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279 Sandy Ln (3) z ��.�-' =' ��'•.• � SIBS �'�:: DAVIE COUNTY HEALTH DEPARTMENT Z IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETIW� *NOTE:Issued in Compliance With Article If of G.S.Chapter 130a j J� _San ry Sew e S Pt 6 Por I �er Name if Date_ N— Location J Sa> Subdivisi giNam Lot No. Sec. or Block No. Lot SiAell House,— Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family — Garbage Disposal YES NO ❑�— Specificatio =-foor,,System: Auto Dish Washer YES NO El ' Auto Wash Ma thine YES 111"`(� NO ❑ F `'� j Type Water Supply __— 'This permit Void if sewage system described below is not installed within 5 years f m-da-�e`of issue This permit is subject to revocation if site plans or the intended use change. k { Improvements permit by 'Contact a representative of the Davie Cod ty ealth epartment for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of c ple\T6epSone Number 704-634-5985. tem Installed b — ��Gt�;LI Final Installation Diagram: y 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. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage System *-G; .Permit Number Name eif/� S Date —/�''9.� ND ( 33 Location Subdivision Name Lot No. Sec. or Block No. Lot Size_ House Mobile Home Business _— Speculation No. Bedrooms No. Baths c;?-- No. in Family Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES NO ❑ � �`" � Auto Wash Ma^.hine YES �j NO ❑ V �� 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. J- 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 APPLICATION FOR SITE EVALUATIOWIMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P.O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By r Mailing Address Home Phone Business Phone 2. Name on Permit If Different than Above 3. Application/Permit for: ❑ General E=obile Septic Tank Installation 4. System to Serve: ❑ House Home ❑ Place of Public Assembly ❑ Business. ❑ Industry ❑ Other. ❑ Unknown S. If house,,mobile home: Subdivision Section- Lot # ❑ Basement/Plumbing No.of People ❑ Basement/No Plumbing No. of Bedrooms ashing Machine No.of Bathrooms ishwasher Dwelling Dimensions b d ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ublic ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes I3'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. i Directions to Property: >� I ,p This is to certify that the Information provided is Correct to � es of my knowledge, and I understand I am r,sponsih!. Incurred from this ipplic?t;:;n. _: 9702 ' 0 . • O T�• a a 187 Z L6£ O VJIZ�T � •�,: t6l <.is CID �N 8 u•'"1�•�i •�� s r �I� a001r• � ' d VN • Qf �'v�� ' 'w•Q� _ r�..j try N 'n •r a' In �In ��r ^ �.� . �• Q � N ,�,�� N h .f ..+��.� • 0 N J � ... r 9Y "" ,Offz6 N Z •ct tZ 'tia't BZI 14 6�j• � f0'£b t— � . . -� �;.�• � -?�•,;• �r .�Y psi, 10 '�'o .� ,' '„ .ref�r'^ f•,�•�p '' I �f ' � �' .y.P•t► I ii roe' p Yl. 1j ,tidy �'• �:. Z�'• y.,y,r,�•, IQ1 t r r,•. 'p 901 ��, �''" ,• •��" CY ''��=+�'nI�'' NQ "• C�'I Inv; •• `•• R I • •I •� mow. •i ..� .� �� '� � � n` ., •� • �, S• t + f ♦ ' •�• •• A• d•. [� ,�. a r-�•�„ 1Yw. Q b� ,hi. �'��p� � � '� r•,,/� ..w... •06•tbC !r Viw�'t9 "n` �i •T•`?+a• ,r ,' 2 "_� (!JI � t•�. ra-L,;,, ,,i}r•� ''(V !- .{ A N. �� ,•�b ��!'t7 •,'�- •� �'r�'Jtij.. �, 7.l•'t ;�' �i.�l��`� { P 'tL .�' +•. + �'�'� \�'t. ' �' � TTS rh• � �Jr i /� I �,•'!w'• .e �.�r,�., Z 10 •'.. r�:. � ' t r + r, .� r+„ T -•fit;+ri y;�"�v' ' "1 O 'uy«i Vii. f. •.� ��<f ,,:+,'�. �(,, w 31•y ti Na. a �ti•+�,+Rr� _01 _ 3 ao;fib ,�w+�� ' =,,.. �:;� '��'.• ! •, .r• ••�, �• �„•� �:,� %. � �� N Q 'w• I.•0 a 6OP 011 y .l' •.j;.,. •' ♦'}�`' :{� A� ^y„i J .l.w t . b+.y r?•!i Jas' t0 t '• � 'c r '{ .,� r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �Y DATE EVALUATED ADDRESS PROPERTY SIZE ,�1C' PROPOSED FACIILTY / LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boringez, _ Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Z Texture group Consistence .0 r Structure / 1 Mineralogy /.• ( fi 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-Finn 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 ■■■■.■■.■...■./■■■■■■■■■■■■..■■■ ■■■■/■..■.■■....■.■.//......MEMO ■EM.O■N■EEE..EN.OO./.O■OO■e■w■...■O./OOOEEO..EM.EE■EE.EMMENEEOEEE■ ■M.EE.E■EEE.■.■■MEE■■OO■■MEl�/■EEE■■MEEM■■O.■..E■E.e./I/J►1ME/e.EEEE■ ■.■EMM■■.■■MEN.■■■■■■■■■■EM�J.■■■■■■1111/■■NO■M■■■■O■■IiY\E..MO■MINE ■OEEEE■■E.E..OE.EEEEMMEEEE..■EEE.■.Eee.■■■■e.E■■■■eeeM■■e.ee.e■■■ ■.■EEM■■■■■■■■■EEEE■■EE■■E.■■■■■■/■■.EEE.EEE.E...E..■E.ee■...HIM ■■EE■■■■M■■■MEOEEEEO■■EEEEE000.■�■■M■■MEM■.e■Ee.eee..eeeE.e■.NEO■ ■■WSO...Ee.M..O.E..EE.EEMEME.EE■ EE■E..EE.e..eMee.eee.■eeE...■e.■ ■EEEEE.■.EEE.M/■..EOO.O■.O■ ■■EO...■0■E■■.■■.e.eM■e.■■■e!l.ee.■e■. ■■■■■E'e.■e.■■■■EE..MEEEEE.■..■■E..E■.■OEE/ee. e.ee.■■■ eeeee.■e00 ■■ ■E■■■■iME■ UMME■O/!.MelE■E...EEE.E.■E..■ Eee■�e.leMee■�.e.eeeN.■ MINEON ■.■■■■■■■■\.ee■■■■■E■■■■�■■e..■■■!■■M.E■■e......N..■..E■■E....■.Me ■EE.E.....E•...EEE.EE■E.EE/1■E. 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