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296 Deadmon Road Lot 7-DAVIE COUNTY HEALTH DEPARTMENT 50,0u IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE' Issued in Compliance With Article II of G.S, Chapter 130a Sanitary Sewage Systems 1 Permit Number Name ^ �:e lz. �.r tim�c� --=Dated N2 7941 �oca/tion Subdivision Name Lot No. �— Sec. or Block No. Lot Size 10 0 K -3 b — House —✓ Mobile Home ---_ Business --_ Industry No. Bedrooms ..No. Baths —— No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO V Auto Dish Washer YES ❑r' NO ❑ Auto Wash Ma^hine YES p- NO ❑ Type Water Supply S ecifications for System: OU t >tir�cK '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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST, SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM, F 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., 1:00-1:30 P.M. or 4:30.5:00 P.M. on day of completion. Telephone Number: 704{834.5985v y glga Final Installation Diagram: fsa System Installed by )e Certificate of Completion —1 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 EVALLIATIOWIMPROVEMENTS Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 Application/Permit Requested By Mailing Address 2. Name on Permit if Different than Above 59910, 3. Application for: ❑ General Evaluation OrSeptic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑Industry�/D � /q/�O�theLr ❑ Unknown 5. If house, mobile home: Subdivision lLT f l /� UDQ Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms 3 0 Washing Machine No. of Bathrooms oZ ❑'bishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: ZPublic ❑ Private ❑ Community 8. Property Dimensions .19 14 Sao Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes V(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: This is to certify that the information provided is correct t h best of my incurred from this application. Z/- DATE I understand I am responsible for all charges CONSENT FOR SITE EVALUATION !Q BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 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 SIGNATURE DCHD (7/93) b, APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department f®��® Environmental Health Section ISI UD P. O. Box 665 NOV 2 81994 Mocksviile, NC 27028 i. Application/Permit Requested By / Mailing Address 30r)` > , �� rleg&/ e Phone�� l�1 fJC:K�U/��r Business Phone—2d Z22Z 2. Name on Permit if Different than Above 3. Application for: DG'neral Evaluation 0 Septic Tank Installation Permit 4. System to Serve: ZX4, use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry t kn ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision SOU4A- Q � Q, Section •-L Lot # 7 ❑ Basement/Plumbing No. of People _�✓ No, of Bedrooms No, of Bathrooms ^- .Dwelling Dimensions / rQA4A '• /.g p 6. If business, Industry, place of public assembly, other: Specify type No. of People Served �14A 7. 8, 12 No. of Commodes No. of Lavatories _ No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures . Type of water supply: ,Public ❑ Private Property mens ons Sewage Disposal Contractor Do you anticipate additions/expansion of the facility this sytem Is Intended to serve? ❑ Yes No ❑ Basement/No Plumbing ashing Machine Dishwasher ❑ Garbage Disposal If yes, what type? ❑ Community -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 Propertyi This is to certify that the information provided Is correct to the best of Incurred from this app'catio . AT I am responsible for all charges CONSENT FOR SITE EVALUATION IQ @F DONE 4l! ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. I OWN the property, ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this formIfLLI ST 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 SIGNATURE DAVIE COUNTY HEALTH DEPARTMENT vd z* - Environmental Health Section C. ;Soil/Site Evaluation. tI NAME>2 CJ W \CR C,OO a DATE EVALUATED i ADDRESS j> Cn S PROPERTY SIZE 7 5 t . X (; 3W PROPOSED FACIILTY A LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit - -Cut - FACTORS 1 2 3 4 Landscape position L Slope z HORIZON I DEPTH-( h" Texture group Consistence Structure Mineralogy 1 HORIZON II DEPTH L° Texture groupC Consistence Structure SZ C MineralogyIt HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture grou Consistence Structure Mineralogy SOIL WETNESS SS SS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: EVALUATED BY: L4 lOs �J(JJ. LONG-TERM ACCEPTANCE RATE: -f OTHER(S) PRESENT: Oa f ia�5A - - REMARKS: ' Qz tie LEGEN - - 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 3C -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 chrome 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD (01-901