The URL can be used to link to this page

602 Deadmon Rd�� .. - ,.�✓ka DAVIE COUNTY HEALTH DEPARTMENT _ IMPROVEMENTS PERMIT ' AND . CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name(Dated F N2 < Location �'�'�`'�Y { - / Lj7�� G1 Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business -- Speculation No. Bedrooms P2 No. Baths L>No. in Family__ Garbage Disposal YES ❑ NO Qi Specifications for System: Auto Dish ,Washer YES NO ❑ Auto Wash Ma :hive YES NO ❑ ;� , , Type Water Supply .4& *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. Improvements permit by -- l "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 112,22,_J (21 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. ,1 Improvements permit by -- l "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 112,22,_J (21 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. 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: / X711 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 from this application. 2/ la h/ DATE NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY , MUST CHECK ONE: ❑ 1. 1 OWN the property. m,-Zl 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 c the Davie C my Health Department to enter upon above described property located in Davie County and owned by ZJE to conduct all testing procedures as necessary to determine Vid site's suitability for a ground absorption sewage treatment and disposal systerry. DATL SIGNATURE DCHD (12-90) 1 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department VED * � !T�! Environmental Health Section _P. O. Box 665 1991 Mocksville, NC 27028 ----------------- 1. Application/Permit Requested By �l3 co 1^ ti Mailing Address Home Phone Business Phone(�- 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation _ ltd Septic Tank Installation 4. System to Serve: ❑ House [11- obile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ��- ❑ Basement/No Plumbing No. of Bedrooms M4ashing 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 7. Type of water supply: 11-11�u'blic ❑ Private ❑ Community 8. Property Dimensions f'nxs Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes l+J' No 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: / X711 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 from this application. 2/ la h/ DATE NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY , MUST CHECK ONE: ❑ 1. 1 OWN the property. m,-Zl 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 c the Davie C my Health Department to enter upon above described property located in Davie County and owned by ZJE to conduct all testing procedures as necessary to determine Vid site's suitability for a ground absorption sewage treatment and disposal systerry. DATL SIGNATURE DCHD (12-90) V ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME/ ADDRESS PROPOSED FACIILTY Water Supply: On -Site Well DATE EVALUATED PROPERTY SIZE /q LOCATION LOCATION OF SITEP�� Community Public Evaluation By: Auger Boring 41--- Pit Cut FACTORS I 2 3 4 Landscape position .0 �- •L Sloe % 2 HORIZON I DEPTH 5 -le - tTexture Texture rou Consistence Structure Mineralogy HORIZON II DEPTH O 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 7ff 7_97 LONG-TERM ACCEPTANCE RATE v 4/ 1 L/ -L/— SITE SITE CLASSIFICATION: �-� EVALUATED BY: ZZ LONG-TERM ACCEPTANCE RATE: �`� OTHER(S) PRESENT: REMARKS: DCHD(01-901 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 Mi neraloity 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 watef 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 ■■■■M■■■■