The URL can be used to link to this page

157 Buckeye Trail 0 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION y *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a NumberSanitarySewage Systms t Permit Name � Date NO 7721 ooi- Location Sub i i are Lot No. Sec. or Block No. Lot Size ' '`- House Mobile Home — Business _- Industry No. Bedrooms No Baths _a—_ No: in Family — Public,.Assembly Other Garbage Dispos,�l YES ❑ NO p( Specifications for System: Auto Dish Washer . YES NO ❑ b'o o G cry. Auto Wash Ma^hine YES NO ❑ — '. ► 1+ Type Water SuPPIY —�" 'This permit Void if sewage system'described below,is not installed within 5years from date of issue. This permit is subject,to'"revocation if site plans or the intended use change. , t^ N. l� - a 4 ESQ c ' �1rR, �a Improvements permit by'`r-�^ _— *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.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by r, ertificate of Completion Date S 'The signing of this certificat s all di ate that the system described above has been installed in compliance with the standards set forth in the ab ve a lation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period o ti e. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE RS C , Davie County Health Department SEI' _ 9 19cA Environmental Health Section P. O. Box 665 Mocksville, NC 27028 --------------- 1. Application/Permit Requested By JLA-\,P-- LJ-P , v\ Mailing Address 142-0 KorK t3;x hg Q•d- Home Phone c -7�L7 00 Business Phone �3U-S9�S 2. Name on Permit if Different than Above ��// 3. Application for: / El General Evaluation CMSeptic Tank Installation Permit 4. System to Serve: ®'House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # -jPt-Basement/Plumbing No. of People Basement/No Plumbing No. of Bedrooms Washing Machine No. of Bathrooms ,� Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ❑ Public CePrivate ❑ Community 8. Property Dimensions ar- Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 9/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. Directions to Property: ��"l 1 LAD Sag 40 �--CKrrYN;h4oY\ burr, U 01r0 'tom � chi rlG }Z�clq KGL Go j010 On 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. Ol-0 -q L-\ DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 OWN the property. ❑ 2. 1 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 the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1193) • i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation c NAME �� U 4= M�\�' DATE EVALUATED 1 -13 ' ADDRESS s �`l�� PROPERTY SIZE Gb- o PROPOSED FACIILTYd S`C LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation Byq:YI- Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 Landscape position S -- S S Slope Z - HORIZON I DEPTH '' %I\ Texture grouL >^ C C U Consistence �- Structure C V_ � MineralogX 1 HORIZON II DEPTH a'' ` 3bb Texture groupC C ` Consistence r�S. Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S 5 -sS S s RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 'S>. EVALUATED BY: �1 LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: \" N REMARKS: C14A - S"\\ - 4 o� " q , 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 3C-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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ONE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■.■■■■■■■■■■■■■■■■.■■■■■■■■■■■■■M■MM■�M■.e.■Mee■■■■.■■.MMe■■ ■■■■■e■■■■■e■e■■M■■MMMMM.■■MMM■■■■.■■.■.■■■■■■■e19\1[1■e.MCe■■■■■■■.■ ■EMNO■ ■■■.■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■��■■■.■M\�1��lM■■ ■■Mee■N■■ ■■■■■■■■■■■■■MMM■■■MMMOMMOM■■■■■■■MO■■r�.. . _Oi■M■■MO■■■M■■■■■ ■■■■■■■■M.■■M■■■■■■■■M■■■.■e■■■.�i■■.■■u■■t■■■■■!!■1�■I■.Mee..■■e....■ MEN ■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■..■.■■■I11i1�tC11■■t/J■e■r�■■■■.■.e...e.■■ ■■■■e.M■■■■■■M■■■■■■M■■■■ecce.■.e■=M■■.Mu��■■ei�■\�■e.■■■.■.■■■...■C ■■■■■■■■■.■■■■■MM■■■■M■■■M■■■■■■■■■■■■■M�,ec�,■n�e■■ela.■■ Mee■■■■■■■C ■■■■ee■■■e■■.■■■■e■■ee■■M■■■e■e■■eee.■■■M..\�ei�e1�■��erae■eee■...■■■■ ■■e■e■■e.■■e.■M■.■■eeeee■e■M■■■■ �uee■e■■.■■■:.i�■i-■r►�e.ee■■...M.e■e■ ■■.■■■■■ee■■■■■M■.I■.M■■M■ee■■e■�!lr.7■�`.:■■.■■.■■■■■■e■e..■■■■eee■■ UCC IMAIN MEMBER MAMEMEMECCCtf/I ��CCCC CCCCCC C�CCCC�CCCCCC ■■■■■eM■■■M.eeM■ri■e.■■Me.■■■ieee■■■■■M.■e�e■■■■■■ee.■■Mee.C■■e■■..■ ■■■■■.■■■■e■H■■■■..■■■■■■■1~r=:: ::._:: ■ ■■■eee■ .MEMO■■ M.■■■e■■ ■■■.■■■MM■■.■■■/,■■■■■■■■e■/I■■■■■rd..■■e■CE■■M■■. EC■■.■■M■■■M■■■ll ■ ■.■■■■■.■■■■■■■a1M■■■■O■■tv.%OO■.■■■u■■■■CCCCCi C■■ C■•C■Cm �■CCCCC■ ■■■■■■■■■■■■■■■r!■■■■■■■/I■■■■■■■■"■■■ MEMO INE ■■C.0■eCe■■■■■■C ■.M■■■■Meeeeee■e[■eee.Mr�e■Meeeee.■.eeee=C■eee■eeCC ■e■M■eee.■emmummommmmCmomm ■..■ ■■■■■■N■Mee ■■■e.■■e■e■eee.�■■e■e■ns.eeMMeeMee=■.e■■H.CCCe= e.■e■■.C■■■■■■ ■ ■■■■■■■■■■■■■■■■■e■■■II■■.■Mee■.e■e■ ■■■■E■■eee■■■■■■ ■■■■■■■■■■■■■e.■■eeee//e.■.e.■■■..e■e.e.ee■ ..e■ ■ e■..■ H■■■■■■ ■M■■Mee■■■eee■Il■■CM■gle■■■e■■■■■■.■■■Ce..■e..=CCiC■■.Me■■■eeNeeee■ ONES No CCC�CI1CCCCCI�CCCCCCCCCCCCCCCeC■=CCCC■It i■EN MOCCCCCCCCRNCC ■.eee■e ■■ MEMO Mom ■■■ ■IIOM■■M/I■■■■■.■■■■■.....■■ ■e.■ ■ ■e e■eM.eNeee ■■ ■■■...........Ile■eM■Il.e.■.■■■M■e.eeee.=0 E■llCMEM■CC M■MMCMMM■■EMMM■ ■EO■■■■■■■.O■■t1■■■R!■IMO■■■■OM■■!■OMEN OMM ■■■■O■■■■■■ ■MMHCME■ ■■■MM■■MOOS■MMI,IMOO\1M■1MO■■■MOM■■■ ■O■M■■■ ■■■■■■■■N■■■■■MM■O MOE■ ■■■■N■■■■■■MOf■M.t!!\O■I■■■O■■■■■OO�iMOE■OO■C■■■■eN■■MMMO■EMM■MM■■M■ ■■■■■M■■■■■M■■r■■M�tr■■1■■■■■■■■■■N■■OMM■■■ OMHMH■■■■HED■■■■M■■O■ ■■■■■■■■■■H■.0■■■ue■■1■MMMM■■MMM■M.e■■■■M■ ■■■M■HM.M■■M■■■MMM■■e■■ ■O■■■OM■■O■■OMI■MMt►!■■■■OMON■OMOM■■■■MO■O ■H■DOM■■■■O■■■■■OM■■■■M ■OO■OMMH■OMMMr■MM■■■■■■■M ■■■■O■MME■■HO■ ■HO■■MM■M■■■■M■■■H■MMM ■■■■■.■eeM■.■■I;�■!G�fw.■■■eMCM■M■■■■M■M■M■■.e.M■.■■■■M■■■e■■H■O■MMD■ ■M■■■■M■■MM■M■rIM�cM■ ■■MM■■MMM■■■■■■M■■■■■■M■M■■.M■■s■■M■■M■■■■■■M ■■■■EMM■■MOMMMri■■■■■CI■■■■M■■MO■■�■■■EM■M■■■M■OO■■M■■■DOM■■■■■■■■■ ■■■■OMOHD■■MOI':IMDDO■■11OM■MMM■DO■ ■■MM■■.MMM■■■■■O.MO■■O■■O■MOMM■■ ■MM■■■■■■■■■M■fil■■HOEIIO■MM■OO■MM■OO■■M■MOMMOO■M■OM■MM■■OOH■MO■■E■ ■e.Mtr�t�;��M■■MMM■MMM■M■■,�■■M■■■M■M■.■■MMM■■M■■■MM■■M■H■■MMM■■■MM■■■ ■eee� �ee.e■■■■■D■.MM■��D■■MMM■■■■MM■M■D■■MM■ED■MMM■■MMD■■■■M■■D■D■ CCS��CCCCCCCCVCCCCCC��CCCCCCCCCOMCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC 1 