The URL can be used to link to this page

430 Ralph Ratldge Rd A. J DAVIE COUNTY HEALTH DEPARTMENT �_� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION q'{4J *NOTE:Issped in Compliance With Article II of G.S.Chapter 130a Fp i Sanitary Sewage Systems �' �� 1�-.c-.�� Permit Number Name `s n �.i^ :,�C:, \� ? --- DateY c�_�`-� N2 8147 Location ( }ti- IN3)�. (.,'a k 5� ~ v\ \A �' VA Subdivision Name Lot No. Sec. or Block No. �. Lot SizeHouse — Mobile Home — — Business -- Industry No. Bedrooms _.No. Baths — r=— No. in Family _ Public Assembly Other Garbage Disposal YES p NO CJS Specifications for System: Auto Dish Washer YES p NO p� ! o.:, Auto Wash Ma^hine YES p"� NO [] Type Water Supply 'This permit Void if sewage system described below isnot 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/LAYOUT BEFORE INSTALLING THIS SYSTEM. 1- � tJ 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 o �. �w fl otilluIlP F =orrywA\ kyEP� Certificate of Completion. v _ Date 'The signing of this certificate sha�re to, at the y tem described above has been installed in compliance with the standards set forth in the abov �be t ken as a guarantee that the system will function satisfactorily for any given period of time. h _ _ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 4 Davie County Health Department Environmental Health Section P. O. Box 665 � Mocksville, NC 27028 1. Application/Permit Requested By ,-D G o b Mailing Address 5 7��-4Q.'� (f?dga oa c� Home Phone �D9 �9.2 -S/fes/ e c[5 V; ve-.- 1/e 9702-9 n Business Phone yo�63!v:- 9 3 2. Name on Permit if Different than Above 4?E n n H C CL.n n C— 3: Application for: ❑General Evaluation XSeptic Tank Installation Permit 4. System to Serve: ❑ House J'Mobile 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 3 B'Washing Machine No. of Bathrooms 2- ❑ Dishwasher Dwelling Dimensions f �bU 5 4• '• /� ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type %' No. of People Sery IVA No. of Sinks T,� No. of Commodes No. of Urinals No.of Lavatories No. of Water Coolers No. of Showers k Water Usage Figures AIW 7. Type of water supply: ❑ Public X Private ❑ Community 8. Property Dimensions /0 acres Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes JK 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: L TaKe Lal Allo►f-&, mow• A cc)4v IFIL �..- � r•.i�tS�, a.,.l i<tirn � e�+ bh� �ibe�-t� e�' ^iZoo-A. Qe .9 n1,;lc ya��-A -f--err le-4- On Wc-jh`r P%04-4 - `]-Krti t`i�LJ�I,,f ov�fm &J yr L ✓1 'Q R ,e r��' r �1O wT • O -%i I C t- Cl. 1-?�C�l t r'Oy�J �+� /�14 1 J1 .s ii `D rt _1 1� �L�.._j6J -j„-t ` 0 0.� �yr r�� C� wee b i �C km J''k� 1�.�`►�� s c, '�' Cf+• c�� Py r�'ls'c; h)e�"r�s 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. 3. /�'9S' DATE S GNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fandd ECK ONE: 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 al system. ATE tl SIGNATURE DCHD(1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME A� \-�a CJ�p DATE EVALUATED a - ADDRESS `S PROPERTY SIZE a C9A PROPOSED FACIILTY �` � LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By:Q'�EJi Auger Boring )/ Pit Cut FACTORS 1 2 3 4 Landscape position -S S Sloe 9. