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134 Terrace Ln (3) �..,..s-._ rn.;.:-� ...r`•,,�-.-,.-r.a•a. .�.r,iv - - -..1 - r+..'srRe..3zw. `..-<:w .-,..•_ - 'p9.w:-a.. - nw. � ^r.,;�-... 'wy.rr:.+.,-..�'�'•rW`twli^} v W r �w-v,s5,�,v„c�,�.,r,e„+ti�.�.. T-:aw�.-...:—^w,.-.+. •.�„ti-.... - -wri+*."`.'tet tr i,a— Zak -N�t�J o Wif97e ZN yo DAVIE COUNTY HEALTH DEPARTMENT 07 MV JD IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Se age S stem Permit Number Name °\o e�N • \A\M\So N Date ' `13 NO 72.55 Location 3 °' L0 L `'\ 66O - Subdivision Name Lot No. Sec. or Block No. Lot Size 1 '`��` ` House ! Mobile Home Business__ Speculation No. Bedrooms :No. Baths No. in Family LV Garbage Disposal YES p'--NO Secifications for to Auto Dish Washer" - YESr-1NO, Auto Wash Ma.hine YES4 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'ofthe 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. i IAPE Final Installation Diagram: System Installed b ` i�D �-1�� Certificate of Completion _�'valel 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. r r 0 -1 \�>ti DAVIE COUNTY HEALTH DEPARTMENT 114 p • =s ` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *DOTE:Issued in Compliance With Article II of G.S.Chapter 130a ' Sanitary Sewage S s ems _ f �\ 3 Peromitlklyfn r Name Date N_ • �`� �J � �U L1�. \\\ C}'^�3.7.x:i��_� , � � �, . ! ��'r t. Location Subdivision Name" Lot No. Sec. or Block No. ' Lot Size ' House , Mobile Home , , Business -- Speculation No. Bedrooms No. Baths — No. in Family — s/ Garbage Disposal YES ❑ NO S ecifications.for stem,:, - e . y . Auto Dish Washer YES ,p NO ❑ , Auto Wash Ma shine YES E) NO�❑ � J , �! 1 J 4; `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 use change. \1 Ub / /4 �\ ' I 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":��% lr 'G2j r Its l /10 >r I— 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMITlow Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address Home Phone Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluati ElSeptic Tank Installation 4. System to Serve: ❑ House obile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # LA [IBasement/PlumbingNo. of People ❑ Basement/No Plumbing No. of Bedrooms -) shing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions o �� ❑ 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: ❑ Public VIV'(Ivate ❑ Community 8. Property Dimensions / M'C'P Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 5;40 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. Directions to Property: _ J This is to certify that the information provided is correct to the be nowledge, and I understand I am respons' all charges incurred ro this a plication. Cts DATE S GNATLIRE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: [D,i l OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(12-90) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 'Q 11 Soill/Site Evaluation NAME + 0\D'Q�� T A S d 1`' DATE EVALUATED ADDRESSS 1�� 1P PROPERTY SIZE N PROPOSED FACIILTY . `A �```� LOCATION OF SITE Water Supply: On-Site Well 1/ Community Public Evaluation By:�'�-L—AugerBoring f Pit Cut FACTORS 1 2 3 4 Landscape position S S 5 s Sloe % -/Eft - IS" HORIZON I DEPTH is 1, Texture group CL Consistence rr :� FT- F T Structure �l Q �- Mineralogy1',� 1 :► 1: HORIZON II DEPTH Texture group t'- Consistence FT- Structure Structure V l Mineralo 1.1 J 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S 1 RESTRICTIVE HORIZON .- SAPROLITE CLASSIFICATION �.S s LONG-TERM ACCEPTANCE RATEI . ►a SITE CLASSIFICATION: S EVALUATED BY: � LONG-TERM ACCEPTANCE RATE: 1 OTHER(S) PRESENT: REMARKS: _ 'tisx �- '1 - • 1 u�c��s��i� 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 ■m.mmmMmm■B■m.M■m.ee■■■.ecce■■eei�.■mm/■■..■...■......■■..■../..■■ ■■■■■■mmMe/Me■■/ee■■ee■mee■■ee■e■■■■em.eee■/e.■m.mem■e■M/emmm/Eee■ ■■■..■.■..■■.....■MM/.mmM.■ /■/m■m■.....■■.■..■..■....■.■.■■.■■■■. ■...■.■..■■■■■■.■■■//■..■....■■..■■■../■■ ■..■�■ ommoomo■mo■■No■ ■m.m..Mem■em■mM/eemmMee■e/Mm■eeWSW■eMMEBmmm■mmmm/Mmmm/m.Mme.mEMMm■ ON iii ■■...../■.■..■....see.memmmemm/■■■.■mmmm/.mem■mM.tm■m .mmm/■MM.■ .......■.■............................■........................... ................................ ................................ ■■/■Mmm■■m.m/■meMEmm■metro■..../■■......■/■......■...■■..■ ...■..■■ MONSOON ■.■■■■■■■■m■■■.m■BE■■m■.m■m■..Em■t■■■m■■ ■■■■Bon■■■■■■■■■■■■■■■■■ �iiiiii■�iiiiiiiM�3iiiiiii�iiii��iiiiiii.�iiiiiii�i�ioii.�iiiiiii■�i ■.■■.■......■■..■■■■.■.■■■■.■....■■■MEMO■IN Boom HMMEME EMEM■ME■ on NONE MWEEMMEMMEMMEME No ONE MEMMEMEMEEMEM on ......■m■■■■■■n■■....■.........■:�..■ ■ ■m■■=I■■11 m■C■C■■C=■mm■■■rl M■MMM ME M■M■M■ ■■■■EB■■M■■■OM.1■■■■■■I■■��i�t�1�iMmmmummomigi/n■ Bmomm.mmom Mom■ ii�'iiiiiiiiol■iiiiiAmmomi Ilmilm.■■■rr■-M0 MMMMMMMMMEM'NMM■M ■..■■■■■t■t■■t/iii•■l : ■ !n■■■I�l'ill■■■�\I�■11■�II�■l!■■■ .� mmommoommommo. ■ ■..■■■■.■t■..■f/Il►_�lIIBILK■�!■M■.■l+yfls.■Ii:1L'J■P1,►im�1■rl■■t■ ■■■■M■■■■■■.■.■■ Emommommosommom .mEtM.Mem.E■E;��aM►��lmmr�■■■■e.m■mml� Mm.MM ■maim. ■■E.Mmm.M■MME►�■i�s;r�!MmmM..M./■:::.�M....��.....iE .■.M■Emm.m■/■■ ■■ ■.■■mu■t■■■■■M■M�ss•-�rM■■■■■■■■■■Brit■■ m■■. ■ ■■i■■■■■■■■■■■■■.■ ■■.t.tM Mt■■■■►-r;M.�■=ir.■.■t■t■■MMM■t=■a■�i■ iR■m°a■■■.■M■W■■■.M iiiiiii iii�iw�i: ■i�iiiiiiiiiii■iiiiiiiii■r.=i ■BillMEMENSOMME No ■B■■■■t■■meme■\lea\\\7\.eO/.e.e.e./e.eH EEE NAME IlMO. ■MEHrom ■■■mmm■mm/.m■mm�\Ju`1\\eEO.M/■■MM ■■EEE■. .■E■m.MEMIIME■M■MME/ MOE■ ■■mM■mME.mEMEm.m■EMmmM\!1[i7►mmm■N■mei■■■■■ mu■1/n■EII■■.■.■M■m■oM■m ■■e■■McMeMHmm.mMmm\MeMil•Mim\MmeM/Me■emmmm /mM/1>fiw7MEllmmmmMe■t/Fromm■ ■■■■■meE■■M■Em■■■■MMMel11■ti\Et■■MmEm■■mM .mmElMimE�l■mmem me/eeme■ ■Mem.mMeE■Eme■memm■e�iemMtO/■Memml�e■■■m/t■/em■I■emMM�!/memeeme■Mete■ ■m■m.m■mM.mmmee.emMeeme\�emetmeM Me■mmeem.meM'.MEmm�imeMmem■ee■Mme■ ■■.■■■■■■■M■O■■■■V■m■m■tm.■ME■..■mM.m.■Mom■■m■■.M■�'■■■■MnO■.■O■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■�■■■■■�;■■■Mee■■MeeeM■ ■■■■■■■■■■M■■MMMMee■eeeEMeEMMete■Eeee■■■■■■■■��■■■■M11■■■■■■■■■■■■■■ ■.■■■■■M■/■m■■MmemeEMeemmmM/eeemmeme■■emee.Me�im■meerl■■■■eeemmmeem/ ■m■■ ■■■■■e■e■■■■■■■■■■■■■■■■■e■�ee■■■meM■emrlEeeeerlmmmeem■mu■mm■