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273 Mason Dr .l s:.:y DAVIE COUNTY HEALTH DEPARTMENT 60 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage System Permit Number Name Date - l( ND 6 910 Location Subdivisiont Name ` Lot No. Sec. or ock No. Lot Size f – House Mobile Home —� Business -- Speculation tl No.Bedrooms 3 No. Baths m No. in Family Garbage Disposal YES ❑ NO [j Specifications for System: Auto Dish Washer YES ❑ NO p' c, a�_,�k Auto Wash Ma:pine YES Q \ 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. nv 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 00 ) Certificate of Completion >` Date J /� '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,, ESF r G l r E ID APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMDavie County Health Department 8 1992 Environmental Health Section P. O. Box 665 _ _ Mocksville, NC 27028 1. Application/Permit Requested By -ni e i5 Mailing Address G, p- a Home Phone / y•� ���� Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation Septic Tank Installation 4. System to Serve: ❑ House >< Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People `IL ❑ Basement/No Plumbing No. of Bedrooms dwashing Machine No. of Bathrooms �`/ /�11 ❑ Dishwasher Dwelling Dimensions C2 ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ElPublic M/Private LAW ❑ Community 8. Property Dimensions )I CL0-V-�-- Sewage Disposal Contractor 40 kV)Yl (A WSW -5f k' 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes Nr 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. Directions to Property: V—, � of This' to certify that the information provided is correct the best of my knowledge, and I understand I am responsible for all charges I r ed from this application. DATE SIGNATU CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. DATE SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH, DEPARTMENT Environmental Health Section o Soil/Site Evaluation NAME \, DATE EVALUATED ADDRESS s IN PROPERTY SIZE PROPOSED FACIILTY �\. LOCATION OF SITE` Water Supply: On-Site Well Community Public Evaluation By:C 'r-.u• Auger Boring Pit Cut FACTORSws�ct. 2 3 4 Landscape position S Sloe 7.HORIZON I DEPTHTexture rou S CS C Consistence 17 T 1- Structure C>? P, Mineralogy :l :I I i; HORIZON II DEPTH 142ZI2 Texture group C_ S C c SC-1- Consistence 1El FJE Structure G \Z Q C 2 Mineralogy `•� 1 I : 1= i HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS s'S s .s .5 -5 'Ir r RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION s < . � LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: .4 �" �r1 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-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 ■/■■■■■■■■■m.oemmmmm■■em■■■■//■■■■m■■.