549 Junction Rd D
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0,
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Saniittaary,Sewage Systems Permit, Number
Name C_ \1 Date U 06062
Location ID
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Subdivision Lot No _ Sec. or
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths , No. in Family _
Garbage Disposal YES ❑ NO E� Specifications for System: _
Auto Dish-Washer YES ❑ NO p' / 00
Auto Wash Machine YES p' NO ❑ 1 .,
f � 4
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
i/ 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 .d• ��� <✓'�-{�
3
Certificate of Completion all 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.
'APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department �, G
Environmental Health Section
P. 0. Sox 665
Mocksville, NC 27028
1 . Application/Permit Requested By l��. (' �t .r r�/,• T
Mailing Address 7 13ax S/,7 -/ 4' o'et-
Home Phone -v9,2 - Business Phone G'.s'411•- l>4
2. Name on Permit if, Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation 0,"S/Tank Installation
5. System to Serve: VHouse u Mobile Home Q Business
0 Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lotn
No. of People Dwelling Dimensions
No. of Bedrooms 3 Basement/Plumbing
No. of Bathrooms 2 Basement/No Plumbing
(Washing 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
8. Type of water supply: Public 0 Private 0 Community
9. Property Dimensions cs'- �
10. Sewage Disposal Contractor
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? ( /Yes 0 No
If yes, what type? +Uri •er') uini , j e
*NOTES 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 application.
Date Signature
44W &aaf.� 4/ ��
irectio to Property :
A41C'4 G /h� �t/2� .% �C.x' Z-4,y
4.
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation ' q
NAME � _ DATE EVALUATED a I
ADDRESS P,�.� _ PROPERTY SIZErr-
PROPOSED FACIILTY oy S-- LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation ByA-1�4N-�- Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe % - 8' !3 ` -15
HORIZON I DEPTH 6
Texture group S?Cr1. sTCA_ CL-1
Consistence
Structure
Mineralogy
HORIZON II DEPTH Ll 2 y 2 1
Texture groupC c--
Consistence "T 1- F I Ft
Structure c' S 1? �=. S SEX
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS S s S S s s s s
RESTRICTIVE HORIZON — —
SAPROLITE — —
CLASSIFICATION S S S
LONG-TERM ACCEPTANCE'RATE q U 0 u
SITE CLASSIFICATION: `S EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: �� U OTHER(S) PRESENT:
REMARKS:
L GEND
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) A,.
Soil wetness - Inches from land surface to free water'or'inches from.land surface to soil colors
with chroma 2 or less } %4.
Classification - S(suitable), PS(provisionally suitable),t(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD(01-901