The URL can be used to link to this page

P7777 Workmans Way l�. � i .y •� _. -XO . . ��. .._ . VIE COUNTY .HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '-NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a } nitary/Sewage ,Systems �o7-k �n� dy�n 1�. ?� Permit '7N'umber NameA';�J7l1L1 !l�> fes//�?S .�llr/� Date /C - 1'r��.?/ /_ N2 1 1 1 7 Location Subdivision-Name Lot No. Sec. or Block No. Lot Sizet— House Mobile Home Business -- Industry i No. Bedrooms No. Baths _ II L— No. in Family 3 — Public Assembly, Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES ❑ NO ❑ / , � G'/ �f Auto Wash Ma shine YES ❑ NO ❑ / �� ' _. Type .Water Supply — OX 'This permit Void if sewage system described below is not installed within 5 years from date of issue. a This permit is subject to revocation if site plans or the intended use change. Improvements permit by _'�46- / *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: Syste In tailed by L.Gt 'it Certificate of Completion Date7 '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 Davie County Health Department Environmental Health Section d C I 4 1 1994 P. O. Box 665 Mocksville, NC 27028 -------------- 1. ____ ___-1. Application/Permit Requested By Mailing Address ( ja5 5�'P�(./ I�rC� Home Phone 910) ?q5-a6/ 1 At Business Phone l7o 33�s� 391 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation dSeptic Tank Installation Permit 4. System to Serve: ❑ House EKMobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms r'� C�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 ErPrivate ❑ Community 8. Property Dimensions f X W�3 _S9,46 Sewage Disposal Contractor 9. Do you anticipatd additions/expansion of the facility this sytem is intended to serve? [EJ'Yes ❑ No If yes, what type? N O U5 E7 '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: POW644-�-otjn kd l°L-A 0 N o let 40 C(`G-.Ct iow,, ed- , 1�e-4- oil K 11 ck a—k4 ro peY�-� f--('e,14 C,-t l ' w000 d . ?rUPa60 fnandv-, horne- we// Slk- (� 1�0-4 �014Vkv-A tj/`SIU veSC This is to certify that the information provided is correct to the best of my knowledge, and I unde tand I am respons• a for all charges incurred from this application. /42 - /?- 9 S� 04�Z-ZlZzQ !� , - � - k - DATE SIGNATU E CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. G�2. 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 the Davie County Health Department to enter upon above described property located in Davie County and owned by rj6 ec_Y� 9` /ylRrLl _ /� ,Ns �sJ ccJ 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(1/93) { DAVIE COUNTY HEALTH DEPARTMENT Z Environmental Health Section Soil/Site Evaluation NAME //l/'% i� s' DATE EVALUATED zo -'2?,< ADDRESS PROPERTY SIZE PROPOSED FACIILTY l LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position �- L Sloe % HORIZON I DEPTH /a It /dot 0" 65"", Texture group 61— z l- -If L Consistence Structure MineralogX HORIZON II DEPTH < " -e " s "V Texture group /04G Consistence Structure A b � 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: PS . 4�/1 - EVALUATED BY: LONG-TERM ACCEPTANCE RA E: Z OOTH R(S) PRESENT: REMARKS: t492I/ev /Jlf��9/rc dJ /k �� SIC 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 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 watee 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 ■■■■■■■■//■■■M■■■/.■e/■./e■■eee■■■■.■■■N■■■e■■//e■..■■■.■■ ■■■■.Rh■ ■////■///■■///////■/■■//■■/■/�� ■//■■////e//./e//■■■/■///MEe/E/■ ■■.■■■■.!■.....■■■//■■/M■ee/ecce■e■./■■■■..■...Me/.e./..■M/M■■N■.■ ■...■■■.■.■■....a....■....■EM..M■■■.■■■.■.■■..■...■■...Me..EEN■E■■ ■...■■■■■■.■■..M■.■M■■■Ott■■MMMME.■■N.■N..N.■N.M.M�N..M..■...MMi.M ■■■UNUM■e■■..NNE■■■■■NEN■■.NNN■.MNNMl.NNi■■■.■...■ .■.NNE■■.EN!■■ MMEMEMMEMMENE ■.■..■.■■...■/.//■.M.■/N/e/..M■./■.■.M.M■MNN.e■.e■NN■ N■Ee.■.■E■ ..............................................■... ............... Kimono MUMMOMMEMMMOMME ■■.....■.■MMM..MM■M.M/■Ms�NNMr�N.■.M.eN.M.r1■E�►N■..Ni.MN■NME ■NEN.E.E .........MNEUMN.i■NNNN■.G..EMMNN■■.N.'1. MIN ..►MUNE. .�.............. ■.■■■eE■■e..e.E■■■...■■.Il�..�i/.M/e■■ffLe. MEMO ■ ■..■NM.NeNN■■■ :::::::i►iiiiii."■iii::::= ::: :�w:::C:.'C� No a N■J=MEMMEMI� ........................�...■1....�...�.■...... L MEMM■MMHM. EME■ ■.■NMMENM.MNUM.MN..NNMM�/.N1IMN../M....�...MMNN�� ■E.■.ME■./ESI■■E■ MEMMOMMEMEMEMM 0 ONO 00 MMMMMMMMM no 0 ONO MUMEMNON 0 MOEN MEMME 0 MEN MINEMOMMEMEMMM ■E■■EMM ..■.N.MM.M.=..�I.■�aEM.M.■■ME=KENN M ■M.�r.M■■.M■.M,i.M■M■ .:��::..:MM:: .......................11.■t1M...M.■.■.NM■.��..■■ MMMN■N.NM.M�■...�.......... ■■■.■■■■.■...■■■.NNMM.■IIMN�1.■■■!..■.HEN.■ ■ENOMNEE ■EMN■M/MNeNMMMeME■NNN.NI1.MIlMMENN�NNNUNUM=MN.NN.M.uE..MM■NN■�iMUSE ■■■■■NMN■■NN■N.MMNM.MM.�1■NII.NEM■ .MM■NNN .■MMNH.NNe.N.M.M.../..■ MOMMMOMMUM ■/...M//■eM..././M.e.■■SIE■Ile■EMM■.E■■.N.. M.N/NMNN.NEH.■■■.e./M.■ ■■/M■.NMN■NMNN....M■■.N.;e.�n.e.M■Ne.■■EMN NMNN ■NN...Ne.N MEMORIES N.■..M■■ .................... ...r.■......................N...........■■..N. ■...■MEME.■M■■■MMM■MC..Ire.�M■N/M■ ■■■■NE..a.NNE■.NNN■NN.NE.M■.■E■■ ■■■M■NMN..NMMME.MNMMN.M■IM�IMM.M..ilieNUNN..■■N■NE■MMEMEUNN■i.NN■/MN■ OMEN EMMUMMEMEMENSIMMEM ■/././/.■e■///■■/■■■//ell■�l/./�.■■■■.■■eee/.■.■!�/./.■../.■■■.Mee■■ ■/!.■/.■■■■..■.../.■/■■�Ie1lE■■ee■■ee■■■/E■■■e■/■■/../e■■E■Ee/..eee■ ■..NUMM.M..MMM■NMMN■//■tl■11M■■■■■■■eN■■■MM■.NM■■■■■N.■NNNM..E.NeNN■ ■■E■�.■E.■■NN■■/N.■■N■■11■1'1■■■■■■.EENE.EMN■■NNE■U.M.EU..N■■M..NEE.■ ■...../M.■■M■■eN/■■■E■erIE1111��!�Gi��e�i�NANN�■ii�i�i/■UNUM■.M■■.■