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210 Riddle Circle PA DAVIE COUNTY HEALTH DEPARTMENT oil.z IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a pSitary Seew,age Systems f Permit Number Name ��Q1� f/, ��/�/i�.7�/�" Date /� Location �Cl'� ✓ er Subdivision'Name Lot No. Sec. or Block No. Lot Size. House Mobile Home` Business .__ Industry No. Bedrooms .No. Baths _V—.No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO Jam" Specifications for S stem: Auto Dish Washer YES NO [D7 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., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by 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. `DGI'r %"f�' of Nk"a. }4 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS F EPXVCEOVED b�S•f Davie County Health Department Z g Environmental Health Section JUL 1994 P. O. Box 665 Mocksville, N.C. 27028 ---------- CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requeted B 1,q 6told Business Phone g � 2. Address v j e / c o�7 d 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 Business Industry Other b) Number of people 6. a}If house or mobile home, state size of ho a and number of rooms. House Dimens' ns 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 urinals garbage disposal lavatory showers �" washing machine dishwasher sinks 8. a) Type water supply: Public Private-Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions l Dl5 x/ �A, D d b) Land area designated to buildin site% �• c) Sewage Disposal Contractor P/`n: AW 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? weo_ What type? This is to certify that the information is corr the b knowledge. A", Date Owner Signature OW ER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: / 1 r' l 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation J NAME � � DATE EVALUATED ADDRESS PROPERTY SIZED PROPOSED FACIILTY LOCATION OF SITE i Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit , / Cut FACTORS 1 2 3 4 Landsca a position Sloe Z �— HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG 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: LONG-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-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(01-90► ■■■■■.■■■■■■■■....■■.■■l■.■■■.■■■■■■■■■■..■■.■■.■■■■■■lid■ ■ ■■■/■ ■.■■■.■■.■■■■il.i■■■■I..■iii..■■■■.I■■■■.I..■■I.iii...■iLll■■■.■■.■ ■.■.■■I..■..■.I■■.I■■.......■.■■�■lll...l.li■■il■.■■■.iii..■..■■■ ■.■l..ii..ili..li.li.l.l■■....■..ilii....I...i..li.liiii..iii..ii■ ■■.■■.■.■■■.ill■■.■I.■I.■.■..■.■■■■.■■Ilii...11.■I......■..II■■■■■ ■.■■.■■■■■■■.■■■■■■■■■■■■..■■.■■■■■■■■■.ill.11■■....Ilii■..iii.■■ ■.■.....■■■■..ii..l■■■.il.l.li■■i.iili..i■ilii■ii■iii■■II■i■liil.■ ■■.■■.■■I■■■■.■...■■■■■■■■■■■■.■ ■.■.■■...■ill■l.i.l■■I.I.II..II■ ■■.l■■■■ill..■■■i■■■■■■■■■■i■■■I�I■■■illl.iili..i.i.ii..liiiii./■ ........................... ...................................... ..ili.i.iii.ii■............................... ........ .......... ■■■■■.■■■.liiii..l....11..l.l...l.■■ill■ Lill.■I.■■■■i■■.I■ii.i■ ■■■■..i■■i.ii.il■■■.I..Illl■■■■■I.I■■Ilii/.■■■■illi■.■■i.■.Iii■■i■ ■...■■I.■■i...i..■I..l...■■.i..�..i.lii■■.....II..■i■ii■i.■iii.■ ■..I■■■■■I.■■.■■■■■■■■■■.■■.■■i ■■■■■■■...■■I■■■■I■.I■■■..i■III■ ■iii.i..iili..■I.I.i■■Ili.l■■■illi.■..i.liiliiiiii.liiii■.i■■■■li■ ■I.il.■■■■i.l■■..III■...I....■.Illi...il.iH.li.il�..11■i......il■ ■.■■■■..II..I..■■.li.■■■■■.ill■■I.I.■I.II....li.i■ ■i.iil..11.li■ ■■■■i.li.l...ii..il■illi.l...l.ii■ ■Iii■i..■iiliilii/iii..i.i..ii� ■■.■■illi■■i.i■■i■i■.i■.■i■ilii.■i�l■ii■i■■■in■■■■■�■.iiiiii■■■■■ ■■II■■Iblilli■I.I■■I.■■■■ii■.■■ ■■■..I..■ ■..i.11.ill.11■il. 111 ■.I■II■..l.l■■.Iii■■■■..i■.i■■II�■■.■■...�..Ilil.■/li..li...■I.I ■i.■■ilii.ii.■i.iiIIIN■■.li.l.iil.bi.ii■■i■■■■.■I■■�■ilii■i.■■■I ■I■Il...il.11..l....■I■■.Ibis■■■■■■■■.■.■■I■.Il.il.. ■.■■.■I.ONE .■ .................................................................. ................................ ............ .................. .............................................. ■.■■i...■■■.■■.■.. ■t■■liBili■i.■■iliiliilii■il■�••�C�i�.� .Il..li■■i■ .■.ilii■illi■ ■■ilii■i■■iiiiii■iii■i■iif�fi.■.t1■■iliii ii.■liniii.li.i■.■i.ii■i ■■■liiiii■■Iii■..iilii.iilli■ii.■i■■ilii■■iii■■i■■li■i'al�li.l■liil■ I�jiiiiiiii�=iiiiiiiii�3iiiiiii.�i�iiiiiii�'iiiiii■�'iiiiiii�iii�ii�iii�i.'�i .........................��..........ii..l■ii■■N■■■i■■■■■.■M■.li.l■■ ■..I■.■ill.lbii■.iiii■I.1/I.i�.l�i.i•i�:l ■li..i ■■i■■.. ■■■■■.■I MENEM■iiiili.iiiiiil■ill■.ii.if:iii�ii■.ii■ii.i ■■.■i■ iliii■■ilii.■■ ■■.■■■Ii.lH.11..l.■I.i.■I■I.■I■ .... .... 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