351 Buck Seaford Road Lot 4DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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°NOTE:*Issued inCommo|�nomVVdhAdk�eUmf���� 130a
Sanitary Sewage ' � Permit Number
Name ---___ Oo�� N��
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Location
Subdivision NarKe Lot No.
Sec. or'Block No.
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Lot Size House __��_-_Mobile Home -_-Business ___---__Speculation
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No. Bedrooms No. Baths No. inFamily
-_{2-_---
Garbage Disposal YES [] NO E�' Specifications for System:
Auto Dish Washer YES E]-/ NO []
Auto Wash k1anhine YES NO []
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Type Water Supply '
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°Thia,pennitVoid ifsewage system deochbedbelow innot inotaUedwithin 6years from date ofissue.
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Thispunnitimou��octtorevmoationifsite plans orthe intended use change.
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Improvements permit by
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*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 (6tz
Certificate of Completion Date
*The signing of this oartdUoote oho|| 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 oftime. '
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
,I
Davie County Health Department
Environmental Health Section �pb�
P. 0. Box 665
Mockaville, NC 27028
1. Application/Permit Requested By �0 )/1 )q S0 h
Mailing Address J�gl 47-cZ,l Fa lJ Mac_kc,;I[( A C,
Home Phone 6 3/ -12 2 -�'" Business Phone
2. Name on Permit if Different than Above
3.
Property Owner if
Different than Above P h h
�/ ��0-���
4.
Application/Permit
For: lC) General Evaluation
b b/Tank Installation
S.
System to Serve:
OxHouse U Mobile Home
0 Business
Industry u O'tAhler[�
0 Unknown
6.
If house, mobile home:
Subdivision '5ti
e�
S�(e++c. Lot#
V
t'ir5r L�rC K Ne7u5C ;S �-e� f�i.5
No. of People
Dwelling Dimensions
No. of Bedrooms
Basement/Plumbing
No. of Bathrooms
2 %vyr3 7 Basement/No Plumbing
Washing Machine
;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: Public r� Private 0 Community
9. Property Dimensions L, - 03
10. Sewage Disposal Contractor
11. Do you anticipate additions/ ;"No ansions of the facility this system -is
intended to serve? Q 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 certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
Ll— y —I oil/
Date Sig ature
Directions to Property:
O>i3c,,Ic. —
Cod W
DCHD (10-89)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME ONNXl DATE EVALUATED
ADDRESS PROPERTY SIZE QLD
PROPOSED FACIILTY �o o gn LOCATION OF SITE \) M
Water Supply: On -Site Well Community Public
Evaluation BAs� L Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
Sloe %
O -% A
O
O'
HORIZON I DEPTH
Texture group
C, L,
C�-
Consistence
Y l
F T
F
r
Structure
R
C
Mineralogy
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HORIZON II DEPTH
<Ib
0
U'
0'
Texture group
C
Consistence
T'R
FR
-
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
—
—
SAPROLITE--
CLASSIFICATION
-77F-7
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: U� EVALUATED BY: \ _
LONG-TERM ACCEPTANCE RATE: ' OTHER(S) PRESENT:
REMARKS: �S L1
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
Tavf��ro
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 - 1n 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