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291 Juney Beauchamp Rd f��' � ��,� , , . . ✓ fid DAVIE COUNTY HEALTH DEPARTMENT �,�lip- IMPROVEMENTS l- y-IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION _ NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a �1✓ Ani tary Sewage Systems f �� 1Permi7593 t NumberdNName �i� .�� l,��ir' //�r� Date 6 _ % / N2 1 5 9 3 ,m Location t- r7 ` /Dd�t S^ . J�� fl_lip __E�_(l",,/ � dam. y./�//�; /�'G' � t3�.iti Gtr-a^'ti.•.. ` , L_ r Subdivision Name Sec. or Block No. Lot Size r�Di�� House Mobile Home Business -- Industry No. Bedrooms No. Baths — No. in Family_ Public Assembly Other Garbage Disposal YES ❑ NO 2-- Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES T NO ❑ y �J` 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. n r, Improvements permit by / /A *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. r Final Installation Diagram: System Installed by S I 6Pd � I Certificate of Completion �R 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. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ��`/�mS DATE EVALUATED _ 6 —i< ADDRESS PROPERTY SIZE PROPOSED FACIILTY �� LOCATION OF SITE �&A,,' Water Supply: On-Site Well Community Public t� Evaluation By: Auger Boring 6/ Pit Cut FACTORS I 2 3 4 Landscape position L �-- Slope % 7 HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH t y Texture group Consistence Structure 53 S' /< <S i 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: //—� 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-Finn 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 - 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Box 665 _ _ _ __ Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 9v 9 1. Permit Requeste By y C h" Ali l Business Phone 2. Address A te T- �' I_ w 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional �Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Bs Industry Other b) Number of people 6. a7 If house or mobile home, state size pfhomg and number of rooms. House Dimensions—/..,// x 7 Bed Rooms Bath Rooms 2— Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes - urinals garbage disposal lavatory showers y washing machine l dishwasher sinks_ 8. a) Type water supply: Public �Private Com unity b) Has the water supply system be n approved? Yes No 9. a) Property Dimensions _ b) Land area designated to building site /� �-w�- * 1_,2_ s*= c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ReAh.4 ah '' _ %632 _j oQ , _ ► r—A o e-k A ren. }� 44 Q OCHD(6.82) \ V J AQ �Ark,60 e-- • t _ ZM,, ` Y a IRs y .\� '.:• w .er " ! � t .may`.��. ` '� ,t��. i GNP- .,y_ ""yam ,4 � � 11•• :.".e :� � 4T �,� fig,.. d •}+;:_' PAIR, , r l'_•ll� I'. ,jam 4� # 1�� ,' 7111 !, •�� r ,�. a<�' �• .I•�J1' ,"inn p.11Cr,e:i. 4, VIC Z A �_+111 p ,�.: � j � ! y\'YC�R �,� t` � • S �SS .jay 1 1 N, sr>• r � > n �