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139 Red Fern Ln DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ' *NOTE:Issued in Compliance With Article 11 of G. �'Ch pter 10a Sanitary Sewage Systems j3 �� '�"'� Permit Number Name •� •/ ~" ate N2 60 9 1 Location j= =am '� 4� �. a•,^:, < r Subdi ' Lot No. Sec. or Block No. ,i I Lot Size l ` House Mobile,Home _� Business 4f!� Speculation No. Bedrooms �5No. Baths No. in Family r Garbage Disposal YES ❑ NO ®''• Specifications for System: Auto Dish Washer YES NO fes" / Auto Wash Machine YES NO ❑ �! �y �� 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 a change. �a 0y, X X ' 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 �• '� �¢2 l� r l3� l�oG �a7S' Certificate of Completion 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. APfLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT pp,\vHealth Department Davie County HeatQ AQR ,1 p� �� + W� Environmental Health Section EC�\v� HDuF-S (, A < P. 0. Box 665�'� Mockaville, NC 27028 ` �(? 1#5 0\ f 1 . Application/Permit Requested By EFFRC J Tl�1TT� ) R OW Mailing Address RT -1 Box LLE NG 2-7029 Home Phone Business Phone ING . R Aly-6 , DEPT '7,96- 2. 7GS2. Name on Permit if Different than Above SPS 3. Property Owner if Different than Above 4. Application/Permit For : 0 General Evaluation Tank Installation 5. System to Serve: House u Mobile Home (�usiness Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of, Bedrooms Basement/Plumbing No. of Bathrooms Basement/No Plumbing 0 Washing Machine J Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type CO3*W---n C/A L kiTCf/�,�/��iFTcR�N6 No. of People Served No. of Sinks T No. of Commodes ( No. of Urinals 0 No. of Lavatories 2 No. of Water Coolers O No. of Showers I 8. Type of water supply.. '0V F+ublic 0 Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes 0 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 plane 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. � - 1t - 90 _ J Date Signature Directions to Property : Go S -ro `bE,4.AMoN RD. LEFT Otv JEAhMON 6d . R I V E �( m . TA K E L-F F T O N C§-oT -s R& 1 Es i 0 C 0LD l� oCl� 6-T D K E St HOCtSE: ON LE FT dw -rE w/ 6 Ppu EN � SFl�t7"T�S DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ;ItA A i d Lyl DATE EVALUATED ADDRESS PROPERTY SIZE !�C PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public /l- Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % s HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH 1 Texture group Consistence r Structure f 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: 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-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 watet'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■■■.■■■■...■...■..■...■■■...■■N■■■■■.■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■.■■■■■■■■■■■■■■.■■■■■ ■■■ U■■■■■■ ■■■■■■ ■■■■■■■.■■■. 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