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1903 Angell Rd / �- - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number !J j Name /�/r "t ; �;f.,�rf,� � �4 '-� Date �.�'� N2 5993 Location ,� L, c� ,`�. .% ,f i .he"f Z-f�J iF3 Subdivision Name Lot No. Sec. or Block No. Lot Size '`/fi'( House Mobile Home / Business Speculation No. Bedrooms _ No. Baths No. in Family Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Machine 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. r l 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 Certificate of Completion r Date :Z —/Z 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. DAA, IE, COUNTY HEALTH DEPARTMENT F,nvironmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE ------- PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: AugorB0ring___._ __ Pit_ Cut 6 FAFACTORS2 3 7 Landscape Slope Z HORIZON I DEPTH Texture group Consistence Structure H 0 R I Z ON, I I D E F'7H All Texture group Consistence Structure 'J'/ Mineralogy HORIZON III DEPTH _T Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence 7 -7— Structure ,Mlineralozy SOIL WET%41ESS RESTRICTIVE HORIZON SAP ROL I T1 F, CLASSIFICATION LONG-TER.M ACCEPTANCE RAT-7 SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE,. 01'111"R(S) PRESENT: REMARKS: LEGEND Landscape Position R-RidQ(' 5..Showldr,l I—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 loans L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loan-) 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 stick), SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP--Very plastic Structure ■!■■■■■■/■■N/■N■//■mN■■■mHOH/■■■■■■■■ H■omnonN N ■ 000/0 .■.■..■.:■.:■.:■o:.■.:/■/.■.K:■■.■.N■.■.......:■..:/..0:0..0.H0.■.K■.■n■m■m■m■■mm■■n■■O■o■/■■m/■■■■K■M■O■M0■■■1M■0M■O1■■/m■■M■HOMOM■E�■S■S■mm■m■■m■MmmHmEn■■■■:/00: � ■■ ■■■:■:■:!■■■:::M::EM::E: N: sommmommonom:ON:■■■■■■■■■■■■n■■■ 00MEN EE:M: EN::O■ M■o■■ ■ ■■■ ■o ■MM■■■■ ■■ N ■ MKNNN ■■■ MS MEEMINIMUM:::::::::::::::: ■ :::0NM ME: � : :■: ■ .N■mMM■ : E :NO E ::: NESE:ORNR ■ M ■ ■ InillimisN■■NNMMN /■/ ■ .■■■...........■■■■■■■ ..............n■■M■■■MN■■NM■o■■■/■M/■■mnm■Moo■�omn■Ea M■_ ■:. 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I a 0 a ■ MN S ■ : E■■Em E■o■ :MEN ■Kon/■/■/■■■//■OO■Mm■E■E■fil�1 MM■■■m ■mMM�■m ■ ■■ ■ ■■H■■■■■mmnmm ■M■ M■■■■N ■■ ON SEMEN :E ::: : : : : E N INS no ....... ■EN■ mom■mKmonsoon■:.. :.:.:.: .::■■ON■ : �MM■ . ..■! am MEN N■■ ■ n■m■mm■ ■M■ ■ N00 1 SIZE■■ ■Mm ■■!H ■ ■ M■■NOMooM MAE ussmsim MMMME=:mm■Mm■m■ �■:■■ ::•N / ■■MEN ■:N■■ H■n■M:�na ■: Hm ■ ■momm■o■■K■■M■■■o■sM■■/ m■/■■■■■ ■K�mK■m■■■■■■■ m ■■mm■■■ ■m ■N■■■■■■ ■M■o■/MMMMMMmMK■■■MMm■■omu■n■m■mO■!■E.m■■■■■mSN■Mmm■:■ M■E■■■m::■m:■S■■M■■■■ ■oomomMNm/■mmMM■■m■mm■■■■■MMN■M/■M■■■nR■■■mm■m■ ■m■m■■H ■SMEm■■ ■■mm■■■■mM ■M■■■m■ ■omoK■ ■m■■mm■o■KM■mMom■M■■ ■o■M ■m■m■■■■mo■■■o■■■■M■m■NE■ ■ ■o■■■■MM■MS■NM■■■MMmm ■■■■M■■■■■■m■■■K■■■Mm■■■MK■■mm■■■mM■■■m■■R■Rmm■■■■MM■■■■M ■KM■■N ENE MEN ■■■mm■M/m■■ mosommoso ■■■■■■■■ ■■■■■/■/■■/O■■■■■■■mm■m/mo■ ■omK■ ■■MK■■■■O■0000■■■M■■OMom■■K■M■■Km■■m■m■■■ ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department l% Environmental Health Section P. 0. Box 665 Mockaville, NC 27028 1 . Application/Permit Requested By Mailing Address Home Phone ©//mac, 5�� Business Phone 2. Name on Permit if Different than Above 3 . Property Owner if Different than Above 4 . Application/Permit For : General Evaluation 950/Tank Installation S . .System to Serve : D House J�obile Home 0 Business U Industry Other 0 Unknown 6 . If house, mobile home : Subdivision Sec. Lots No . of People A.11,4L Dwelling Dimensions No . of Bedrooms w Basement/Plumbing No . of Bathrooms 7 Basement./No Plumbing ' Washing Machine 21Dishwasher 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 : a Public Private n Community 9 . Property Dimensions X/0-e- /,/ 10 . Sewage Dis'posal .Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? J 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 tnF: best of my knowledge, and I understand I am responsible for all charges incurred from this application . Date Signature Directions to Property :