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389 Fork Bixby Rd (3) DAVIE COUNTY HEALTH DEPARTMENT 3 �p IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTEAssued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name V t c e t.� Date - (a - 91 No 629-4. Location �_ RY �,� c\. V p, SubdivisionName Lot No. Sec. or Block No. Lot Size 1_`1.13 House -.Mobile Home �/� Business Speculation A- No. Bedrooms No. ,Baths No. in Family Garbage Disposal YES [3 NO p' 'r` Specifications •for System: Auto Dish Washer YES ❑7�- NO p-- f z: O o o C, Auto Wash Ma.hine YES p-1 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. Y - 4 Improvements per by� s *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 Installed by bo Fall 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. U DAVIE COUNTY HEALTH DEPARTMENT 4 -..; "IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION " *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name- i r. :: n t Date l.� ` j' NO 6294. Location �'+ '- '-'r `�q _ �l f; �� ,. �.1 th ,` 0 0 Subdivision-Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. BedroomsNo. in Family No. Baths ti _ � _ Garbage Disposal YES ❑ NO Er I Specifications for System: Auto Dish Washer. YES p', .NO a0c, ..�_ Auto Wash Ma.hine YES Q' NO ❑ t� c> t. ` a `` ' �'�`'� Y 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. i 4 r S— 4 13 Q i `,t 4 t Improvements permit by J *Contact a representative of the Davie County HealthµDepartment fob 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. j I Final Installation Diagram: System Installed by -�� -�-: 5411 _. _._�.. ', b 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT I �' U0 .kku Davie County Health Department v Environmental Health Section 'vED FCS 2 P. 0. Box 665 Cf Mocksville, NC 27028 IRE- 1 . Application/Permit Requested By /1,d&Q, Mailing Address a 9V/) Home Phone qC\ �.� �.� BtK34 C> Phone 0XM q 4,��D 2. Name on Permit if Different than Above 3. Property Owner if Different than Above ". Wyu 00M-U' A 101� 4. Application/Permit For: lC) General Evaluation J• S/Tank Installation 5. System to Serve: HouseMobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions 1`), -K ea-L5 No. of Bedrooms1 Basement/Plumbing No. of Bathrooms 1 Basement/No Plumbing 0 Washing Machine-1T1��� J Dishwasher 0 Garbage Disposai 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: V Public p Private 0 Community 9. Property Dimensions 1 act X--S 10. Sewage Disposal Contractor `l J wit rt r� I 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. 11 a 0 -A10 Date Signature Directions to Property : �9 V . DCHD (10-89) 7 ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME NI C_ DATE EVALUATED ADDRESS PROPERTY SIZE ZI + 12 PROPOSED FACIILTY LOCATION OF SITEyh P Water Supply: On-Site Well Community Public Evaluation By:C_�,L Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S S Slope Z A - &° O -£s" - o O HORIZON I DEPTH L `' Texture group S C S C S C Consistence FTS Structure Mineralogy HORIZON II DEPTH 2" u' C' Texture group Consistence IF �3 Structure C Mineralogy1 :1 1!► /;/ HORIZON III DEPTH Texturegroup Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S$ S S S RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S $ S S LONG-TERM ACCEPTANCE RATEI -,y0 , SITE CLASSIFICATION: S EVALUATED BY: LON G-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: S EGEND 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 Mineraloey 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(O1-901 ■■■■■■.■..■.■■..■■..■■.■■■■■■e■■t■..■■■■.■■■■.■.■■■■■.■■■■..■. ■■ ■■■■■■■e■■e.e■■■■■■■tt■el■■■■■.■■■■■■■■e■■■eeele■■ecce■■■■■.■■■■■■ ■ttt■■■t■■■Otte■tee■■se■e■■■■.t■■■■■■■■eee■e■■et■■■e■■a■■e■■■■■■■ ■.■■■.■■■.■■■■■■■■■.■■■■■■■■■■■■..■■■■■■■■.■■■■.■■■■■■■■■■■■■■OMEN ■■■■e■■■e■■■■■■■■■e■■■t■■■Mae.■■ ■■■ecce■■e■e■t.■■e■■■t■■etl■■■e■ ■..■■■■.■■.■■■■■■■■■■■■■■■■.■■■■.■■■■..M■■■■OO■O■■■■■E.■■■t■■■■■■■ ■Mete■MeeOlt■■■e■■■et■■■■■eee■■e ■e■■■ee■■■■■.■■■ee.■■■.■■■■. 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