146 Idlewild Rd Lot 9 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital street
Mocksville,NC 27028
(336)751-8760
Account #: 990003354 Tax PIN/EH#: 5862-34-9883.09
Billed To: H&V Construction Subdivision Info: Idlewild Lot#09
Reference Name: Location/Address: Gordon Drive-27006
Proposed Facility Residence Property Size: see map
ATC Number: 4276
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CO STRU TION IS VALID FOR A PERIOD OF FIVE YEARS
Environmental Health Specialist's Signature: ? Date: DS
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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. i
/pS
/D
Septic System Installed By: � �"�
Environmental Health Specialist's Signature: Date: /
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
. . Environmental Health Section ed jqjo�
' P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003354 Tax PIN/EH#: 5862-34-9883.09
Billed To: H&V Construction Subdivision Info: Idlewild Lot#09
Reference Name: Location/Address: Gordon Drive-27006
Proposed Facility Residence Property Size: see map
ATC Number: 4276
**NOTE**This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
� t
Residential Specification: Building Type #People #BedroomsC y #Baths
Dishwasher: W Garbage Disposal: Ef— Washing Machine:r Basement w/Plumbing: ❑ Basement/No Plumbing:
Commercial Specification: Facility Type �� #People #People/Shift #S`eatts13� Industrial Waste:
Lot Size Type Water Supply Lg Design Wastewater Flow(GPD) Site: New❑ Repair❑
r • i� s�ten%
System Specifications: Tank Size/a GAL. Pump Tank GAL. Trench Width� Rock Depth Linear Ft,.1 m
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m. on the day of installation. Telephone#is(336)751-8760.****
6�
J
Environmental Health Specialists Signature: / Date:
DCHD 05/99(Revised)
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_ DAVIE COUNTY HEALTH DEPARTMENT
• . Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account M 990003354 Tax PIN/EH#: 5862-34-9883.09
Billed To: H&.V Construction Subdivision Info: Idlewild Lot#09
Reference Name: Location/Address: Gordon Drive-27006
Proposed Facility: Residence Property Size: see map Date Evaluated: I 1 '12-1p4
Wat
-
Water Supply: On-Site Well Community Public ✓
Evaluation By: Auger Boring Pit f Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH - n
Texture group
Consistence l ,r
Structure
Mineralogy
HORIZON II DEPTH -Z
Texture group
Consistence '
Structure
Mineralogy
HORIZON III DEPTH
Texture group r 4t P -
Consistence
Structure QW
Mineralogy
HORIZON IV DEPTH
Texture group rA_-F
Consistence ff C
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE D• -O
SITE CLASSIFICATION: P EVALUATIONBY:
LONG-TERM ACCEPTANCE RATE: +I r�04 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- 3cSticky
NP-Non plastic SP-Slightly plastic P-Plastic VP
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular AB Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic p-
Mineralogy r•
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 05/99(Revised)
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