■■.■■■■■m.■■■■mm■■■■ ■■.■■ctrl ■■.■■.■■■■■■mmmm■■m/■■m■■m■ammo■m/■■■.■■.■■e■■■/■comms■.mm■■■■■■■■■ ■■.■■.■■■■■comm■■mm/m■■■■■■/■■■■■■m■■//■.■■■/■■■//■■■■■.■■/■■■■■■■■ ■■■■.■■/■■■■■./■■■■■■■■oee■■em■■m■oeeme.00memeooeeoeo.memomemoem■ ■■■■■.■■■m■■em■■■■■e■■mmmme■mm■■mmommmmoem■emmmemmm■■■..■eee■mm■e■ ■■■e■e■emm■■■■■■■■/■■o■■■■ee■e■■ ■■■■■■/mmmmmmem■emeee■ee■ee.mee■ ■■■■■/e■■mmmmmom■mom■■m■■■e■■m■■ a■m■mo■■memm■mmmm■■me■■eem■emme■ ■■■e■.■■■e.e/■/■■■/■■■e■■■■■■/■///■■e■oe■■■■mm■/mmm■mmm■emo■m■mom■ ■■■mom■■■moo■■m.mmmem■mm■mmommm■me■mmmmommeeemme■e■■mmeomeemme■e■m ■■■■■■■■■emmomemm■■m■■eem■■ee■mm■■ee■■eeeoeemmeommeemo■e■mm■o■mm■■ ■■mmm■■mm■■■mmme■m■■mm■e■■■■■■m■■eo■mee■m■mmm■emmm■mmmemmmmmmmmme■ ■emomememmmm000mmmmmooeommeomm■■■m■■mmm000mm■o■■mee■■m■m■mm■■om■m■ ■■■■■ommeeee■■■mooem■mmme■■eeee.■■■■m■meeeoeeeoeee■eeemeee■eem■ee■ ■■■memmmmo■mmmmm■■■m■memm■mmmmm■ ■■.eemmm■■meeeme■oeee■■mmemoeee■ ■.■■mo■■mmommm■■m■mmommmmom■■■■m�im■■■m■mm■m■■mommmm■mmmmmmmmommm■ ■m■■■ommmmmmmmmmmmmmmmmmmoo■memono■■■memo...mmmmo■mmomm■omm■ommmmm ■■■■m■■■■■meommmm■■mm■■m■■o■■■e■■■■emeeeeeee■eeee■.eoe■eeem■e■mee■ ■■■.ee■■■ee■e■■■■.■m■em■■■■e■■■■■■■o■■■■em■eem■■ee.eemeemm■eemee■ ■■■■■■momee■eoem■■■■m■■em■eemm■■e■■mm■■eee■eem■eee■eeeemm■mmoemmm■� ■■■■oome■om■■oo■mm■eeo■seem.om■■■■■■eemeee■.■oommmmmmommo.m■ommm■m ■■■■■■■■■■■■■mem■■■e/■/■■■■■■■■■■■■■■■■■■■■■■■■■m■■■■■e■■■e■■■ mm■ ■■■■moommmmmomm■■mmm■mmmmmommm■ ■■mmmmm■mmmem■eeeeemeem■■em■=mmo ■■■■■■■e■em■■me■■e■■■■■m■■■■■■■■ ■■■■■■■■■m■■■■■mm■e■■m■mmmmmmmm■ ■/mmmmm■■mmeommm■■mo■m■mmm■mmmmm■mmemmmom■mmmmmemmommommmmmmommmm■ ■■m■ee■■■■■■■ee■m■■■e■e■e■■■m■■■■■■■■■■■me■mmommomm■mmmmmemmmommo■ ■e■■mm■mmmmmmmmmmmmmm■■■■e■m■■m■■■■■■■e■■■■■ee■eeem■■ee■■e■■e■■em■ ■■■e■■eem■m.■■■■me■e■m■■m■e■■■■■■mmmmmmmmmmmmmmmmmmmmm■m■eeoeee■■■ ■emmmmmmmmmo■mmmmmommmmmomommmmmmm■mmommmmmomeeo■emememoo.mom■mom■ ■mmmmmm■.■m■■mmo■■■mm■me■eeo■.e■■e■■.eemmm■mmommmmmmmmmomommmmmmm■ ■mommmoommmmmmmmmmmmmmmo■m■mmmm■ ■■mmmmommmmmmmmmemommmmommmmmo■■ ■e■e■■■e■■■m■meem■e■■■■e■me■■■■■ ■■eemeem■.e■eeeoomemeeemeoee■■.■ mmmo■mmmmmmmmmmmm■mmommmo■m■mmo■m■mmommmommmmmmmmmmmommommommmmmm■ ■e■■■■■■■m■■ee■ee■emee.