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH " 42' 2t' �,• Texture groupC Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS -5-5- RESTRICTIVE SRESTRICTIVE HORIZON — -- SAPROLITE -� CLASSIFICATION LONG-TERM ACCEPTANCE RATE 4 V <L4 ILl I SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTA CE RATE: 1 OTHER(S) PRESENT: oNp 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 SILL-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-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 SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralosty 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■/■■■/SSSS ■■■■■■■■■■■■■MMMMM■■■/■■■M■■■■EMM/■■■/EM■M■E■M■M■e■nm■■■■■■ms■■■■■ ■■■■■■■■■■■■■■■■M■MM■M■■EMM■M■■■�■■MM■m■Mn■me■■n■■n■■Mm■em■n■■nM■ ........................... ................... .................. ■■■■■■■■■■■■■■■II/%■►1■■■■■■■■■■■■■■■■■e■■�■■■■:■■■�■■■■:SSSS■■N■■ ■■■■■■■■■■■■■■■�.�■■II■■[I■iii'1l�?�:i�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■M■■■■■■IBJ■Orr■M■■ir►i\%rii■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■Oe■■■■ ■■■■■■■■■■■■■ii■■■mEE■■E■MMM■E■■�■■■■■■■■■■■■■■■■■■■M■■■■■■■■■■■■ :::::::ii::i::�■i:�i■i:i::i:::iii::iii■::::::�■i:Mi::::::::Mi=::: ■■■■■■■■■■■■■■n■m■m■■■SSSS■■nm■■■■■■■■■■■■■■■■■■■■■■■ MEM■O■■■■■ ■ ................................ ................................ ■■■■■m■M■■M■mo■■■■■■■■M■M■■m■■■nM■Mm■■■■■■■■■■m■E■■■■m■■■�■■all■MEN ■■■■■■■■■■■■■■S■■■mMM■m■■■■■■■■■ SOMEONE SSSS■mu■■■■■■■■■■■■■■■■■ ■■■■■■■mmmmM■m■mm■m■m■mM■■m■■■mne■■meM■■E■■■■■■■■■■■■■■:■■■mono■■■ ■Emn■m e■■■■m ■nm■■■ ■■e■■n SSSS■■ SSSS■■ SSSS■ ■■mot■ , ■■■■E■E■■■mM■■■■mm�■■■■■■■nine■■■■m■M■■m■■■■■■■■■■■■■■■■■■ ■■■■n■■■ .....................■................... ....... ■M■E■■■:E■■E■O■m MENEM..........m■m■mmmmO■memo■■■mOm■M■MO■m■ MEMOS■ ■ ommommommmmom■ ...........■■■N■E■S/%_=.......•:�:� .. moon m■MC ■■JIMMEM::: ■■■■MEmeM■E■mem■mEMG�►.�OCE\mEM■<iM c\1■ mmmm No ■:■e ■■■■a■m■m■■mm■■■■■I/ml�!n/►\1m■em!•\ Cry/■�H■■■eH ■■■Mmpou■m Mee■ ■n■■■S■■■■:=_�■■E■Ll■■Illy■�•••\■\��i/G�■mE■■■mE■■:: ■■■■■mean■■momom SSSS■E■■/,%■■o._\`oOL':��u�i��%%%%■■■�■ii..■■E�■■ ■■ ■■■/,!!,\7�',■En■■ ■ ■■■■■O■■►I■■'►ore■SO■■e■■■■O■■■n■■■��/.�1■ ■� m■malufmaLlrym■M■■:■ ■■■EE■■■11■■I�►_\t■■►\■M�Ciimiiiiiiiiii...��a■%iiall ��■■MEm ■■■■1�i1eo■ME■■e■ IN NEW ON MENEM MMENEEMN ■■■■■■■Ee■■■■em■■■■■■■See■Em■Em■�■■mmEHii►\■O mmom■mmm■mmemmo■ IN moommommommomm SSSS■■■ ■■■■■■■■■■■ ■O■■■■Smm■■�mmE m■■E �Im ■ ■■m mmo■mmo■ MEMO ■■■■■■■ ■■■�■■■■■M■�■■■■■■mE■■Hilt■■EO■■eE�/■■ No ■oomm■m■ MEN ■■■■■■■■■■■m■e■MOSS/:J��■■mS■I1■M ■ ■M SSSS■■u■■E ■■ �■■Em�mom■ mmom■■mono MEMNON MEMO on ■■M■u■■■■mm■mmMmm■■E■■■ie■eine■■�._��■f7�t��e■em■m■M■■m■mm■■EmmemE■E■E■ piano ommosomammonommom ■■■■■■■■■■mmmO■■■■m■■mmol■■EIiEfMflOer■YYme■ ■1�■■eH■■e■e■Eme■emO■■m■ ■■See■m■■■HO■■m■mM■mM■IlseMitmMM■■■■m■m■eO ■I�mmn■memm■mmeO■■ME■■■E■ ■■■■■Ema■e■■■mm■nee■■■I■.__�:_::.■�....■.■■+■m mom■■■mem■enmanm■■ Seem■einem■■■OO■■■■■■ mine■emcee■■■VM■■M■MemMSeem■■mMEM■M■■■EM■MEMO■ ee■.e■■■E■■■■.■■■.■.C........... .....■.......................... ................................ m■mommmom■Em■MOM MMMMM■MMMMMM■Mee .................................................................. moon.................................................................. ....................�.............m■■■m■■■■m■■■■■m■H■m■■inn■m■■■■■ ■■■■emmMm■■■■■■E■■Mme■■Ee■■■■■■■��■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NONE■■■■■■■■■■■■■■■■■■■■■■■■■■■E/lim■■■M■M■■■■■■■■■■■■■■■■■■■■■■■■■ k v • `