389 Fork Bixby Rd (2) 1 ,
s
DAVIE COUNTY HEALTH DEPARTMENT'-i, _
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ,GNU
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a !)
Sanitary,Sewage Systems , Permit Number
Name f/�1i �' v�J�; , —•°' �`f ! Date N� '600
Location
Subdivision Name Lot No. Sec. or Block No.
Lot. Size ¢� � House Mobile Home _Y�f Business Speculation
No. Bedrooms No. Baths -�� ,✓ No. in Family _
Garbage Disposal YES ❑ NO Ej-' Specifications for System:
',Auto Dish Washer YES ❑ NO 0--*
Auto Wash Machine YES 0 NO ❑ „ r
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: j System Installed by --- —
1
H
Certificate of Completion �� ° � Date &-42`"§22
"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.
—I
~APPLIC'ATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
' Davie County Health Department
Environmental Health Section RECEIVED
P. 0. Box 665 OCT ttipnn,,,,
Mockaville, NC 27028
1 . Application/Permit Requested By
Mailing Address (JR 2�_� .
C 3 I d � `�. �n�� 60 �n
Home Phone qw � ��(� Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
AX-
4. Application/Permit For: 0 General Evaluation (-57-Tank Installation
5. System to Serve: [j House
ile Home 0 Business
Industry u Other 0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms a Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
O—Washing Machine J Dishwasher 0 Garbage Disposal
7. If business, industry, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
B. . Type of water supply: Q Public rivate a Community
9. Property Dimensions
10. Sewage Disposal Contractor 0,2
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? Yes E—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.
This is to certify that the information provided is correct to tnf_
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
bat Signatu
Directions to Property :
.GAP e-7- s'"o'�l �G>�'L" �j �7�/✓ �� Q �a�G �/D X71/.
DCHD (10-89)
' - DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �QS,��C DATE EVALUATEDyl�d
ADDRESS PROPERTY SIZE 11,fG
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On-Site Well t� Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position Z_ L- L
Sloe Z �- 2
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 4Zs d
Texture groupG
Consistence r
Structure �x
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 RATEI le I
SITE CLASSIFICATION: EVALUATED BY:
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
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
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
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