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589 Hwy 801S DAVIE COUNTY HEALTH DEPARTMENT . 3 - ` IMPROVEMENTS PERMIT,AND CERTIFICATE OF COMPLETION ~' '*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a ? Sanitary.Sewage Systems Permit Number Name �.�f rii� lS� �� `- – ✓1�� Date " – / N2 Location VT Subdivision Name Lot No. Sec. or Block No. Lot Size �'��G House Mobile Home Business Speculation No. Bedrooms .No. Baths — No. in Family — Garbage Disposal YES ❑ NO Specifications for System: Y Auto Dish'Washer YES NO ❑ ylJ',C:G Auto Wash Ma.hine YES NO ❑ �'� �' ria" Type Water Supply __— "rev *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. Improvements permit by -- *Contact a representative of the Davie County Heal Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completio Ilephone Number 704-634-5985. Final Installation Diagram: System Installed by ,1 Certificate of Completion Date LA *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 Environmental Health Section 7"R P. 0. Sox 665 EIVE® Mockaville, NC 27028 0 8 19911 . Application/Permit Requested By _ 6D Mailing Address ?,Ox 4;�R-A Rcl\jc rye NC - t�• Home Phone 0A %AQ Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: lC) General Evaluation E�S/Tank Installation 5. System to Serve: House u Mobile Home 0 Business Industry Other Unknown .- 6. If house, mobile home: Subdivision Sec. Lott No. of People 14 Dwelling Dimensions (91-xa4 rtaeaa n ,-k z:X No. of Bedrooms 3 Basement/Plumbing No. of Bathrooms V/1 Basement/No Plumbing Washing Machine FZ Dishwasher 0 Garbage Diisposai 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 CCDun+)) 0 Private 0 Community 9. Property Dimensions , ronLA to -�4 h, o3 10. Sewage Disposal Contractor ' Croc,. Cnntraelnr 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Q Yes 2/No If yes, what type? is$ 7P 3 *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. h-8-9I uaio"& Date Signature Directions to Property : '601 n,-v4- -Io o�arn o`� ►U C �,�"" `Ct `�'� Coil me- 0\- When' \'When UO w i 1111 S 1Z. ` VJanKS, ?aL'o �- DCHD (10-89) jr DAVIE COUNTY HEALTH DEPARTMENT Environmental 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: Auger Boring ej, Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % — - HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH ��- Texture group Consistence Structure 7 J r11 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: 7- EVALUATED BY: LONG-TERM ACCEPTANCE RATE: I / 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 - 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 ■■■■■■■■■.■■■■■■■■■■e■■■■■■ee■e/ ■ecce■e■■■■■■■..■.■■..■■■■.!■..■ ■■■■■■■■■■■ecce■■ee■■■e■■■■■■e■■�i■■■■■■.■.■.....■..■■■.!■■■■■■■■■ ■eee■■■■■■■■■■■■■■■ee■■■■■.■■■■■..■.■....■■.■.■te■....■.■■■■■■■■■■ ■■■■■■■.■■■■■■■■■■■eee■■ecce■■■e■■■■e■■■■e■■■■■.■■■■..■...■..■■..■ ■■eee■.■■■■.■tt■..■■......■■■..■■■■■■.........■.......■.....■■■■.■ ■■..■■..■..■■■■■■.■■■■■■■■■■■■e■ ■■■■■e.■■■i■■..........■■■■.�■■■ .................................................................. .................................................................. siiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiwe��=��■!■!■■■te■■■e■e■■■■■■■■■■■■ l:CC::: 3MEMNON :C:::: :::::IJi1M::MEMSEM:::CCl::CC::MEMEMMEM i� iiiiiisiiiiiiiiiiiiiiiii��iiii::��■��e■■■■■■.e■■■■■■■t .■.■!■.■ ■■■■■■■■■■■.■...■.■■■■■■...■..........■......■■■■..�■■■.■!■■..mom ■ ■■■■eee■.ee■■■■i■.■■..■■.......■�..■N..t■■...........■..... ■■■■ ■..■....■.....■■......■.....■.■...■■.■.A■..■.'J■.■■.■■.■■■■...�■■t■ ::C:C:::CC:MNON 0 ■■■.■■■■■■■■■tt■■..............■ ■■....■..■■.■..■......tet.■■...■ MENEM MMMMEMEM MEN ME ■■ecce■■e■■■■■■■...■■........■.■■..■....... ......�i.....■■■■■t■.e■ ................................ ...........................�■■.■ .................................................................. ■....■..■■■.■■■.■■■■■■■■ecce■■■■�e■■■.■........w■■■■.e.■■■..■...■ ■e��e■e■■■■■■■/ecce■ee■ecce/■■■■■e■■eeeeeeei■■!■.■■..■■■■.....■■.■ ■ee■■■■■■■■■■e■eeeeeeeee■■■e■ecce■■eeeee■■eeeee///e/ee/ee/e■eeeee■ ■............■■■s■■■■e■e■■■!■eee■■■■■■e■■■i■■.■■.....■..t.■...■■■■ ■■eeeeee■■ee■e■eee■eee■■■■■■■■■■ ■■■■e■.■■■■■■■■■.■■........■■..■ ■■■■■■■■■■■■■■■■■■■.■■■■■■..■■■....■■■■i■■■■■■■■■■ecce■■■■■■■■■■■■