The URL can be used to link to this page

131 Quail Hollow Rd Lot 3, Sec 1 "% DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I,of G.S.Chapter 130a Sar itary Sewage Systems 4 7• Permit Number Name , " f1�i/i1r�, S�' �✓ f;'i Si `1./� Date —LL- clL �,r' N2 7 3 7 4 Location : Subdivision Name ^ Lot No. Sec. or Block No. Lot Size House House 1� Mobile Home _T Business -- Industry 1 No. Bedrooms - ? No. Baths No. in Family Public Assembly Other Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ ^ Auto Wash Ma^hine YES ❑ NO ❑ ,�`'�� / �J/� J 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� Improvements permit by -- 1� *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: Syster>ri tall ed by L r- 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. Roy-F, :7 APPLICATION FOR SITE EVALUATIOWIMPROVEMENTS P�RMIT - / � �,/,/"Davie County Health Department € + I All �' ' Environmental Health Section 1 51993 ca7ege 2 P.O. Box t Mocksville, NC 27028 1. Application/Permit Requested By L) at)5% -ZZ C . Mailing Address e/—_ 8 O cee s t/ Al.C. .270- Home Phone Business Phone 9k - 7-:;) 7 4 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: (R" Ouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home:Subdivision lSl cIA!L Section Lot # ❑ BasemenVPlumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms C!rWashing Machine No. of Bathrooms TO -2 M�Dishwasher Dwelling Dimensions CYGarbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks . No. of Commodes a - No. of Urinals No. of Lavatories CrZ- --3 No. of Water Coolers No. of Showers D1 Water Usage Figures 7. Type of water supply: C1 P/Ublic ❑ Private ❑ Community 8. Property Dimensions / A CJ—,';F— LO 7-1b Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes U?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: This is to certify that the information provided is correct to the best oLmv knowledge,and I understand I am responsible for all charges incurred from this application. 3 - /V - 2& Q,��J;�51 DATE SIGNATURE CONSENT FOR SITE EVALUATION !Q BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. DATE SIGNATURE ' v DAVIE COUNTY HEALTH DEPARTMENT d Environmental Health Section Soil/Site Evaluation NAME �� Q. N C` �2 S n DATE EVALUATED 3 - J 13 ADDRESS ��C 26 g °L:tt 3 LLQ C�o��r PROPERTY SIZE PROPOSED FACIILTY o s LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:C C Auger Boring Pit ✓ Cut FACTORS 1 2 4 Landscape position S S Sloe % b -g HORIZON I DEPTH Texture group L L Consistence Structure C R 0- Mineralogy I '.1 1 1 HORIZON II DEPTH v'' yo ` Texture group C C Consistence S=-Z 1=-y_ Structure A3`t; Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 S SS RESTRICTIVE HORIZON — SAPROLITE -- CLASSIFICATION S. -S LONG-TER.M ACCEPTANCE RATE . 4 4 SITE CLASSIFICATION: . S . EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: "LEGENIJ 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 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(Ot-901 ■■■■■■■■.■■■.■■■■■...■■.■■/■.... ...././...■■i/.....././.■/..�.■/ .................................................■ ■■■■.■/■■.■.■t■ .................................................................. CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC<CCCCC�%��mom MMMMMMMMMMMMM ME MMMEMMOL"I' m Mom CCCCCCCCCCCCCCCCCCCC:CCCCCCCCCCCCCCCCCC:":::CCC:CC'CCCCCCCCCC .........................................E'.:�� =C n:': ...................................... . ................................ .... .....0■CC.INN C■C.CC■..■/.� ........t...■...../.t.../......■�i.■■.C...../..■C...........■C.... CCCCCCCCCCC:::CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC�CCCCCCCCCCCCCCC .......................,.........■.CC"u CCCCCCC. CCCCmom MOCCCCCC CCCCCCC'■CCCCCCCCCME ��C�CCi iCCCCCCi■C■i■CCCCCCCCCCCCi CCCC:CE CCCCCCCCCCCSCCC�CCCCCC:::CCCCCCCCCCCCCCC�CCCCCCCC'.S■CCCCC :CCCCCCCCCCCCCCCCCCCCCCC:CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC'CCC' ■■..\fir...■......................■....../...■/■/1!."J►.../.../.... ■....fi./!/!.i/.■.........../..../.......i.t..■■■.■■illi■...■■.■.■■.■ ■..■t%■�wii1..\1..............■./..■...H....H■.■/,..1■..l\■.�■■H.■t■ ■.■......■.....//......■/.■....H.■■...a/■■......■........../■...■