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448 Baltimore Rd (2)Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms — No. Baths No. in Family_ Garbage Disposal YES ❑ NO Specifications for System- Auto Dish Washer YES NO ❑ -Z Auto Wash Machine YES NO ❑ r�dd Type Water Supply Lam_ PP Y — *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: System Instil by�- i_ G 14 J i �w Ar Z. Certificate of Completion e- Date "The signing ,pf.;this certificate shall indicate that the system described above has been installed in compliance with the standards set forth Wffie above regulation,�but shall in NO way be taken as a guarantee that the system will function satisfactoriVfor any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a " nitSewage Systems Permit Number Name ZN7,f"—" > .�i / �/ iX iil Date (5��(� Ne i Location A�� Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms — No. Baths No. in Family_ Garbage Disposal YES ❑ NO Specifications for System- Auto Dish Washer YES NO ❑ -Z Auto Wash Machine YES NO ❑ r�dd Type Water Supply Lam_ PP Y — *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: System Instil by�- i_ G 14 J i �w Ar Z. Certificate of Completion e- Date "The signing ,pf.;this certificate shall indicate that the system described above has been installed in compliance with the standards set forth Wffie above regulation,�but shall in NO way be taken as a guarantee that the system will function satisfactoriVfor any given period of time. �- APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental.Health Section P. 0. Box 665 Mockaville, NC 27028 RECEIVED MAY 21 10 1. Application/Permit Requested By j � Mailing Address �i� '7 . ,�y� �TT Q I/An�C� , A C Home Phone 917y- �� 7� Business Phone 5,4 2. Name on Permit if Different than Above — 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation R/S/Tank Installation 5. System to Serve: 0 House Mobile Home 0 Business L Industry u Other Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms - Basement/Plumbing No. of Bathrooms �_ ` Basement/No Plumbing 91"Washing Machine J Dishwasher 0 Garbage D:isposai 7. If business, industry, 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 8. Type of water supply: Public 0 Private 0 Community 9. Property Dimensions I � gCkcS 10. Sewage Disposal Contractor 11.`Do you anticipate additions/expansions of the facility this system is intended � to serve? 0 Yes eNo 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. Date Signature Directions to Property: -�/-'!1Y►�- DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS /7 PROPERTY SIZEpe f /G' / PROPOSED FACIILTY 11f LOCATION OF SITE � alll'h lle Water Supply: On -Site Well Community Public G� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position C, L Sloe %c HORIZON I DEPTH " �� •� �� Texture group <14 514- S _rk Consistence Gl r '' - 1/161 - Structure Structure s" e- Mineralogy /: / /: / HORIZON II DEPTH L i +' t r Texture group Consistence f Structure SimS• ,� S f 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: �/1 EVALUATED BY:v� LONG-TERM ACCEPTANCE RATE: 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 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 DCHD(01-901