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145 Gobble Ln DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Namet" ,�? l 't f 1% / l/,,,,i'•: Date .r ,�'i�f`i'.' N2 6071 Location !%� . 7` 1 '�/�- t' / i ;`,:,i.—c .'�% .r, Pte✓ /�` '' . Subdivision Name Lot No. Sec. or Block No. Lot Size /u'r House Mobile Home Business Speculation No. Bedrooms -.-SE No. Baths No. in,Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ eeo C. rG Auto Wash Machine YES E] NO ❑ f 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. I Improvements permit b , *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 bo Z � , 1ci'f 7r �� r- Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in comp ance 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. -�a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section l Soil/Site Evaluation J NAME DATE DATE EVALUATED PROPERTY SIZE ADDRESS P /�� PROPOSED FACIILTY LOCATION OF SITE �'`­ Water Supply: On-Site Well Community Public oil Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L L Sloe Z HORIZON I DEPTH Texturegroup $� S S Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 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: EVALUATED BY: LANG-TERM ACCEPTANCE RATE: 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 ■ ■■■■■■■■■■■/■■■■■■■■■■■/■■■/■■■/■■■■■■■/■■■/■■■/■■■■■■■■ ■■■■■■■ ■■■■■■EEEEEEE/EEE/■EE/NMM/■E■/■■�■■■/■■■/■■■■■■■/■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■E/NEE■NMN■NME/■■EE■EE■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■.■■■■■■■■■■NEE■EN■E■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■M■■■EEEE■E■EE■EEEE:E/NNEEE■EE■EEENEEEEEEN■■■OEEEE■■EEE■N■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■M■■■■E■EEE■■EE■E■iE■■EEE■■■■■■■■E■■OEEE■■E■■■■■■■■■■■■■■■■■ ::::::::::::::::::::NO:::::::::::�on:::::::::::::::::::::::::::_::: ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■VV■■■EMEENNEEEOMENN■EEE■EEEEEEE■ ■ ■NNENEEEEE■EE■■EMNiiii■ii■EEE■iN ■E■EEi■■iE■■■E■■■i■■E■■■■■■■EMon ■■■■■M■EO■iii■■■E■NN■M■NO■■EM■EMEENNNEOEEEM■NOMEEE■EEN■E■ NE■EEE■■ ■ilii■■■E■■EE■■iEE■■EEEEE■■■M■������a�■N■■■■■■■■■■■■■■■■■:■■■■■■■■ ■■■■■■■EE■EE■■■■■■E■■■■■iii■EES■■■■■■EMM :,\■■■■E■■iii■■■■■■■E■■■■ ■M■ilii■■■EEEN■EE■EMEiEE■i■EEEEEE■iEE■EE■EEE�IEE■■■EE■E■■EE■E■■■E■■i ■■■■■■■■■■■■■■■■■■■■EE■■� MEMNON■■■■E■■imommommmmommmmmommomi■■Eli■E■/I■i■■■■■■■■■■■■■i■■i■■■ ■■■■■■EEE■E■E■■EEEEEEEEEI/EEE■E■iEE■EE■EE ■■EEEEE■E■■iEEE■iEEEEEEE■ ■■■■■EE■EEE■EE■EEE■EE■EE��■■■■■■■■■■■■■■■■■■i■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■MN■NE■EM■■E■■■■■�■■■■EE■■■■■■■■■■E�IEiEE■iii ■■■■■EE■ilii■■ ■■■MO■NOEMMNEMEE■■■■■■OL'��i��■■■ ■NNO■O■iiNMEE ■ No OMEN EE■EMME ■■EEEEEEE■■■■■■■EEE■EEEEE■EEEE■EN■■EE■EEEE■EEEEEEMEE■EE■iEMEN EN■■ ■EEEEEMEE■EE■EEM■EEE■ENEE■■■EEEENEEEEEEEi■■Ei■ EE■iEEuai M■=MEMM■MMME■NON E■■E■E ■ ........■.......................■...■....■..■.: : ■ .......■........■■EMM■■■N■E■ME■E■■Ei■EE■i■uM■■E■ ................ MMMEMMEM ONE on EEEEE■uiEEEEEEEEEE■■■EEENEEMEEE ENNEEE■■E■EEME ■■EEEE■ENEE■■NEE■ ............MEEOM■NO■■MM■MNNMOElMEMEEMEEME■ MMM■MM■MMMMMMMMME MMM ................................�...........................:MEM■ ................................ ................................ .................................................................. ......................................... ........................ ■EEE■EENEMEEEEEME■■■■EEEM■EEE■■■■■EENE■■:MMMMMMMMMMMMMMMEMMMMMMi■ ■■■■■■■ENEE■■■■ENEEEEEENMOEEMMEME■E■■NOES■EEi■■EM■■EEE■EEN■iOENi■ ■■■ENEE■■EEEEEEN■EEE EEEEEMEMEEi/NEEEENEMEEEiE■EM■■■iEEEi■EEiEENME ■■■■■■EEEEEEEEEEEEEE■■EEE■E■EEE■■■■E■E■EEEEEME■Ei■E■■■■■iN■EEEEi■ ■■EEEEENNEENEEN■■M■E■MMM■■MNM■EM■NMN■EN■■MEM■MEM■■ENa■■M■EN■ENEE■■ ■■EEEEEEEi■■EEENE■■■■■EEM■■■■■EEEEN■■EEE■EEEEEEEMEEEEEEE■EE■ME■EE■ ■■EEE■■■■■E■■EE■■EEEEEEE■■■EEEEu■E■■EEi■iE■■EEE■■■M■■EEM■EEEEEEE■ M APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT /lp/W Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone(704)49.2'5118 1. Permit Requested By Q rent Cobble Business Phone " 2. Address Rt. l Box I18 A MisGkSVi IIc, NC ff7628 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: Housed Mobile Home Business Industry Other b) Number of people �+ 6. aT If house or mobile home, state size of home and number of rooms. House Dimensions 75 x 30 Bed Rooms 3 Bath Rooms 2 Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory showers I washing machine dishwasher 1 sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions I 01G1'e b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? - What type? This is to certify that the information is correct to the best of my knowledge. 7-4- 90 Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 44 W -fa Shc;field Rd.. / mile Pas+ lamas Church . Turn in-16 d rive, by Larry evhblGs 113 Go b bles. Staked on lelf cif Cu rve . t DCHD(6-82)