The URL can be used to link to this page

147 Canton Rd Lot 15, Sec 2 DAVIE COUNTY HEALTH DEPARTMENT 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 A 01111-Coe-11 ZteALl 2 �;//, Date N2, 7 8 2 5 Location Subdivision Name ��fQ 1 �� Lot No. Sec. or Block No. Lot Size l House Mobile Home _ Business ._— Industry No. Bedrooms No. Baths c---Z�2– No. in Family _ Public Assembly Other Garbage Disposal YES ❑ NO ❑/ Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES 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 usethange. 41 o Joe e Improvements permit by A/-4�-Izz— *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: S em-lr stalied by yo �1 43 fiv ; j y ��'' e4d r Certificate of Completion _ /2 Date 42142= � "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. ' DAVIE COUNTY HEALTH DEPARTMENT N 9 - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION tdp *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems /�}� PermitNumber Name ` � �fn..✓ k7, Date Date /--.s'/- �r'c " N27825 Location iw Subdivision Name Rao � ll��10C.c1 — Lot No. �� Sec. or Block No. Lot Size House — Mobile Home —T Business -- Industry No. Bedrooms - --No. Baths 7:2Z,- No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO E;J� Specifications for System: Auto Dish Washer YESNO ❑ Auto Wash Ma^hine YES LJ NO ❑ /�� ` �� "U �� 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. 3 Improvements permit by —! *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: em-Installed by 01 f i 4 Q4d r Certificate of Completion -lezzll�— Date /vv '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. i Roy APPLICATION FOR SITE EVALUATIONAMPROVEMENTS P MIT. . �.._.._.- •-- i Davie County Health Department ✓ Environmental Health Section I'i,ti' 1 J 1993 P. O. Box 665 Mocksville, NC 27028 .rj 1. Application/Permit Requested By D(Cle 4,1V/-21—=.1e ,nAJ l DSU 5 T -Z;JC. Mailing Address e,T 8 /YIOc/LsV"44� _ Al.C, : 2o-a Home Phone Business Phone 7-;� 72 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: Voouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry I , El Other ❑ Unknown 5. If house, mobile home: Subdivision QUAIL f-iG_Lncc� Section Lot # lb ❑ BasemenUPlumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms U!rWashing Machine No. of Bathrooms 7V Q"'Dishwasher Dwelling Dimensions (YGarbage 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 _,7C-- No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: 0,44blic ❑ Private ❑ Community 8. Property Dimensions XGA C-61'E to M Sewage Disposal Contractor 9. Do you anticipate additicns/expansion of the facility this sytem is intended to serve? ❑ Yes 91,'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 o y knowledge, and I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TQ BE DONE ON ABOVE DESCRIBED PROPERTY Fand 