P0035 Alamosa Drive Lot 12.!
Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
P.O. Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRICTION
'111isued in compliance with Article 11 of
S.S. Chapter 130A, Wastewater Systems)
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***This Authorization For Wastewater System Construction must beJfl��tp avie�County�vironmental Health Section prior to
issuance of any Building Permits. This Fore/Authorization Number should be presented to the Davie County Building Inspections
Office when applyingforBuilding Permits.***
NAME I' 0l � DATE %f ,r— AUTHORIZATION NUMBER '.
MINE ON IMPROVEMENT PERMIT (If different than above)
SITE, LOCATION _
,tiJ,.. /: 6
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DAVIE COUNTY HEALTH DEPARTMENT r,
IMPROVEMENT PERMIT and OPERATION PERMIT
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**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater)
system. AN AUTHORIIATION 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)
NAME e /V.715- PROPERTY ADDRESS _ 141a - --n SGL. �� a DATE /19
LOCATION ./J/l)C xi r"', - �i✓ �l T
5UBDIVISIDN NAME LOT LDT NUMBER/.� SEC.%BL NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS ff_ # BATHS # OCCUPANTS 1 GARBAGE DISPOSAL: Yes/&
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE A d,(10d TYPE WATER SUPPLY �i. DESIGN WASTEWATER FLOW ((PD) NEW SITEy''REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE,& /) GAL. PUMP TANK GAL. TRENCH WIDTH . d- '� ROCK DEPTH ,ILL LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:38-9:38 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8768.
OPERATION PERMIT SYSTEM INSTALLED BY�
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75
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AUTHORIZATION NO. OPERATION PERMIT BY 461d
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 .1980 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FL1NCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1 _ Home Phone
1. Permit Requested By Pi L I S N
Business Phone ot• / 0 U
2. Address D /� v r✓ le,
�.70G10
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy,— Conventional `Other Type
Ground Absorption
c) Sub-Division�A 101,V10-1 Sec./ 6a Lot No.
�� '4 L A In 6 S
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
�'70
House Dimensions 154
Bed Rooms 3 Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount4f waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes .rZ urinals
garbage. disposal
lavatory showers
washing machine
-
inks
„vd'shwashe
8. a) Typ water s pply. ubl.ic ' Community
-
S I b) Has' the wate y system been ap oved? Yeses No
S W
N �
- 9. a) -Pro rty Dim sions 677 -S I
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a Dispo al 6&iractor o R
10. nticipate a d�` ' s or expans ons of the facility this s
I
age sys�em is intended to serye
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9 his -i -to certify that the i formation is cQrrect-t
best o y nowledge.
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DaIt' I r I I� I I I r
wnfr S nit
_ WNER I SOLELY REtPONSIBL'E FOR_qQMPLIANCE WI
H ALL S TE AND LOCAL LAWS
5 I All w 5tZRys for ro
erections to p operty:
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' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME _ DATE EVALUATED S�
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On -Site Well _ Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1
2 3 4
Landscape position
,L
Sloe Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
®�-
Texture group
Consistence
i
Structure
5- /e
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: /' EVALUATED BY: -4 /-/
LONG-TERM ACCEPTANCE RATE: / OTHER(S) PRESENT: 09 f
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 -: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 film
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 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 - gat/day/ft2
DCHD(01-901
Davie County NealtFl De artment
oke Aealtfr Men
and �l 9 cY
210 HOSPITAL STREET/ P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
April 22, 1996
Love Homes
Attn: Dave
828 Piedmont Dr.
Lexington, NC 27292
Re: Septic Tank Permit/ATC #0035,
Woodvalley/Sec. 1/Blk. D/Lot 12
Alamosa Drive/Advance
Dear Sir:
The septic tank at the aforementioned site was installed on
October 30, 1995, per Robert B. Hall, Jr., R.S., Environmental Health Section,
in compliance with Article it of G.S. Chapter 130A, Section .1900 "Sewage
jTreatment and Disposal Systems", but shall in no way be taken as a guarantee
that the s stem will function satisfactorily for any given
period of time.
j Sincerely,.
j� Robert B. Hall, Jr., R, S.
1 Environmental Health Section