■■mm■ee■■■■e■meeme■■mmommmm.mmmmmmommmmmom■ ■emmomomm■■mo■mmmmmm■■ommm■mommmmmmmmmmmmmm■omm■■mmmmmmmo.■mmmmmo■ ■■e■mmmmmmmmmmmeeMMMMMMem■eee■m■emmoommmmmmmmmm■mmommm■■■■■mem■mm■ ■mmmmmmmmmommmmmmee■■m.ommmomm■mmemmmmmmmm■mo■eemmooeeome.e■meeem■ ■■■■■■■■me■oe■oe■■e■e■.oe■■emm■■■eeemm■emeeeomeee■me■oe■emoeeeeem■ MMMMME�EMMEMM�mmmomm�iMMEMEM mommommmmmomm"MEMMEM EMMMME ■■mmm■■mmmmmmmmmm■m■mmmo■■mmmmmmmmoe000mmmmommmmmmmee.ommmmmemem.■ ■e■■■ee■.e■■mmeee■■eemee■eeemem■■■■■eeoee■eo■e■mem■omm■me■moeoeem■ ■■■ee■e■.e■■em■■■meee■■■eeee■mm■■■eeeemmem■mmom■mmoemmmmm■mmmmmmm■ ■■e■■■■■■e■eo■m■■mm■mm■mmmmmmmmmm■mmommmmmmmommommommmmmmomommomm■ ■mmmmme■m■mmmmommmmomm/■■e■m■om■■mmmmmoemememmemmeomeemmmommeeem■e ■.■.mm■....e■me..emm■....e.m.e.■m■■■emmmmmmommmmommommomMIMMMeme. ■■■■■■■■■■■■■■ee■■■o■m■m■m■■■mm■m+••_ennmmmmmemmmemmmm ■m■■ mmmemm■ ■■■■■■■m.memmme■■■■■■ee■■■eemoo■"mmemm■mcamemoommommmmemmmm ■mm■ ■.m■mm■mmemmoommo■mmomm■oe■mmero■emmommmmomomm.namemomomeemmmmmo■ ■e■mmm■mmmmemmmmmmm■m■emmmmomeemmme■mommmmoem■ mmmmmm■mom ■■emmm■■ ■mmmmmmo■moemmo■■m■om■emm■momommm■mmmoammrruoem■�me o■eem■■�e■eeeee■ ■■mo■mm■■■■e■■■e■■eom■oome■®■omr�m r��srnls�■e+�.�ie��:2e=ee■■ee■e■e■e■■e■ ■ommmmm■ommmmom■■m■mm■e■■mmmoommm■mummwmomwmmommommmmmm■ omomommo ■■mmeom■■■mem■■o■mmm■o■■■eee■o■meemos■e■O•No■e■■=eee■m■■�mm■■eemo e■■■e■emeemmem■mm■ee■■e■eeem■eom ■■mmm.m■.em■mm mommmmmmmmoemmmm■ ■e■mmmm■.emmmmeemmmmmmmm■mammomm�■■mMMMIAwMMmmmmome■■em■momeemomom ■■o■eommemoom■■oememo■o■I!■m.e■■m■■■■MENMLi■n►mommm■■■■■m■m■omm■ooee■ ■■eeoeeeeeeee■o■ee■m ■■KI!mzmom■■.■eo■mom -_•meoem■■■■■o■em■■eammo■ ■■mmmmm4omm=m■ommmmEee■MWEMMU■■■■■■m■■m■Moommmogmmmmm■mmmmummmm■ ■e■■■■ee ■■e mm■■■mmmom■m//memmmmmm■■mm.mmmemmo/mmmmm.m■■mmmmm■mm■ ■■■m■m■mems■■comm■mm■■I,r��omn�!r�►���/r�rwrGi�mmmer��,��mme■e■■m■e■.memo■em■ ■■■■m■/e■m■■■■m■/■■■■t/�■E■■6ii1■■■■■r:���■■■■■■���IS:�■m■■■■comm■■■■m■m■■/ ■/■■e■■■■mmmmm■m■e■■■■■■It■■■■e■IGS'Siimmmm■■■m■mm■■mmmmme■■m■m■mm■■■■■ ■■■■■■e■mm■■m■mm■mm■■■m:amml!//�''AIS/!�'_"!�!�!�!7m■m/■mmmmm■m■m■m■■■■■m■ ■■■■■■■e■■■■■■■■■■m■■■1,1■riii�i�....i�ti�ii�iiil■mmmm■mm■■■■mm■■■■■comm■ ■e■mem■■mmmmmmmmmmmmmmnmmmmoommmm�tlnmmmmmmn�■■mmmmmmmmmmmmmmm■■m■m■ ■■.mem■mmmmmmmmmmm.■■�11!■mmmm! �'►1�mm■1;=.��■.■mmm'l!m■■comm■emm.mmemo■comm■m■ ■ee■■■■eemmmm■■m■■m■ 111>■■■■■llell\m■►�.Iter■m■■m�'�m■comm■comm■■■comm■mm■■m■■ ■.■■■mm■e■■■■■■■■■■e■111■■■mm■///■�■■■■■■1•/a■■mm■mmmmmmm■■■■■■■comm■