Loading...
110 Overlook Drive Lot 1 Section 2r, =r" DAVIE COUNTY HEALTH DEPARTMENT Sr s IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a. //Q Ve /600/L Sanitary Sewa a Syste s , ermit_Number t Name Date Location 1 L. Subdivision Name Lot No. ` Sec. or Block No. Lot Size House ,___Y___— Mobile Home _�. Business _— Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES d NO ❑ S ycifications for -y -System,: p/ 1. J • . v _..:* Auto Dish Washer YES t'7 NO ❑ { Auto Wash Ma :hive YES C3, NO El,� Type Water Supply __— *This permit Void if sewage system describbd �ow is not installed within 5 years from date of issue. This permit is subject to revocation i. -f site plans or -the intended -use change. - 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. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by 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. .i i' { 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. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by 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. • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT fc n Sg Davie County Health Department ©� Environmental Health Section Ufa 2 3 1993 I P. O. Box 665 — Mocksville, NC 27028 1. JApplication/Permit Requested By Mailing Address f *°X i�� �% c l's .i 'Ile e A . Home Phone �` y �` �S 8� Business Phone 2. Name on Permit if Different than Above 5/0 ry- Q 3. Application/Permit for: ❑ General Evaluation 0 Septic Tank Installation 4. System to Serve: 2"House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision (', -.,/ d I- ` epr-w 3 Section Lot # rnAp -�=8- _q - N5 Py. S c 7 ❑ Basement/Plumbing No. of People No. of Bedrooms No. of Bathrooms �2 - 5 - Dwelling Dwelling Dimensions ? a o U 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories 511 No. of Showers 7. Type of water supply: Public 8. Property Dimensions No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private Sewage Disposal Contractor ❑ Basement/No Plumbing O/Washing Machine E]�Dishwasher R(Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? ❑ Community *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 G This is to certify that the information provided is correct to the best of my incurred from this application. DATE and I understand I am responsible for all charges 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 DCHD (12-90) SIGNATURE 1 DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section Soil/Site Evaluation NAME �D /Y� DATE EVALUATED ADDRESS PROPOSED FACIILTY '�-1Z 4,Jf f PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public L_- Evaluation By: Auger Boring / Pit Cut FACTORS 1 2 3 4 Landscape position L-- L L Slope % — — HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC. C' 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 s' - LONG-TERM ACCEPTANCE RATEI 1 SITE CLASSIFICATION:0� -'�WIZIOu/ S1 s21 , EVALUATED BY: LONG-TERM ACCEPTANCE RATE: e 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 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(01-901 Daae County NealtIIi De en artment and .�lvme .dealtii ly cy 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 June 30, 1993 Steven G. Holt c/o Potts Realty P. 0. Box 11 Advance, NC 27016 Re: Site Evaluation Greenwood Lakes/Block 3—Sec. 2—Lot 1 Dear Mr. Holt: As requested, a representative from this office visited the aforementioned site on June 29, 1993. The site was found provisionally suitable for the installation of a ground absorption sewage system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure