207 Wildwood Ln r /yo
DAVIE COUNTY HEALTH DEPARTMENTU.0 0
' IMPROVEMENTS PERMIT AND CERTIFICATE. OF COMPLETION .
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date
to
Location
Subdivision Name � o. Sec. or Block No.
Lot Size ^+' House Mobile Home Business _.— Industry
No. Bedrooms
DHo. Bath`s ' » No. in Family _ 'Public Assembly Other
Garbage Disposal r YES p NO Specifications for Syste "+
Auto Dish Washer YES [[ NO p as UOo• �� - D • 1� o,1t
Auto Wash Ma.nine YES V NO,❑ '�-
Type Water Supply
This permit Void if sewage system described below is not installed within:5 years from
' m date of issue.
This permit is subject togrevocation if site plans or the intended use change.
ER.F
k
;tl �
r 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
"sn
w
� 'J 't' a" � • ti _
Z
a� L 11
Certificate of Completion Date 1
*The signing of this certificate shall indicate that the.system descriped 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 .3d
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mockaville, NC .27028
1 . Application/Permit Requested By
Mailing Address lx ,qz
Home Phone , ?9Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For : 0 General Evaluation 0 S/Tank Installation
5. System to Serve: House obile Home 0 Business .
0 Industry u Other 0 Unknown
6. If house,, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms �, Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
W'aalshing Machine J Dishwasher 0 Garbage Disposal
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: 24ublic 0 Private 0 Community
9. Property Dimensions d . �,, i9 G.E�ES
10. Sewage Disposal Contractor
11 . Do you anticipate additions/e�x�pa sions of the facility this system is
intended to serve? 0 Yes iT"0
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 10 1989.
This is to certify that the information provided is correct to trif
best of my knowledge, and I understand . I am responsible for all
charges incurr d from this apple ation.
U to Signature
Directions to Property :
DCHD (10-89) •
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME U P'cc..e s 'A N c"- DATE EVALUATED ADDRESSPROPERTYPROPERTY SIZE S •a C �
PROPOSED FACIILTY en,p S LOCATION OF SITE o t;N At Q gam_
Water Supply: On-Site Well Community Public
Evaluation By'Z tl_ Auger Boring 1/ Pit Cut
FACTORS 1 2 3 4
Landscape position - 5
Sloe R
HORIZON I DEPTH
Texture group
Consistence Fs
Structure QC
Mineralogy
HORIZON II DEPTH Ll 2 11 .1
Texture group (ft S is y
Consistence r l
Structure
Mineralogy ► ',I l i l S o 1 a
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture grou2
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE _ L}
CLASSIFICATION J _�
LONG-TERM ACCEPTANCE RATE 1 3,5 .yo1 .3
SITE CLASSIFICATION: .S EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: >� `y0 OTHER(S) PRESENT: 3P�as �s-
REMARKS: — .e3-
LEGIT ND
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.
a
DCHD(Q1-901
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