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190 Ginny Lane Lot 15ISD iv DAVIE COUNTY HEALTH DEPARTMENT t• T` c .16'-_ . IMPROVEMENTS PERMIT AND.CERTIFICATE OF COMPLETION fi��S_� *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a -' 'Sanitary Sewage Systems 9'-/41 rI Permit Number Name UFl> �ory �1 �7� �5�1r /A::'!!icepate 49i N O Location Go��/,✓�/, v� 6398 auociwsion Name— `w�%w(aii(/' Lot No. Sec or Block No V Lot Siie- /S�� House __Lef� Mobile Home _ Business Speculation No. Bedrooms s No. Baths - No. in Family Garbage Disposal YES ❑ NO p- Specifications for System; Aut6I Dish Washer YES q NO ❑ Auto Wash Maohine YES 111 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. 0 Improvements permit by __124Z *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: rstem Installed 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 ' RECEIYEp MAy Mockoville, NC 27028 . 1. Application/ Permit Requested By _�' 7FVkF l(ll Mailing Address &oX /y3 /�'/oC�SyiLG� A/_C. 27028 Home Phone Business PhondJJ,)72..SG7/? 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation IU"'/Tank Installation 5. System to Serve: 2/House. [) Mobile Home 0 Business 0 Industry C Other 0 Unknown 6. If house, mobile home: Subdivision .SPA1;1C A.4<N Sec. Lottt No. of People Dwelling Dimensions 'f5 X.3H No. of Bedrooms .3 _ FT -B'asement/Plumbing No of Bathrooms _3 Basement/No Plumbing Washing Machine 8,/Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type No. of People Served No. No, of Commodes No. No. of Lavatories No. No, of Showers of Sinks of Urinals of Water Coolers 8. Type of water supply: p4ublic [] Private p Community i 9. Property Dimensions =���/ K 3 O Li 10. Sewage Disposal Contractor 11. Do you anticipate additions/expansions of the facility this system is intended to serve? [] Yes B 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 responsible for all charges incurred from this application. l3- Date gn t e .Directions to Property: r7 ©l(V Cr 1-41 DCHD (10-89) TY cros4 mg"r S 8b° oo` 54 Lot i� Lot' t5 SPR�NCtiDhI.L: L,oT i& Lu � r Do o � ISZB sQ. m r /$off H 86' 4Z'39" w GtNNY k.A 'r. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS// PROPERTY SIZE /S PROPOSED FACIILTY /4/0 #S LOCATION OF SITE S Tp Water Supply: On -Site Well Community - Public C/ Evaluation By: Auger Boring Pit - Cut ✓ - FACTORS 1 2 3 4 Landscape position L L L L Slope % — — HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 6 f S Mineralogy /- i ! • �( 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 i SITE CLASSIFICATION: EVALUATED BY: Ila, LONG-TERM ACCEPTANCE RATE: ,/4," 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/ftz DCHD(01-901