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262 Hobson DriveDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems J__�/-<it Number y Name `rDate Location n %�—/ "/� / �'��'f,'r,� � � •:��� G:- ,�'�!%,�;J,'� ,,, '— ,,� � ` -- — /r Subdivision Name Lot No. Sec. or Block No. Lot Size r;� r-' House Mobile Home — Business _— Speculation No. Bedrooms = — No. Baths —va� No. in Family — Garbage Disposal YES ❑ NO ❑' Specifications for System: Auto Dish Washer YES NO Auto Wash Machine 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. 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: 704-634-5985. Final Installation Diagram: F Certificate of Completion )%G 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. j APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Q Environmental Health Section CCQ P. 0. Box 665 RGC� Mocksville, NC 27028 1. Application/Permit Requested By ULU-4-- A -AC daIV' , Mailing Address r'�''� ` �i,-t �C / J�y `1 5 b u.�y iy ,cs=r� Home Phone 63.7 Business Phone -20V - (n 3 (, 2. Name on Permit if Different than Above 3. Property Owner if Different than Above �� ;� 1L-,, AL4 i��C 4. Application/Permit For: l7 General'Evaluation 5/Tank Installation S. System to Serve: 0 House Q,-Kobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions 11 f 1C 17(D No. of Bedrooms Basement/Plumbing No. of Bathrooms -Basement/No Plumbing leashing Machine 0- Dishwasher 0 Garbage Dlsposai 7. If business, industry, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 8. Type of water supply: E;,PUblic 9. Property Dimensions add 10. Sewage Disposal Contractor No. of Sinks No. of Urinals No. of Water Coolers 0 Private 0 Community 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes -340 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 applicatj.,on. 8) Date Signature Directions to Property: 71 d -n- %oI'd, ; -?Ifo e�� h, use DCHD (10-89) ,. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME W_U'2!Z ADDRESS PROPOSED FACIILTY Water Supply: Evaluation By: DATE EVALUATED �? "/ Z' PROPERTY SIZE a�p LOCATION OF SITE On -Site Well Community Auger Boring Ll__� Pit FACTORS 1 2 3 4 Landscape position t— 4-- Slope -- Slo e % 10— HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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:;, LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: A OTHER(S) PRESENT: LEGEND Public Cut 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 'r-fil- 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 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/ft2