The URL can be used to link to this page

286 Cornwallis Drive Lot 3 r _ DAVIE COUNTY HEALTH 'DEPARTMENT ,00 71MPROVEMENTS PERMIT AND CERTIFICATE."OF COMPLETION-. t •NOTE Issued'in Compliance With Article 11 of G.S.Chapter 130a unitary Sewage Systems Permit Number 5',- Date �- Name f� .�fs /`v� � �a S".r�l•�_.._ N2- -7_fir%i''• 1 '7F� 14141L ifs://, Location Subdivision Name ea�'-, �� y�° Cs, Ll Lot No. =_.j Sec. or Block'No. z Lot SizeHousei _� Mobile Home _ _ Business —_ Industry , No. Bedrooms __:No. Baths ! No.'in Family Public Assembly Other Garbage Disposal YES p NO Specifications for System: Auto Dish Washer YES NO p Auto Wash Ma^hine ' YES u 'NO Type Water Supply; 'This permit-Void if sewage system described below is not installed within 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 INSTALLJNG THIS SYSTEM. �:i uiS�r f � 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:'. System Installed by ?^ b]"o U Ou ' •f �rj It'�� '` .` 8L �' ' , _ .. - Certificate of Completion Date The signing of'this certificate halt indicate that the system describedabove 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 •1a�� Environmental Health Section Soil/Site Evaluation p NAME DATE EVALUATED ) ADDRESS PROPERTY SIZE PROPOSED FACIILTY _��►'c�ll,�� LOCATION OF SITE U e Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit i/ Cut FACTORS 1 2 3 4 Landscape position L ,L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 13V Texture groupL Consistence 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 BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: zS?e J 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 :lay 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 1 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 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER i l5 v Davie County Health Department Q Environmental Health Section P. O. Box 665 APR 1 Q Mocksville, NC 27028 1. Application/Permit Requested By77-i tehQ Z le i `! Mailing Address a-0 -S, �/,ki Home Phone XZ- Business Phoner)Qj�,J 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation O'S'eptic Tank Installation Permit 4. System to Serve: eHouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Z Lot #3 ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms 75 21"Washing Machine No.of Bathrooms •�l 0 Dishwasher Dwelling Dimensions a?L12�X �d ❑ 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: 9 Public ❑ Private ❑ Community 8. Property Dimensions /• d.3 �� Sewage Disposal Contractor f 1e� 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: 71- D A� lqc 4 / 14 (d7,e This is to certify that the information provided is correct to the best of my knowledge, and I underst I am responsible for all charges incurred from this application. L� DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: .M1. I 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 DCHD(1193) .�, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence 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 BY: 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 Texture 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-Vcry friable FR-Friable FI-Film 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