121 Oakridge Lane Lot 79IMPROVEMENT PERMIT
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
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NAME �!'�() /� �> PROPERTY ADDRESS MAVY L Ge— L/✓• - 71()AffDATE ,
LOCATION
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SUBDIVISION NAME (/��„/�' /Yl�ii7lif LOT NUMBER i SEC./BLOCK NUMBER
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RESIDENTAL SPECIFICATION: BUILDING TYPE c # BEDROOMS # BATHS I # OCCUPANTS GARBAGE DISPOSAL: Ye
s6
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COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE Ii PEOPLE/SHIFT # SEATS INDUSTRIAL. WASTE: Yes/No
LOT SIZE /W/P,/,-10 TYPE WATER SUPPLY / DESIGN WASTEWATER FLOW GPD) 3/ D NEW SITE I----rREPAIR SITE
SYSTEM 5PECIFICATIDNS: TANK 5IZE GAL. PUMP TAM( GAL. TRENCH WIDTH �i 'ROCK DEPTH %� • LINEAR FT..i-d6)
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FORIFINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
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PERMIT SYSTEM INSTALLED BY I •e -
OPERATION PE
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AUTHORIZATION NO. lJ '� OPERATION PERMIT BY �� DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
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Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
r�; t P.O. Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 111 of
G.S. Chapter 130A, Wastewater Systems)
***This Authorization For Wastewater System Construction oust be issued by the Davie County Environmental Health Section prior to
issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.*** I
� / AUTHORIZATION NUMBER
NAME P dAle DATE �_Zl--�l /�� ° J ? 5
NAME ON IMPROVEMENT PERMIT (If different than above) I
SITE LOCATION
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE O
Davie County Health Department i D
lil Environmental Health Section ��nn
P. O. Box 665 !Li' 1 19z
Mocksville, NC 27028 9
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1. Application/Permit Requested By. M=14AG AZCAP-I
Mailing Address 13 14 J` Sn'.'IPSdile Home Phone C7-04
(e ae(t%-%Lp t �G 01'7013 , Business PhoneA C910) %fie'8030
2. Name on Permit if Different than Above ,
3. Application for: General Evaluation ❑ Septic Tank Installation Permit
4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown G�
5. If house, mobile home: Subdivision Section Lot # _L-
❑ Basement/Plumbing
No. of People
❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing'Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ 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.
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7. Type of water supply: ❑ Public R Private
8. Property DimensionsSS' �� 1 a Ch�� __ Sewage Disposal) Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Yes ❑ 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.
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This is to certify that the information provided is correct to the
incurred from this a115'
plication.
9 1 1
DATE
t of my knowledge, and I understand I am responsible for all charges
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SIGNATURE
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CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE L)ESCRIBEDEMPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 2. I 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 I
to conduct all to ting p ocedures as necessary to:79YL
's s ' abilit or a ground absorptLon sewage treatment
and disposal sy em. ! G�
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DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
Soil/Site Evaluation!
NAME
ADDRESS %
PROPOSED FACIILTY �sr
Water Supply: On -Site Well _
Evaluation By: Auger Boring Z/
DATE EVALUATED
1
PROPERTY SIZE a
LOCATION OF SITE
Community
Pit
Public a�
Cut
FACTORS
1 2 3 4
Landscape position
Slope
r r"
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
�r
Texture groupC
,
Consistence
Structure
Mineralogyr
,-
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:
LONG-TERM ACCEPTANCE RATE: Z
REMARKS:
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
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
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- V+ ---y 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
3C --Single grain M -Massive CR -Crumb I 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
Davie County Nealt§r Depariment
and Nome Neallfi Ayr- ency
210 HosPITAL STREET I P.O. BOX 665
MOCKSviLLE. N.C. 27028
PHONE: (704) 634-5985
October 3, 1995
Michael Arcari
13945 Statesville Blvd.
Cleveland, KC 27013
Re: 2 Site Evaluations
Oakland Heiahts-Lots 7 & 9
Dear Mr. Arcari
As requested, a representative from this office visited the aforementioned
site on September 28, 1995. Based upon the information provided on the
applications for site evaluation and after the evaluations were completed, the
sites were found to be provisionally suitable for the installation of an on-
site sewage disposal system on each lot. I
If you have any questions, please feel free to contact this office.
Sincerely,
6�7ya�x '�-'s
Robert B. Hall, I Jr. , R.S.
Environmental Health Section
RH/wd
Enclosure(s)