The URL can be used to link to this page

294 Split Creek Ln (2) DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION a' 3 *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name 1 .�. � .. • s _ Date �� " N27 1>r Location i�3 / r .?l� L� � ,,.�� 'tri �?\^ ._�„•.�. ��y� r �' �' �`. ��\,c��.D`:.:+J�. ,•.tee r •,..,il�, .v.�..;.J_ Subdivision'Name v Lot No. Sec: or Block No. Lot Size 1 t 'N ` House Mobile Home Business Speculation No. Bedrooms .No. Baths No. in Family S Garbage Disposal YES ❑ NO R Specifications for System: Auto Dish Washer YES Ej NO ❑ / - ti. -"� - �, � Auto Wash Ma shine YES NO ❑ _ z " Type Water Supply *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. I S v Improvements permit *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. i Final Installation Diagram: System Installed by i)d r Certificate of Completion ``- S. ` Date J ) 2- "The "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. APPLICATION FOR SITE EVALUATIOWIMPROVEMENTS PE a Davie County Health Department R �r Environmental Health Section 1992 P. O. Box 665 FEB 2 Mocksville, NC 27028 s srr�r 1. Application/Permit Requested By Mailing Address 7;41 ZZI-ack-5tl S Home Phone �Q�— 7540 Business Phone /�9�" 5637 2. Name on Permit if Different than Above 3. Application/Permit for: FrGeneral Evaluation ZSeptic Tank Installation 4. System to Serve: L(House ❑ 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,Washing Machine No. of Bathrooms 3 ER Dishwasher Dwelling Dimensions 3.2 X #I ❑ 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: ❑ Public Q'Private ❑ Community 8. Property Dimensions__'Z00 X too Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2-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: Nwy . (��/ ,Casj -/o CornafzeY �d, f urn O�t- 6'� aT�r Pass t►-n over ba4eh m Creek brid JCc. sio Grna` 7e CGnH/ You (ravel �o F�u/l /ard / // Fi' Id'J &afed 6" idle �',yht. jure G�ocvrr '(hed;rf dr%ve- /)ass /6Q// { /o0sj snob;/e /Ia//1e .1you Wi/l be dr.'v►'nq on a 1LQmPa -Of dr,vQ in the /aAs lure C'a7rJ/ihue 07t d&-" y� .1 �ti rUu�h l G(I^G �S VVVlN/. SL7%e �fJ J e Lif/I over /oo.f1�z9 s�ie rr7eaalow. p h �J 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: el. I OWN the property. ❑ 2. 1 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 of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section } Soil/Site Evaluation NAME u Ce, A DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY 4 y s e LOCATION OF SITEVW iL Water Supply: On-Site Well Community Public Evaluation By.N l.,Auger Boring Pit Cut FACTORS I 2 3 4 Landscape position Slope % Ci- w HORIZON I DEPTH Texture group C L C Consistence FI EI FT F-t Structure C R C t Mineralogy :/ I � HORIZON II DEPTH YA" Texture groupC Consistence IV Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S�e RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S s PS LONG-TERM ACCEPTANCE RATEI < u SITE CLASSIFICATION: EVALUATED BY: Rea LONG-TERM ACCEPTANCE RATE. L OTHER(S) PRES NT: ° 4k \ REMARKS: Pox uo., �.' LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope , T-ATerrace ` 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 ffiable FR-Friable FI-Firnl VFI-Very firm: EFI-Extremely firm Wet r 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 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 ■■■■■■■■■■■■■.■■■■■■■■■■■■■.■■■■I�■■■■■■■■■■■■■■■■.■nae.■■■■■.■■■■ ■.■■■e■■■■■■.■■■.i�■.■ale■■■■■■■■■■■■■■■■■■■■■■■i�■■.e■■■■■■■■■■■■■■■ ■■■■■■■■e■ ■■■■ ■►:e■■■■tri■■■■■■■■■■■®e�;:�e■■.e��■s.._PP.■■■■■■ee■■s■■ ■■ ■■■.■e■a■■e■■■n\wee■e■r�.��.:::c�=ee=�■■s■■■■:..■■e.■ s■■ ■■■■■■■■ iiCii=iiiiiiiiiiiiiiiiie�iiiiiiiii�iiie■iiiiii�iiiiiisiimiiiiiiiiiii ■■■■■■■■■e■■■■■■■■■_■■■■■■■■■■■ekes■■■■e■■■■■■ee■■■■■■■eae■■■■■■■ ■ ■■■■■■ ■eN■■■■■■ .■■■■■■e■■e■■■■■■■■.■e■■■■■■■■■■■..■■■■■■■■■■■ ■■■■■■■ ■■■■ ■■1�■n■■e■■■■■.■■■■■■............................... ....■..■.■■■■. . .................................■....■..■....... .............■C.....e............................................. ■.■■■■ ■■■■■■ .■..■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■.■ ■■■■■■ ■■■e■■■■■e■■■e■e■nee■■.■■■■■u■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ONE ■■■.■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■■.■■■■■■■■■■■■■■■■a■■■■