150 Bugle Lanef _ .DAVIE COUNTY HEALTH DEPARTMENT f b°
`i IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issd} d in Compliance With Article 11 of G.S. Chapter 130a
s Sanitary Sewage Systems Permit Number
Name
c-1 L� T_ �a 5 �' Date - a 2 j r� N2 6 U0 5
Location �% `� �l �ti\:a_ �1c` E s� \ `-• �a� , `� .:
er
;7"17 T11—
Subdivision Name `t'' ���>`3 �`��� � �^� Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms �� No. Baths �- No. in Family
GarbageDisposal YES ❑ NO [E.1-1 Specifications for System:
Auto Dish Washer YES !M/ NO E]/ Op Q —
Auto Wash Machine YES 0;/ NO E]
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 torev_ocation if site plans or the intended use change.
Y,
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
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.
0
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department -�
Environmental Health Section 2
P. 0. Box 665 ���p MAY 2
Mockaville, NC 27028 RS'F
1. Application/Permit Requested By ^ -�• ✓`
Mailing Address o�����CiTN.SIf/,��� .CS/I)Q ff�/ %�'�~ S4liSL��aY✓ 6U� ��/��
Home Phone /M-r2,zr Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation S/Tank Installation
5. System to Serve: House Mobile Home (] Business
Industry u Other 0 Unknown
\\\\ / D C ,tom
6. If house, mobile home: Subdivision C��t'� -41�L'p �iQ\�C. Lott
No. of People Dwelling Dimensions�v X�"T
No. of Bedrooms Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
N Washing Machine 'Dishwasher 0 Garbage Disposal
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
8. Type of water supply: A Public
9. Property Dimensions
10. Sewage Disposal Contractor
No. of Sinks
No. of Urinals
No. of Water Coolers
0 Private
0 Community
11. Do you anticipate additions/expansions of the facility this system is ;
intended to serve? 0 Yes A 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.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am re ponsible for all
charges
� incurred from this apple on.
a/,�2 Y�
Date Signature
Directions to Property:
�► SDI A) . ��t �l� roast
Am " X, ,UGtr�i� �61oU l�
Gv 1 q,
agittked
DCHD (10-89)
102
T DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY mu 1
Water Supply: On -Site Well
Evaluation By:CZt. Auger Boring
DATE EVALUATED 70
PROPERTY SIZE .1
LOCATION OF SITE u, e
lie a
Community Public sM
Pit Cut
FACTORS
1
2
3
4
Landscape position
S
SC5
S
Slope %
:J—
- �
q..)
HORIZON I DEPTH
'`
I
Texture groupC
C -
Consistence
Structure
MineralogX
A
•'
HORIZON II DEPTH
L1a I.
��
Texture group
Q_
d__
Consistence
Structure
S
Mineralogy
`1 =
'
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
S
5
RESTRICTIVE HORIZON
--
-F-
--
SAPROLITE
--.
`-
CLASSIFICATION
IV S
S
LONG-TERM ACCEPTANCE RATE
7i!- L4VJ
' P� 1
-5--11131
SITE CLASSIFICATION: \ ---I:> " EVALUATED BY: `- ly�
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 -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