ,Permit:-Number Name � � UI:>Y,7:/�� Date _ �✓�j � N2 6 3 Location .°� r rir� ,i /.. �j / Subdivision Name Lot No. Sec. or Block No. Lot SizeHouse Mobile Home _T Business Speculation No. Bedrooms - No. Baths � No. in Family Garbage Disposal YES ❑ NO p- Specifications for System: Auto Dish Washer. YES -NO E]Auto Wash Ma.hine YES•/ NO E] 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 Nte plans or the intended use change. t� t� Improvements permit by *Contact a representative of the Davie County H alth D partment for final inspection.of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completi n. Tel phone Number 704-634-5985. Final Installation Diagram: d Ztern Installed by a s Certificate of Completions Date M� *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 ,f Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1 . Application/Permit Requested Byfin w T S Mailing Address 7/01) ? Home Phone f 3 ��S Business Phone 2. Name on Permit if Different than Above -Ro R R5 i s 1 1,1 LD L�2S /tel C - 3. Property Owner if Different than Above E�/w E % 21 M M C A?M Ad 4. Application/Permit For: General Evaluation 0 S/Tank Installation 5. System to Serve: ouse u Mobile Home 0 Business -] Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lott/ No. of People ,� Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms �_ Basement/No Plumbing (-Clashing Machine J Dishwasher 0 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 : &--�ublic 0 Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes g—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 tn(_ best of my knowledge, and I understand I am responsible for all charges incurred from this application. - 73- 9/ �e Date Signature Directions to Property : CD aV - V P- uJF0 / L� DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation l NAME /�.J- DATE EVALUATED ADDRESS l ° S� PROPERTY SIZE 2� PROPOSED FACIILTY LOCATION OF SITE Ol° Water Supply: On-Site Well Community Public C� Evaluation By: Auger Boring Pit Cut FACTORS4571/— 2 3 4 Lands—cape position .0 Slope % -� HORIZON I DEPTH Texture group S Consistence Structure Mineralogy HORIZON II DEPTH y y Texture group 0 Consistence Structure / ✓L Mineralogyi HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION _ J, LONG-TERM ACCEPTANCE RATE 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 G&-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo[ty 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 ■■■■■■■■■■■■.■.■■■■■■■.■■.■..■�■aBaum■■..........i.■■■■■■■ .YMM ■■ ■■■■■■■■■■■■■■.■■■..■.■..■■ee■e..■■■■■■.IIS■■■■■■■■e■■■■■.■■■■■■■■■ ■..■....e■e■...■■.......e■.u....�e■■.■■■■■■■■■■■ee■■e■■■■■■■■ ■■■ ■■..■■■■■■■■ee■■■■.■.■■e■■■■■■�i� -....■ii■■li\■■■■■■■■■■■■■■■■■■■.■■ CCCCCC�iMOMMEMCCCCCCCCCCCCCC CCCCCC=CCCCCCCCCCCCCmmomom ■■■■■■■■■■e■.■■■■■e■■.■.■ice■_==�....■■■■■.■■■..eee■■.■ ■e■■ ■■.■■■■ ................................�..................CSOME C■e■.■e■ ■■e■■e■■■e■■■.e■■■■■■t■■■■■■■■.■■■■■■e■■.■■■■■■et■..ee■■■■■e.C■■■■ :::::CCC:::::CCCCCCCCCCCCCCCCCCC:CCCCCCCCCC� ::_:ME CCCCCCCCCCCCa ■.e■■■■e■■■■■■■■■■■■■■■■■■■■■�e■■■■■a■■■■■■■■■■eke■■■■■■■■■■■■■■■ ■■■■■■u■■■■■■.■■■e■..■■■e.ele..�..■.e..e.■.eee ■te■..e■■e.ee■.e■ ■■■.■■■■■■■■■■■■■■■.■■■■■■■■ee■■■■s■■■■erg■■■■.■■■■■■■■.■■■e■■.e■■■ CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCiiiiiiiiiiiiiiiiiC■iiiiiC ................................ ................................ ■■.t■■■..e■.■■.e■■■■■■s■tee.■■■■■.■■..e■..ee..t■.■■■.■■■..■....... 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