Loading...
194 Cedar Ridge Rd • '� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a 30.95 Sanitary Sewage Systems �Bp Permit Number Name . < '� _ �I�-SDattN2 8075 Location '.c'�S-1 ^ t' ` 6 / �r�. i� /�d9iri/ ���t' //� ✓ lli�J �_1�.� � Subdivision Name Lot No. Sec. or Block No. Lot Size % / _House _ Mobile Home --_— Business _- Industry No. Bedrooms —.No. Baths -c:5-7 No. in Family Public Assembly Other Garbage Disposal YES 0 NO p' Specifications for System: Auto Dish Washer YES � NO p Auto Wash Ma^hine YES NO [] Type Water Supply �-- ----- --- l� Xf2 *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/LAYOUTI BEFORE INSTALLING THIS SYSTEM. 1' 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 ]��A�1��w•a1� 6lo di 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: r R ^ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER U — 7 Davie County Health Department Environmental Health Section Ela" gS°EEdiR lf;hLT� P. O. Box 665 „ t iten Mocksville, NC 27028 ' lf{Y 1. Application/Permit Requested By 1+I't '\ cot e- C Mailing Address Not L>ALei tf e— 2 Home Phone fd 6�a 4 $o-Z Business Phone — 2. Name on Permit if Different than Above 3. Application for: � ❑General Evaluation ptic Tank Installation Permit 4. System to Serve: 2--House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other n � ❑ Unknown 5. If house, mobile home: Subdivision 14 1 Section Lot # ❑ Basement/Plumbing No. of People ?/ VBasement/No Plumbing No. of Bedrooms Z Flashing Machine r No. of Bathrooms 2 l2 Z�-Tishwasher Dwelling Dimensions -1'0 X 2- t 2Y I x ��� ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served 2' No. of Sinks No. of Commodes 3 No. of Urinals No. of Lavatories 3 No. of Water Coolers No. of Showers Z �e2 Water Usage Figures 7. Type of water supply: ER"Public C1 2Z A 76 ZX 75'Rea,,❑ Private El Community S75/ A PReox i m AT e L'-I ale Re g 8. Property Dimensions 375' F R-O&JrAr U� Sewage Disposal Contractor No? P<NoC,J Ye 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ®' l-O 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: C)C1 L `-� -o c,�a A A p S L e x t N C, T-CD Q J4 t LEF oN CebalQ tI> C, R o ?e ,-Ty �3 �,- C f`r S Z Z �" t o s c o R o N F L-t4 e e a Ft T $2 n >L © r o 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. lo" -? RS ' DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: 03 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by.the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. DATE SIGNATURE DCHD(1193) +KMctr *a..e: �<b 6083 E1< o `N 7i� 23� e' t N 380-24'_20'>W . 30 p I $ 133.38 X1398 tAZgRp , F. t o 0� A REq Op � Q2h I / nity PonEI No. ?0308 I ? f i . �, 1 Po t O —I o. iron i placed\ s�, Ab 5 33� 49�_ 20E Total 1900' _ / �Go %0 0 10 5 / iron found — I 1l i 0) f <, EO I / (D ,. oIIUY � �\ " Wire I I✓ J O �� - �y HICKORY } l R`. V ACRE /; 6 . 