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139 Foster Road Lot 1DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION y *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a X Sanitary Sewage Systems . Permit Number Name ArVII' ll !1 ✓fi 0 Ii 63 i//��OF'�/�//�/Date � `/�% I % N_ Location�/-, A�-7//I' //r, �V �-/ r/� 6707 Subdivision Lot No. Lot Size �/la'G7s' House Mobile Home _[,� Business _— Speculation No. Bedrooms No. Baths —�— No. in Family (— Garbage Disposal YES ❑ NO Specifications for System: y Auto Dish Washer YES ❑ NO Auto Wash Ma;hine 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. , �=J F ]� r</ly T)5 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-704-6�4--5985. Final Installation Diagram: IGD Certificate of Completion —�_ Date f /2%2 - `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. fAPPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department VYt� 1041, LED 1 Environmental Health Section to P. O. Box 665 h Mocksville, NC 27028 �pR 992 1. Application/Permit Requested By /1/ PiPj a 2 at l Mailing Address L( A. y b6cl I /it /W 1) C/!C7/l /Le. /V -C • �/_ /OG 6 Home Phone (0,7y Fy c// Business Phone (o y �� C(B 2. Name on Permit if Different than Above 3. Application/Permit for: Q' General Evaluation ❑ Septic Tank Installation 4. System to Serve: ❑ House 206bile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision E1E� Section Lot # No. of People — No. of Bedrooms J No. of Bathrooms Z Dwelling Dimensions 2 F X y d 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water -Coolers No, of Showers Water Usage Figures ❑ Basement/Plumbing ❑ Basement/No Plumbing ashing Machine ❑ Dishwasher ❑ Garbage Disposal 7. Type of water supply: ❑ Public p'Private ❑ Community 8. Property Dimensions /20 )C j, % Ste- Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 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. Directions to Property: ls� 16 -v" -0l` 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. DATE / %6NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: L�3'LUt. I 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 DCHD (12-80) r. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME/ DATE EVALUATED ADDRESS PROPERTY SIZE ��'%© JV 9o> PROPOSED FACHLTY 1 LOCATION OF SITE Water Supply: On -Site Well ✓ Community Public - Evaluation By: Auger Boring - Pit Cut FACTORS 1 2 3 4 Landscape position L Z 2 - Slope % HORIZON I DEPTH M i< o Texture group S L jr Consistence Structure Mineralogy HORIZON II DEPTH jr, Texture groupG Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence . Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: —.6C EVALUATED BY: LANG -TERM ACCEPTANCE RATE: a 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 -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 GIZ-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/fl2 DCHD(Ql-90)