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P6507 Daye Ln "2' . •s, r r \y.::r,�� Y„ i3 ,j-i:yd• a i DAVIE' COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION1Bp *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sgnitary.Se/wage Systems Permit Number �i N Name Pater ' it ,"1/ ;lr}J Date '.� r / NO 65 07 .,Location a Subdivision Name Lot No. Sec. or Block No. Lot Size , ��� House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family Jl✓/ Garbage Disposal YES ❑ NO ❑ Specifications for System- Auto Dish Washer YES ❑ NO ❑ ���� .�� Auto Wash Ma shine YES ❑ NO ❑ Type Water Supply �1 YP *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 _ A6 *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 704-63475985. Final Installation Diagram: System Installed by b4� l Certificate of Completion 4// 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 is Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Reques d By Old Business Phone 2. Address i, e 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: House Mobile Home Bs / IndustryOther b) Number of people !� 6. a)If house or mobile home, state size of ho a and number of rooms. House Dimensions �.S�e d Bed Rooms_Bath Rooms 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 3 urinals n garbage disposal lavatory — showei washing machine dishwasher sinks ' 8. a) Type water supply: Public Private Community b) Has the water supply stem een approved? Yes No 9. a) Property Dimension/-� f X 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? Al 0 What type? This is to certify that the i formation is corr to the b knowledge. Date Owner Signature OWNER IS SOLELY RE ONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: �v OCHD 18.921 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME _ Poo DATE EVALUATED el`0141` ADDRESS PROPERTY SIZEd ��� PROPOSED FACIILTYLOCATION OF SITE Water Supply: On-Site Well _ Community Public fr� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Z. &-- U L Sloe Z HORIZON I DEPTH 41-1• Texture group .L .4_ Consistence Structure Mineralogy HORIZON II DEPTH d y Texture group 4o" 01 Consistence i ,- StructureMineralogy �,- 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 (� Iq ) SITE CLASSIFICATION: /!. EVALUATED BY: l LONG-TERM ACCEPTANCE RATE: j 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 ■■■■■■■■w■■■■ww■■■■■■■w■■■■■■■.■■www.■■ww■■■■■■■■■w.■■■■■■.■■■■.■ ■■.wwww■■■■■■w■■■■■■■■■■www■■■w■ ■■■ww■■■■■■■.■■.■■.■■■■.■■■..■■■ ■Citi.■■.■■■■■■■■■■■e■■■■■.■■■■■■■�t■■■■■■■■■..■■■■tt..■■■ttt■■t■■ ■ww■■■■■■■■.■■w■■.■www■.■■■■■■www■■.■■w■■■■■■■■■■■■■■■■■■■■.■■ ■■■ ■■■■.■.■■.■■■.w.■■.■w.■■■■■■.■ww ■■■■■.■■■■■■■.■■■■■■■■■■■■■■�■■■ ■■■■■.■■■■www■■...ww.■■■■■■■www■■■�iwww■■■■.r��■■■■■■■■■■■■■■■■■■■ ■ ■■■■■■■■■■■www■■■.■■wwww.■■■■■■■■■.■�a�e��nwws..■■■■■■■■■■■..■■■■■ ■■■■....■■i■■■■.■t.■■■■t■ln...===:iii®...■■Id■■■■t.■■■■■t■■■■■tt■■■■ ■.■■■■ ■■■■■■ ■■.w■■ ■■■■■■ ' ■■■dl■■ Il0■■■■■ ■■■■■■ ■■■■■■ C:C :::':::8 ..............................................�■. ■■■■■■■C■■■e■t ■ SOMEONE ■............................... .............. ................. ::::::: :::_::::::CCCC ■■■■■■■. ■■■ ■.■■■■■...■■■■■■■.■■ttt■■■■.■..■■■t.■t.■.■..N■■.■ ■■ ........................................... ...................... ................................ ................................ .........■........................................................ ......................................... ........................ ■.■■www.■w.■t■■w■■..■■■wwww■■w■■■■■■■e■■■■■.■■■■■■■■■.■■tu■■■■■■■ ■■■■■■■■■■■■■w■■■■■■ ■■■■■■■■w.■ ■■■■wwwwwwwww■■■■w■wwwwwwwwwwww■ ■■■■■■.■..■.■■■www.■■■.■■■■■■■■■�ww■..■■■■■■.■■N■■■■■■■..■■■..■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■