349 Oakland Avenue Lot 1263 Z -'X. o
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETIONt.
'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit
Number
Name ? *. � �• n J-q-q#�LDate �� N2 -7 5 U 7
Location
Subdivision Name '✓- Lot No. J 4L�, Sec. or Block No.
Lot Size+' k (� House Mobile Home Business __ Industry
No. Bedrooms .No. Baths —_ No. in Family Public;ssembly Other
Garbage Disposal YES [D\, NO M/ Specifications for System:.
Auto Dish Washgr nYES E] NO [g-,'oo
Auto Wash Ma^hine YES Q/ N'0 ❑
Type Water Supply
'This permit Void if sewag, 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.
1
�Z F
At
31;
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°�
V
Certificate ofomple'
'The signing of this certificate shall indicate that they stem t
the standards set forth in the above regulation, butd, in NO
satisfactorily for any given period of time. ,
\fl
. ` ► °- Date.;,
ibed above,. as been installed in compliance with
be taken a guarantee that the system will function
t�
1
�Z F
At
31;
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°�
V
Certificate ofomple'
'The signing of this certificate shall indicate that they stem t
the standards set forth in the above regulation, butd, in NO
satisfactorily for any given period of time. ,
\fl
. ` ► °- Date.;,
ibed above,. as been installed in compliance with
be taken a guarantee that the system will function
a ��
C f� PPLICATI FOR ITE EVALUATION/IMPROV EM PI RMIT ; i'�'
10 P � D vie CountyHealth Department
/ V environmental Health Section 2A
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By e> a r /a 7-7-e 5 u e 1'�e elf
Mailing Address gr /I %l' O k f ~7 M d C fiS 1) �' / 1 e IV,
Home Phone 1V /19 — rJ 3 3 Z Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation Q Septic Tank Installation
4. System to Serve: El House 91 obile Home ❑ Place of Public Assembly
❑ Business ❑ Industry �9 ❑ Other ❑ Unknown I
5. If house, mobile home: Subdivision l/ �%CI� S _ Section Lot # J cL0
No. of People
No. of Bedrooms
No. of Bathrooms
�2
Dwelling Dimensions 5")(5/
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
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/Plumbing
❑ Basement/No Plumbing
X Washing Machine
❑ Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2 No
If yes, what type?
S --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:
�V�e'�"
Lv�. PSS ,
106L
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred fr m this application. / pp
6�
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 0,4' 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 o!Pe Davip Count Health Department to enter upon above described
property located in Davie County and owned by -6Z
to conduct all testing procedures as necessary to determine said site's sui bility for a ground absorption sewage treatment
and disposal system.
ATE SIGNATURE
DCHD (12-90)
. .•
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME Ply DATE EVALUATED
ADDRESS
PROPOSED FACIILTY —_41E Z1L,-
Water Supply: On -Site Well
PROPERTY SIZE _ Z.4
LOCATION OF SITE
Community L/ Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1 2
3 4
Landscape position
Slope %
"
el
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
) ,
Texture group
Consistence
i
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
1
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: G� 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 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
f
Davie County Ylealt)Ii ?fie artment
.do
and me Xealt Aen
9 cy
210 HOSPITAL STREET I P.O. Box 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634.5985
July 2, 1993
Charlotte Sue Reed
Rt. 1, Box 287
Mocksville, NC 27028
Re: Site Evaluation
Oakland Heights — Lot 126
Dear Ms. Reed:
As requested, a representative from this office visited the aforementioned
site on July 1, 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