310 Cornatzer Rd Lot 3 y�' °✓�1` DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
PSanitary Sewage Systems Permit Number
Name � /'�' /� �"
Date N�
Location ��✓Ar _
Subdivision Name Lot No. - Sec. or Block No.
Lot Size House Mobile Home — Business —_ Speculation
No. Bedrooms No. Baths =J No. in Family --�
Garbage.Disposal YES ❑ NO p
❑ Specifications for Syste
Auto Dish Washer YES NO
Auto Wash Machine 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 Z4
*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 byte's
o - � -
Certificate of Completion �� Date _ u�_._L_.pp0
"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.
Z'' - APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
` Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mockaville, NC 27028 AUG G
JJ
1 . Application/Permit Requested By 1e: ��� �• �h e7�'�
Mailing Address t�lC -7 ' IJ 0 e-1,
v
Home Phone /0 I'S y Business
/Phone �/ / F-- 7 177-Z,�/
2. Name on Permit if Different than Above 10-1 5ef+ C :
hiJ.STdrh
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation /Tank Installation
5. System to Serve: Ouse Mobile Home Business
Industryu Other r 0 Unknown
6. If house, mobile home: Subdivision .L-aks/ Q e 644An Sec. Lot#
No. of People -� Dwelling Dimensions j5l X
No. of Bedrooms - Basement/Plumbing
No. of Bathrooms ^ Basement/No Plumbing
8-Vishing Machine t-6lshwasher 0 Garbage Disposa.i
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
8. Type of water supply: C Public 0 Private ommunity
9. Property Dimensions Q Ac.-
10. Sewage Disposal Contractor �bA)IVtP_ L� �ce�
11 . Do you anticipate additions/expaasions of the facility this system is
intended to serve? 0 Yes &""
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 cer•tify' that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges incurred from this ap 77.,�
Date Signature
Directions to Property :
A7 '2'
1
1
DCHD (10-89)
A. DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
' )) Soil/Site Evaluation
NAME S�fr,9/ DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY r4'f��� LOCATION OF SITE
Water Supply: On-Site Well Community Public G_�
Evaluation By: AugerBoring_ Pit Cut
FACTORS 1 1 2 3 4
Landscape position 10 70
Slope .141
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 7)
Texture group
Consistence ;
Structure ,� k
Mineralogy
HORIZON III DEPTH
Texture grou2
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION _
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: 1/• EVALUATED BY: __ 14111
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
LEGEND
t
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
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