170 Sawgrass Drive Lot 288DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary S wage Systems /c-:/ Permit Number
Name%/°�/�/ U(/C"� _ •� Da N2 7862
Location /, �'; . i/•, , .r n -/ % l / _; v �/�%
It
J
Subdivision Name Lot No. Sec. or Block No.
Lot Size sJ. i _,House _� Mobile Home ---_ Business _-- Industry
No. Bedrooms _Cl ..No. Baths _? — No. in Family Public Assembly Other
Garbage Disposal YES p NO E) Specifications for System:
Auto Dish Washer YES 4 NO p
Auto Wash Ma shine YES UJ 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 use change
ATTENTION:
YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM. 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.,
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
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.
1111i
_w J� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
If Davie County Health Department "
p�e 1� E C; 'E
Environmental Health Section
X5C i P. o. Box 665 JAN — 5 1995
23 I) Mocksville, NC 27028
SPP ---------------
1. Application/Permit Requested By
Mailing Address Lill( VS Home Phone ���a�r`7
Vc,nr^ t? 14 L 2,900b Business Phone
2. Name on Permit if Different than Above
3. Application for: I] General Evaluation JfSeptic Tank Installation Permit
4. System to Serve: J$ House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
�f ❑ Basement/Plumbing
No. of People ff� Basement/No Plumbing
No. of Bedrooms `/ 21,Washing Machine
No. of Bathrooms 3 ��, ® Dishwasher
Dwelling Dimensions —�s ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes _
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures _
7. Type of water supply: K Public ❑ Private
B. Property Dimensions 42, at ce( Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is Intended to serve?
If yes, what type?
❑ Yes i� No
❑ 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:
See �aP °�` �cIL Sio%
This is to certify that the information provided is correct to the best of my
incurred from this application.
DATE
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. k 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 byKeller
to conduct all testing procedures as necessary to determi a said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (1)93)
eget c - VAS.
us ise'
�j-
vC kc'� q
c�.,-l-r.l FIY,�q -C�u
'I
Y n
❑Goble .{'1o�e
(.bile � � 7err-I Ildler
1)p/'$Si61e ti xc-s oA •i �1-4d �
,
- - DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME ei)e/l / DATE EVALUATED
ADDRESS PROPERTY, SIZE
PROPOSED FACULTY oc-,.- LOCATION OF SITE
Water Supply:
Evaluation By:
On -Site Well -
Auger Boring - )/
_ Community
- Pit -
Public '--
Cut -
Slope X
FACTORS 1
2
3 4
Landscape position
Slope X
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Ve
Texture groupG
Consistence
Structure ii
s6i
S iL
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: X1 EVALUATED BY: l�
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 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 -Finn VFI-Very firm EFI-Extremely firm
Wet
NS -Non stick, 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:i, 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/ftz
DCHD (01-901