3 �5 f� o ACR . 13 0 _w (7 I I N on I iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�■iiiiiiiiiiiiii=i=iiiiiiiiii�Nii ■■■■■.■..■..■■.■...■......■.■.■ ON MEN sommoomm ■■M■■■■■.■■■■■■■■■..■■■■■■■■■■■■ ■■■■■■.■■■■.■■■■■■■...■.■■■■■■■ ■Mee■■■N■■■■■■■■■■■■■■■■■■■■■■■ monsmoommosmomom ..................................■..■.............. ......... ... .....................■■........■�■.N.N■■N�E■SENN■M■S■OO■■■�M■■ ■■.■■..■N■■M.■M■■......■.■.■■■....■.■..■■■■.■.■■ ■M.■ .MOON■ ...............................................■_ EMUMMEMEMEMC ■■■OM■■■M■■■■■■OOe■■■■■■e■/■■■■■■■■■■e■■■ ■■■■■■ ■■■■ ■■ ■■■■■■■ .....■...................................�....�... ■■■■■■■M ■■■■■■■ MEN SOMEONE ■ ME0�■■■■■■1 ■......■....■■.■■.....■■.....■.N■ ■ loommimom ■■. OMEN IN MEN Him ■■■M.■E■■■■■■■■■.■■■■■■■■■■Nl�����:.�. ■■p� Hr■ ■ ■ ■ NONNI ■■■■■■ M■■MMM■ MM■ME■ ■EMOe ■A■MEN ■■■■ ■ENe■ ME■� EN.NE■ . ENNEN�■M■■■■�■■■■ !HEMM■ ■MEN�EME■EN� ■..■■.■■■■Ne■■■■■SEES ■�I�■■■■■■OMEN OE■■■.■■■■ ■.■■■■■■■.■NOD■..■■■■■.NNO'�O■■■E■�■E■ EN ■■ NEEMEMO■ MEMMEMON MEN MR O ME MEMEMEMM OEM MINUMMMEMM 0 NOON ME ■■■■■■EOE■EO■■■■■EO■Ne■■■■■■■■■ ■ N■NH ■ ■■■ MEMOMMEMOMEME mmmmmommmol NMI M MEMO ■■■■■■EMe ■■■ H■H■■■■ mom on M No MEMEMMIN ON MOONS 0 ■■■■■■■■■■■■O■■■■n■■■■.■■■■NONE N ■■ uMM■MEM ■.■■■■■■■■■■■OO■■■■■OO■O■N■■MOON■ ■■ H■S■■N/ ■...M.NMMEM.N■N.■■■.M..M■.DONE ■■ ■ MEMEMEM ONO ME ■M■MEN■ M■OM ■ HEMM■M■■MME■ ■mommoom■N■■■M CNM�:C::::DMEMEom MMEMMEN ONEM MUMME . ■o ..::■■ Co ■■■................■■■■■■■■.■E■NMEM ■ N■ ■■■ MMME■ ■■OON......■■...N..O.M....■..■ EEN ■ ■ ■ ■ ■ .....NUMBER= ME ■■ M.....■ ..E■...M..■N.■...NM■. ■ NN MEMBERS SEEM.. NCE■OeeEE.■EO■ME .....■■NEM ■ ■�M■N■EN NOON.. .... ... ......C.....NOMMEMEMENNO■.. .. ■ C ps;EMMOOMMEMMEMMOMME■�■N■■M■EN■ ■ME■■. ■■UMEMME mo■■■N■M.■■■■■■ 00 ON IN■� ■ SMUMEMEMSEN .■■O■MN■■■■■ENE■.■■■.■■■■S■■■uNMEIONOS■NO■■N■OOO■N■.■■N■NMS■■ ■..■■.■■■■�N.■N■N■■■M..■■■■NN■■■■■NMN■■■■■EO■MN■■..ONNE■MUM■ ■■■■■O.■■■ MOON■.EO■■.■■■■.■■■■■■■■■■■ ■.0..■.....■..■■/■.■.00..■ ■■■S■■■..■■■■■N.■■.■.■■■■■■�...■■NON■.NOON■.N■■■■■O.■ENM■.■O■N..■■ MEMO . M • DAVIE COUNTY HEALTH DEPARTMENT �. Environmental Health Section Soil/Site Evaluation J NAME DATE EVALUATED / ADDRESS PROPERTY SIZE 496�6 PROPOSED FACIILTY z�6/, LOCATION OF SITE Water Supply: On-Site Well _ Community Public [/ Evaluation By: Auger Boring Pit �/ Cut FACTORS 1 1 2 3 4 Landscape position L L L Sloe % '- HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 3 4 Texture group Consistence r Structure / Mineralo 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: 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 :lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vl--.-y friable FR-Friable FI-Finn 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 ,;C--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