P6172 Davie Academy Rd Vx
DAVIE COUNTY HEALTH DEPARTMENT
' . IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Isqued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Date �Q - jGName . 30
N2 6172
Location �� x \ ���/ ` u� ��,S 'Q ��� •�.. � C:i ` .
Subdivision Name Lot No. Sec. or Block No.
Lot Size . House Mobile Home Business Speculation
No. Baths No. in Family
No. Bedrooms —
Garbage Disposal YES V NO ❑
Specifications for System: & - C � }
Auto Dish Washer YES E] 'N'NO - i c)c�
Auto Wash Machine YES,[�' NO ❑
Type Water Supply l C-)v \X t X
*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 plan's or the intended use change.
f
Improve ents 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
S'
N
Lq
Certificate of Completion Date 7
*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. x
PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section �^-
�
P. 0. Box 665
c10
A ' Mockaville, NC 27028 ,Qo
1 . Application/Permit Requested By J 0 IJ -S
Mailing Address
Home Phone 7D 5f- Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation S/Tank Installation
5. System to Serve: House u Mobile Home 0 Business
L Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lott/
No. of People Z Dwelling Dimensions
No. of Bedrooms -3 Basement/Plumbing
No. of Bathrooms Z ` Basement/No Plumbing
�® Washing Machine Dishwasher 81 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: C Public 'ted Private 0 Community
9. Property Dimensions , Z �{Lt A- (i ta.»�ca.Q Lwat' 9•t0-qo
10. Sewage Didposal Contractor
11 . Do you anticipate addition /expansions of the facility this system is
intended to serve? Yes 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 the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
4 Date Signature
X46- qo
Directions to Property :
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DCHD (10-89)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation C U
NAME A o N es DATE EVALUATED
ADDRESS S PROPERTY SIZE D_:�1 Cmc Rn
PROPOSED FACIILTY LOCATION OF SITE V c,.(\ p rm` h
Water Supply: On-Site Well Community Public
Evaluation By:e Z U Auger Boring Pit Cut
FACTORS 1 X21 <3 (4
Landscape position
Sloe Z C - cl, C) 0 -,74 d �'-
HORIZON I DEPTH 14 / % �w
Texture group C C 6 c c 1� C. C
Consistencei-T- ..
Structure C` C` C ye, G R
Mineralogy
HORIZON II DEPTH %6
Texture group
Consistence 1 -
Structure S Bk
Mineralogy �• �
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS S 7 S S'S S -S S ssi�
RESTRICTIVE HORIZON 13ReC� e ec�
SAPROLITE
CLASSIFICATION S VS
LONG-TERM ACCEPTANCE RATE O , a' �•D
SITE CLASSIFICATION: 5 Q S EVALUATED BY: *�o��
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: C n N cs
REMARKS•
s 9 n•s,. .. ,,,LEGENDD` Cool
X p�►.,Q �v� �.�v��-
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)
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