Loading...
2593 Hwy 64W DAVIE COUNTY HEALTH DEPARTMENT , D (} _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems , / Permit Number Name�•�F ; i, ,�„ / / �.i< Date N2 6041 Location e"'! r �CrF' Subdivision Name Lot No. Sec. or Block No. Lot Size li House ,t --�'� Mobile Home _ Business Speculation No. Bedrooms No. Baths _ _ No. in Family __ Garbage Disposal YES ❑ NO C2,' ti Specifications for System* Auto Dish Washer --YES NO ❑ ���0/'�` � Auto Wash Machine NO ❑ cJ �t� G, � _ 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. Improvements permit by Ai *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 66AI2 r t Certificate of Completion IF Date "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 P. 0. Box 665 ' D SUN Mockoville, NC 27028 t ��� 1 . Application/Permit Requested By Dianne F. Baits Mailing Address 6176 Ridgecrest Road Winston-Salem, NC 27103 Home Phone 919-766-8890 Business Phone 919-998 6800------ 2. 800--2. Name on Permit if Different than Above 3. Property Owner if Different than Above Ruth Ferebee (492-5408) 4. Application/Permit For: 0 General Evaluation S/Tank Installation S. System to Serve: House D Mobile Home 0 Business 0 Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People . 1 Dwelling Dimensions No. of Bedrooms 3 - Basement/Plumbing No. of Bathrooms 2 Basement/No Plumbing OX Washing Machine � Dishwasher 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: 0 Public ( Private 0 Community 9. Property Dimensions 5 acres 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 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 th4 best of my knowledge, and I understand I am responsible for all charges incurred from this application. /(10 Date Signatur Highway 64 West 5 miles out of Mocksville on the left side of the road. The open Directions to Property : Pasture past the first house past the Center' Fire Station on the left. (past the Charlie Barnhart farm) DCHD (10-89) DAVIE COUNTY-HEALTH DEPARTMENT Environmental Health Section Cl Soil/Site•Evaluation NAME T DATE EVALUATED 4ro� � ADDRESS PROPERTY SIZE S/�C PROPOSED FACIILTY / ►� LOCATION OF SITE G�l Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH f• '" Q' �` Texture group Consistence ,' F% t /Z.- Structure rA Al a /C Mineralogy 1.' i n 1 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 1: SITE CLASSIFICATION: �,r EVALUATED BY: LONG-TERM ACCEPTANCE RATE: c 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 i 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/f42 DCHD(01-901 WWI ........................... ...................................... ..........■... ...............................................■.■■ ■■■■■■■■.■■.■. .................................■................. ......................................................■........... ■.■■.■■■■.■■...■...■.■.■..■.....■.■■..■■..■�.■■■..�i■e■■w■■■..■..Ell ■.■...■■.■■■■■■■.■...■■■..■..■.■.■.■�.�.■■■■.■■■■.■..■■.■■..■■ ■■til ...................,................■....................�....■,um�. UMEME:: l:::::: ON::C: MENNEN ■......■■■!.■■....■..■..■rl.■e.�iw■■.■.■...■..■■■.//■■......■.■■.11■ ■■.......■e...■■...■■.■..■■■■/./.■■■■.■■■..e...■■■G.■...■...■.■■■11■ ■■..■■.■■..■..■..■■..■■■■...I■■.i..■.■... ...e■.■.N■.■...e..■■■11■ MMMMMMMMMMMiiiiii■� ................................ ONO■�■■■■■■■■�i.■■.■.■..■■�■Ell 1■ ■.■■.■.■..■...■.■■...■;�■■■.■■.■■■...e.■■■..■.. ■!.■■■Ne■ ■■■■■■1 ■ ■.■■■e..■...■....■■■■■■■■■■■■.■■ A.■■....■..■.. ■....■..■■.■■.■11■ 111111011111 SENSE MONO