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310 Bridle Lane Lot 14DAVIE COUNTY HEALTH DEPARTMENT 'Jot). G D F�-,�-- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMP A3N Y • NOTE: Issued in Compliance With Article I I of G.S. Chapter 1301 7V ..a � H Sanitary Sewage Systems tp �s Permit Number Name _ Date %i- 7 4 5 4 Location<. , �� h am, - t�� »�. Z; , }• �l�j \ '�c ', ;: f ) C� Ci Ll VN c-.3 c a Li F:. Subdivision Name iZ t�li%;t �' Rka V�. Lot No. Sec. or Block No. Lot Size E House Mobile Home _ Business -- Industry No. Bedrooms No. Baths No. in Family — Public Assembly Other Garbage Disposal YES [}-/NO ❑ Specifications for System - Auto .-Dish ystem•Auto-Dish Washes YES p,/NO ❑ / jj b - 3 o�x Auto Wash Ma^hine YES EV NO ❑ i .� Type Water Supply X `� 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. laous=h b' 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: 704-634-5985. �y Final Installation Diagra i yD. c.� O–,f� � System Installed by VI I��l Certificate of Compl "The signing of this certificate shall indicate that the syst m the standards set forth in the above regulation, but shall i N satisfactorily for any given period of time. Q Date ribe above has been installed in compliance with be ken as a guarantee that the system will function Home Phone 77K- K'y1/ y -,c Business Phone 2. Name on Permit if Different than Above /g- 39,�� 3. Application/Permit for: 4. System to Serve: ❑ House ❑ Business ❑ Industry 5 If hous , mobile home: Subdivision ❑ General Evaluation ❑ Mobile Home ❑ Other No. of People -3 No. of Bedrooms -3 i No. of Bathrooms 1:9kL Dwelling Dimensions 4 -VPV 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: ❑ Public Z1 Private 8. Property Dimensions & re -s Sewage Disposal Contractor R Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ® Basement/Plumbing ❑ Basement/No Plumbing 10 Washing Machine ® Dishwasher Q Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No 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 Property: �t�/ ��-5 Chi ON a"IVA-tz'r T ,//l T hAl a X - 144 l lvgw-se-- © N 2� A t � � gii-4 /-'4r'" flv?p , () This is to certify that the information provided is incurred from this application. DATE to the best of my knowledge, and I IGNATURE I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. [9 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: 1 hereby give consent to the authorized representative f t DRI Co ty Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to deter ine said' s itability for a ground absorption sewage treatment and disposal system. ATE SIGNATURE DCHD (12.90) .. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section \\Soil/Site Evaluation NAME �'PQ-'may �r ���R S"k. Q DATE EVALUATED Iv TA ADDRESS Sy''�PROPERTY SIZE S �J PROPOSED FACIILTY I�cZ>�' Water Supply: On -Site Well Evaluation Byk'_";,L Auger Boring Lo" LOCATION OF SITE« Foss Community Public Pit Cut FACTORS 1 2 3 4 Landscape position S s -S Slope % S" 16°° T_-16- l -HORIZON HORIZONI DEPTH / " `' & 11 Texture group C L C t- C L Consistence T Structure Mineralogy HORIZON II DEPTH Texture group Q_C e - Consistence F� Structure MineralogyT 1 t'l 1 1 t HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS S s s s RESTRICTIVE HORIZON -- — — _ SAPROLITE— CLASSIFICATION S s LONG-TERM ACCEPTANCE RATE 3 SITE CLASSIFICATION: 5 EVALUATED BY: LONG-TERM ACCEPTANCE RATE: J OTHER(S) PRESENT: REMARKS: ��D� oy ��� J 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 :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 chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/fU DCHD(01-901