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2252 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT o 0 IMPROVEMENTS PERMIT AND, CERTIFICATE -OF COMPLETION '*NOTE:Jssued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name Date NO 6580 Location V\ '25 U _E Subdivision Nama L61 No. Sec. or Block No. Lot Size' s House Mobile Home Business Speculation r\ No. Bedrooms No. Baths No. in Family Garbage Disposal YES [E/ NO ❑, Specifications for System: Auto Dish Washer., YES' NO C, Auto Wash Ma-.hine YES [� NO E] Type Water Supply c, v 6-`K,��/ I *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. Vo vtx, Improvements permit by County He alt a representative of the Davee0C lealt artment for final inspection of this system between 8:30- _ apartment 9:30 A.M. or 1:00-1:30 P.M. on d f completion. Talephone Number 704-634-5985. Final Installation Diagram: (I �System Installed by Certificate of Completion Date x k '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. PLO r APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT, ,\ OCT 2 81991 k h ► Davie County Health Department .Y w —41991 Environmental Health Section% (_ P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address Home Phone 2/9- 21.x— l --5;-9,e Business Phone g/%" 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation 4. System to Serve:ouse O -A -B'fulobile Home ❑ Business ❑ Industry ❑ Other 5. If house, mobile home: Subdivision No. of People No. of Bedrooms 13 No. of Bathrooms _ _ 2 / Dwelling Dimensions /860 e5Q >Z 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 III -VA eptic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing 2 -Washing Machine GJ-dshwasher garbage Disposal 7. Type of water supply: 93"Public ( ❑ Private��11 ommunity 0 8. Property Dimensions Accas Sewage Disposal Contractor �A-J' le /vim 6) cwA Ze� 12- 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes Aa -9 -0 -- 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: =S S M c% c r✓ Cc"C� Com_ `'�v�, v 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 CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ®0<I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be com tete y the owner or a person authorized by the owner: I hereby give consent to the authorized representati rre C9un t to enter above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said a te's suitabili for r n absorption sewage treatment and disposal sys em. / e��2 1. X S.. --?,Z - -.,n -1 4 , - , I - - - , .4 --* & —Q DAT SI URE DCHD (12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS Sa PROPOSED FACIILTY \A rn oa \L Water Supply: On -Site Well DATE EVALUATED PROPERTY SIZE LOCATION OF SITE 1961-S Community Public V Evaluation By:�—'�,V Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position S" 3 -5 Sloe % 7 -IS S -►s `d �IS HORIZON I DEPTH /�." Texture group Sc L S c� c: t-. S c L Consistence -R FR6z �k2 Structure CQ R 2 (_1 R Mineralogy 1.1 1 1 7 ;l HORIZON II DEPTH Texture group S C v C S S c Consistence -� �. _ !Z FR Structure Mineralogy i11 I t I HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON — - - - SAPROLITE CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE 3b SITE CLASSIFICATION: � _ EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �S OTHER(S) PRESENT: N o ti9 REMARKS: V-411.1 S X�. � .� a Is", z- - �) � mow, 3I1 n __\01 DCHD(01-901 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/ft2.