144 Mattie Ln (2) DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS 'PERMIT AND CERTIFICATE OF COMPLETION
r .
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date 1 N2
t. 6402
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size <:> = House Mobile Home _ _ Business Speculation
No. Bedrooms } No. Baths � — No, in Family —
Garbage Disposal YES ❑ NO' [1 Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Ma,hine 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.
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 '�
.7
F0 j Uv
i
Certificate of Completion - ( � Date 3
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 anyAgiven period of-time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665 RECENM MAY 0
Mocksville, NC 27028
1 . Application/Permit Requested By ��1 _� -
Mailing Address1 ( l �o �. l K���I l�i vi.
Home Phone ��a�1 q N' �7�1Q Business PhoneC r) knJil
2. Name on Permit if Different than Above a
3. Property Owner if Different than Above CA ,
4. Application/Permit For: 0 General Evaluation yr S/Tank Installation
5. System to Serve: 0 House Mobile Home 0 Business
Industryu Other 0 Unknown
6. If house, mobile home: Subdivision /ISec. Lot#
No. of People 9 Dwelling Dimensions VNF�
No. of Bedrooms Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
,211"Washing Machine J 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: Public 0 Private 0 Community
9. Property Dimensions Nen'
10. Sewage Disposal ,Contractor
11 . Do you anticipate additions/e pansions 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 the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
_/
Datd Signature
Directions to Property :
Sib SZa�-►on 'taKe
Rig
,mer ���T F�e�d I3�h:�d Ga���,n
DCHD (10-89)
44
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �\ c�AQ� ���a cJ �J 1'N DATE EVALUATED
ADDRESS S k�'l�� PROPERTY SIZE \
PROPOSED FACIILTY �� d LOCATION OF SITE �� a SaQNQ�
Water Supply: On-Site Well Community Public l/
Evaluation By� �- Auger Boring ✓ Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe Z6 • �' o, -`� ,` .
HORIZON I DEPTH I DL" u
Texture group LC1_ L L
Consistence
Structure
Mineralogy '
HORIZON II DEPTH -1
Texture group C
Consistence Fa FM
Structure Q i3
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS SS S SS -SS
RESTRICTIVE HORIZON - -'
SAPROLITE -
CLASSIFICATION S S -B
LONG-TERM ACCEPTANCE RATE .3S - ,1k13 ► f= ,tjD 13,C A0 9
SITE CLASSIFICATION: S EVALUATED BY: S �•�a_�; .
LONG-TERM ACCEPTANCE RATE: d 1A0 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-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