316 Riverdale Rd_^,. `r ,- ,-r. ..a �' i 'i:-• , ).r'.r ..�:iq-,.�u r � e..i„t.."ck:•:,.t -. o a. :?'.... .- .. E., .. . - .. ,-�
w ” _ X0d
DAVIE COUNTY HEALTH DEPARTMENT /00, 00
~' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION : DD
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
` /Sarii#ary Sewage Systems Permit Number
Name \-, A� v� Date N2 6474
Location �' .L . �1 1 C)v_ o zt 'cr+. e 0 `V h,
A 0 - C'
Subdivision Name Lot No." Sec. or Block No.
Lot Size House House Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths D_ No."in Family n
Garbage Disposal YES ❑ NO.Ce
Specifications for System:
Auto Dish Washer °a ,, YES [.J,/NO ❑
Auto Wash Ma.hine Y YES EJ., NO p
Type Water Supply 0
*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.
T
e
..kv N
F. V r V
Improvements permit by
*Cpntact a representative of the Davie County Health Department for finalsinspection 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.
r
Final Installation Diagram: y f System Installed by
P
Certificate of Completion r_ * Date-
"The
ate*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 I�S 4
•-� Davie County Health Department —�-
Environmental Health Section
P. 0. Box 665
Mocksville, NC 27028
1 . Application/Permit Requested By & , n.vt�X � ��r A
Mailing Address AdBoX �gc� �Dr��2.� P .Q, /JCS 2,-70 :L*
Home Phone Business Phone 6 3e --I9 0 $�
2. Name on Permit if Different than Above 'QGclej-e-
3. Property Owner if Different than Above Slr 'toe czs Aboci-ems
4. Application/Permit For: 0 General Evaluation S/Tank Installation
5. System to Serve: [) House /mobile Home 0 Business
lL] Industry u Other Unknown
6. If house, mobile home: Subdivision Sec. Lots
No. of People a Dwelling Dimensions
No. of Bedrooms _ .3 Basement/Plumbing
No. f Bathrooms _ 7 Basement/No Plumbing
ashing Machine Dishwasher 0 Garbage Disposai
v
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
S. Type of ,water supply: Public 0 Private ,. ommunity
9. Property Dimensions G AC-/`�
10. Sewage Disposal Contractor '4711) �/1 w�
11 . Do you anticipate additions/exp nsions of the facility this system is
intended to serve? Yes @Ao
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.
— ;2_57--q4 V i llz� 4
60-
U to Signature
M
Directions to Pro77:
4r
I '
n C
� T
DCHD (10-89)
VW
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
(° Soil/Site Evaluation q
NAMES y �� _ DATE EVALUATED - Y I
ADDRESS S p' r"`S' PROPERTY SIZE p
PROPOSED FACIILTY \*k\• A LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation BytVV Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position S S' S
Slope % O -26 O'to O
HORIZON I DEPTH
Texture group CL C L-
Consistence
Structure
MineralogX
HORIZON II DEPTH V% o 40
Texture groupC
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH'. ,'
Texture group •
Consistence
Structure
Mineralogy
SOIL WETNESS S S S S
RESTRICTIVE HORIZON — - —
SAPROLITE — —
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE -,:77477-7741u 1 3S -
SITE CLASSIFICATION: EVALUATED BY:
LANG-TERM ACCEPTANCE RATE: _�S " .LV OTHER(S) PRESENT: N 4
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