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 SIGNATt,rRF r DAVIE COUNTY HEALTH DEPARTMENT J r Environmental Health Section D� I Soil/Site Evaluation NAME �� . N\" DATE EVALUATED ADDRESS �� 26 g�\ 3V2 PPOPERTY SIZE � �\ PROPOSED FACIILTY 1 o u s a LOCATION OF SITE ('��10," \-1 Water Supply: On-Site Well Community Public Evaluation By:C E L, Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 Landscape position X Sloe Z — — HORIZON I DEPTH �' 4" Texture group �'G G Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence 011 Ir Structure S' 77— '7777 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: f� ` EVALUATED BY: LONG-TERM ACCEPTANCE RATE: - �j OTHER(S) PRESENT: REMARKS: ,//A Z/ 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 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(01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■.■■■■.■■.■■.■■■..■■WHO■ ■ ■■ ■■■.MMMM.■■■■..M.■■.MMMEMMMM■■■■�■■■.■■■■.■■■■■■■■.■■■■.■■■■■■■■■ ■■■■■..■■■MMM■MM■■■M■MMM.MMM.MMMM■■.■.■■.■..■■■.■■■..■■.■.■.■■■■.■ ■■■■■■■■■■■■■■.■■.■■MMM■■MMe.�■■■�■■..■■.■.......■.■■■.■■..■■■■■■■ ■■■■....■■■■■MM.MMMMM.MM.■■ ■■■■■■■■■■■■..■.■■■..■.■■■.■■■■■■■■.■■ ■.■■M■■■MM.EMM■■■■■■■■■�■■■■■■■■■■■■..■■■...■■ .■■.■■■■ ■■■■■■■■■■ ■■■■■■■■■.■■■■■■■■■■■■■■■■■■.■■■.■■■■MM■M..MEM MEN ■■■M■.■■■O■■MM■ ■.■■■MM■MM■■■MOEMMM■■MM.■.MME■.MMM■■■.■■■.■.■■.■�■■.■■■..■■■.■..■■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii.iiiii.��aii.�iiii�■iiiiiiiiiii=ii■ ■.■■■■/■.■■■■■■■■■■■■■■■A�7■■■■■ ■■■■■■.'■■■■MMM■■■.■■■.■■■■■■ MEN .■■...■/.■.■.■■.7e.MMEME..MMMMME■.■.■■■■■.■MM.■■■.■M■■MEM■■■.... ■■■■■M■■M►\MMM■M■■■■■■■■.■■.■■■■■ ■MM■■■■■■■■■..■..■■■.■■ ...■..■■ ■■■■■■■■■.,■■..■■■■■.■■.■.o■.M■■■■■■■■.■■■■■■■■■■.■..■■■.■�■■■■■■■■ ■■■■■.■■■■■.■MMM■■MM■MM.■M■EMMMMMM■■.■■.■■.■.■■■MM..■.■.■C..E■■■■■ ■.■■■■.■■■►■.■.■■■■..■■.■■■■.■■■■■.■■■■■■MM.MMMMMMEM ■.■■ ■■MM■E■M ■MMMM.MMM■a.■M■■■■■■.■■. ■■...■■■■■.■.■Ea..■■■■■.■■._■■■■■■■.■■■■■ �i■iii�iME EONMOMEMEN iiiiiiiuiiiii =MEMNON EMMIEN�iMEMNON ■.■■..■■.■..��...■.■■■....■.■■■■.■..■.■.■.■....■■ ■■■■_■■■■■■■■■■.■� ■■..■..■.■■■■1...■■■■■■.■..■■■■.■.■■M.EM�.N■M■■.■■.■.■■■ ■■.■■■■ ■■■■■..■■■..■.��■■■■.■E■rl■M...�■■�`!�.■■■ .111■■u■E■ ME MEMO= i'■iiii�■iiii■iic'�iiiii�iu��i'.iiiiiMEiii■ i =INMON0 MIEN�MMNMMMMMMMM MEN mom mom MEMO .................►...............�3EMMEMEM ■■MO■..■EMME ■■■■M■■■.M■■■.E■■M ■■■M.■!%..MEMO■M.\1MM■■.■..■MN■...■■ ■■■� MN EMEM■EEMMMOMMEMOM■ WMEMMAME.■■■.■. CC:mmommoom mom':::::::.:::::::::::::::=:::� a': ' Ll'NIN:'::m::C:=:C':N .....................,....C■■M■MMEMM.■MM.,.■■ 0 mCM■■■■■ME■IMNMEM■MM■ ■■■■MOMM■MMMM.EE■■M.Mc�./...■M■O■►�.M■■ME.E.M■■.MEEMMMMMMM■■■■■MEMO ■E.■MMM■■M.■■■MMMM■■MMMM■■■■M'fMMMMi��eE■.ME.■M■■■MM■EM■MMNMMEEM■■ ■■■■MMMMM■MM■M.■■■■MME■MM■■■MMMM.■■.■MM.■...M■■..E■u.■■.■■■■■..■■ WMMMMMMMEMMM ■MMMI■■■■■MEMMMEMMM■■■■M■■■■■■ENMM■■■tit ■MMMM■■MMO■■ME■■■■M■■■■■