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340 Bridle Lane Lot 12*contact a representative of the Davie County Health Department for final Inspection of this system between 8:30-9:30 A:M., 1:00-1:30 P.M. or 4:30-5:00. P.M. on day of completion. Te,lephone,Number:.704-634,5985. Final Install on Diagram: Syst• tailed by — - 13'a X` Certificate of Completion �' Date d 'd - The signing of this certificate shall 'indicate that the system escribed-above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way'b'e•tAen as a guarantee that the system will function satisfactorily for any given period of time. y_ ' •� , , , ' DAVIE COUNTY HEALTH ,DEPARTMENT i =,. a IMPROVEMENTS -PERMIT AND ,CERTIFICATE OF COMPLETION'""`" ;NOTE: Issued in Compliance WAh Article I I of G.S. Chapterr130a sanitary' Sewage systems Permit Number Namel—c_`l� Utz�Q-' = Date '" N� - - 8058 Location N , `Z' 0 C4 _ " 'or Subdivision Name _. rh—,Lot No. Sec. Mick No. c ? Lot Size t� ��S �_�� ''_ House _ Mobile Home ---_ Business _— Industry :i0. 'No. No. Bedrooms.No. Baths _-- in Family — Public Assembly Other Garbage Disposal, YES p NO 21Specifications . for System: Auto Dish Washer' ' ,> YES p NO Ef Auto Wash Ma -hive : YES ( NO Type Water Supply ti Lk - — '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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. i :,. ;. • ' .k ImnrnvAmantc norm ,f`hu •b'19•s�J�`r.o *contact a representative of the Davie County Health Department for final Inspection of this system between 8:30-9:30 A:M., 1:00-1:30 P.M. or 4:30-5:00. P.M. on day of completion. Te,lephone,Number:.704-634,5985. Final Install on Diagram: Syst• tailed by — - 13'a X` Certificate of Completion �' Date d 'd - The signing of this certificate shall 'indicate that the system escribed-above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way'b'e•tAen as a guarantee that the system will function satisfactorily for any given period of time. V9 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section f� f P. O. Box 665 Mocksville, NC 27028 uAVIr.tuu,al� 1. Application/Permit Requested By /64 � �' � � �� �� Mailing Address Pi f7 %� O )C 0 / f' Home Phone 9/0 " %G M o c K ss& f l rP N* �—� G a Business Phone C C( (3 V' S �� 7 2. Name on Permit if Different than Above 3. Application for: �,eneral Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: (LleMuse ❑ Mobile Home ❑ Place of Public Assembly p Business ❑ Industry // ❑ Other ❑ Unknown jj 5. If house, mobile home: Subdivision ©� %� �ryi 7i t%�/� � Section _� Lot # asement/Plumbing No. of People ❑ Basement/No Plumbing 7 No. of Bedrooms ;Zshing Machine No. of Bathrooms 3 ❑ Dishwasher Dwelling Dimensions % �-7 G ❑ Garbage Disposal 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 7. Type of water supply: ❑ Public Private ❑ Community 8. Property Dimensions a U G 1 g ? Co Sewage Disposal Contractor Caw �° �C 1!T3 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes �' 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: G IV Z 0 7-0 %j /2 4 r C o 'j0 L (/�-�,7 Imo �-t 5 �= a Al2 !C �� r W C G o A/ (f( -,l l46 -i - This is to certify that the information provided is correct to the best of my k incurred from this application. DATE I understand SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY for all charges MUST CHECK ONE: ❑ 1. 1 OWN the property. l2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of he vie C unty ealth D partme t toenter upog above scribed property located in Davie County and owned by to conduct all testing procedures as necessary to determines site's suitab ' lity f a ground absor ion sew ge treatment and disposal system. DATE SIGNATUR DCHD (1193) . DAVIE COUNTY HEALTH DEPARTMENT • _ Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE cvL&/p,_tl� PROPOSED FACIILTY LOCATION OF SITE Water Supply: On -Site Well L/ Community Public Evaluation By: Auger Boring k__11 Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH acr i Texture group C .- Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence / r Structure 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: EVALUATED BYA4-// 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 S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty ;lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Vl---y 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 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mi neraloiry 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 Daure County Nealth Department and dame Nealil .�; yency 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 May 26, 1995 Michael F. Hester R. 0. Box 811 Mocksville, NC 27028 Re: Site Evaluation Rabbit Farm — Lot 12 Dear Mr. Hester: As requested, a representative from this office visited the aforementioned site on May 25, 1995. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, kea &�. Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure