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139 Applewood Rd (2) ac:- DAVIE COUNTY HEALTH DEPARTMENT p o jj u � r -,}IMPROVEMENTS PERMIT AND CERTIFICATE, OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a 4 "Sanitary•Sewa�e Systems _ Permit Number c Name : � tw��� �� �:� - r Date [n rl`� 10 NO 6053 Location ��'1 \> Y. 1�� t ♦ C��i�..v i\�.�, �,� — Lw Subdivision Name Lot No. Sec. or Block No. Lot Size rl `'�'� `=� House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family .5 — Garbage Disposal YES ❑ NO ©f Specifications for System: Auto Dish Washer' YES ©"� NO ❑ / Vic, �, ���oZ. �Ly_ ��.• ; y Auto Wash Machine YES ( ' NO ❑ _� ,Y1 R iR Type Water Supply 1-� . 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. �d0 . ................................. a)' r.. Uf_ N Improvements permit by - '��-"� *Contact a representative of the Davie County Health Department for.Ainal 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 Installed by �M-�*r^ Li y Certificate of`Completion-�---- 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. l j _� -t► APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mockoville, NC 27028 RECEIVED JUN 1991 1 . Application/Permit Requested By Franklin G. McBride Mailing Address Route 4, Box 607, Mocksville. NC 27028 Home Phone (919) 998-2071 Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: General Evaluation JkS/Tank Installation 5. System to Serve: House I Mobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision N/A Sec. Lot# No. of People 2 to 3 Dwelling Dimensions 14 x 70 No. of Bedrooms 2 Basement/Plumbing No. of Bathrooms 1 3/4 Basement/No Plumbing Washing Machine FJ 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 8. Type of water supply: C Public )g Private Q Community 9. Property Dimensions 2 acres 10. Sewage Disposal Contractor Not selected, as yet. 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Yes 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 the best of my knowledge, and I understand I am responsible for all charges incurred from this application. June 23, 1990 Date ignature SEE ATTACHED. Directions to Property : /t�•�o�--�-- tea- �s.�-�� a-.-.a.�'� . DCHD (10-89) j A _ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME azo '� Q' DATE EVALUATED �r - ADDRESS PROPERTY SIZE CBCs 1 PROPOSED FACIILTYLOCATION OF SITE a Water Supply: On-Site Well Community Public Evaluation By:C F I. Auger Boring Pit Cut FACTORS 1 1 2 3 4 Landscape position V11 r-Z Sloe %. HORIZON I DEPTH Texture group C_ S Q_ �- Consistence Structure Mineralogy1 l HORIZON II DEPTH L4 0 L4 O Texture group C I (L C- Consistence Structure C. C- Mineralogy ( • 1 i HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S S $S S S RESTRICTIVE HORIZON - SAPROLITE - CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE '3 - u SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 3'� ' ,� OTHER(S) PRESENT: �g, \�� Q- ��R) 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 1 ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic is Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches L 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 Z 4 90 S�Q 2 3'0:J •�A p6� IP —BAXTER BARNHART— pOy�AO BAXTER BARNHART 2.18 AC. elf IP ryAa 522.46. ej. ss e OcO O X90 33.Z.4-H' J(47 L° Ip t� 1 FRANK McBR DE _ `,yO�9 13.O5AC. -_ Od PPS O `8 _S i I oR _ 1 / M J j N O t J S P 1 I P 1539.94 TOTAL. _ IP yQ' I P _ — — — — — 000 _N44.20'22'W — — — — — — — — — — — — — — — — — — CEntER A�`• �' = PRIVATE ROAD r —LLOYD GRUBS=` —DALE CHAFFIN— STATE OF MORM CAROLINA �K CA,,r'', DAME tYMpII1f �`.2.�fP4,6lSE9�r�% JERUSALEM TOWNSHIP Gey% SEAL I, JOEL_+_PERM!!.-r1R--_.CERTIFY THAT THIS = r L-:53' t c IAAP tYi_'U '.Y7:I"r.'A ni AC'.U:.L FIELD SUFI MADE BY ,�; c AS Uj%!�hTEO GY UTI• .!!ti••.,SUh�E,,:��•-� S 10000 THAT THE �•,,�QERt:1`1 2 r