P8098 Underpass Rd t/Xd
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DAVIE COUNTY HEALTH DEPARTMENT �..l.j�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems _ Permit Number
Name ,C �:� 4..� ,.y <.�`�4,��Z.r.: �s ::�u��'. .4_�::Date - �L N2 8098
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size / `" � _ House — Mobile Home __ Business __ Industry
41
r.
No. Bedrooms —_ No. Baths -_ No. in Family r _ Public Assembly Other
Garbage Disposal YES, p-' NO ❑ Specifications for System:
Auto Dish Washer YES D/ NO ❑ / �
Auto Wash Ma^hine YES O' NOLI
❑ - ,
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM. to
r v Z
,-r
Improvements permit by '__ _x�
*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
!31
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.
' w
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
4 r t r Davie County Health Department 6 b
_ Environmental Health Section '
P. O..Box 665
Mocksville, NC 27028
i
1 Ppplicatip;terki Requested By
Mailing Address Vh- .r U CJ�—
Home Phone j� Business Phone �7
.�.. e�
2. Name on Permit if Different than Above ,_./
3. Application/Permit for: B Ueneral Evaluation Septic Tank Ins Ilatio
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ IJnknown
5. If house, mobile home: Subdivision Section Lot#
I
❑ Basement/Plumbing
No.of People ❑ BasemenUNo Plumbing
No. of Bedrooms "ashing Machine
No.of Bathrooms / ffl-Dishwasher
• I
Dwelling Dimensions rbage 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 Private g� ❑ Community
8. Property Dimensions_�Za / hGS Sewage Disposal Contractor �t -kT a�be
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No
If yes, what type?
I
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvement ls Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
I
Directions to Property: g ag1d or S'
/o1 s Or
J 4),45 -to
This is to certify that the information provided is correct to the bestof kn and I understand I am responsible for all charges
incurred from this application. -
DATE SIGNATURE
CONSENT FOR SITE EVALUATION IO BE DONE ON ABOVE DESCRIBED PROPERTY
F6anddisposal
CK ONE: ❑ 1. I OWN the property. Ird z. I 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 t e Davie C unty�ea)p Department to enter upon above described
cated in Davie County and owned by e_alc
all testing procedures as necessary o determine said site's suitability for round bsorption sewage treatment
al system.
t
DAT "7� SIGN URE
DCHD(12.90)
A
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation o,
NAME � �S�tJ V ti ,�P-S DATE EVALUATED 1
ADDRESS A'�'`�R PROPERTY SIZE �0 043%�-Z
PROPOSED FACIILTY14
�t9� LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation Bylz-L Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position S 5 S
Sloe - 15� Fs- l5` - S O 77
HORIZON I DEPTH
Texture groupL
Consistence V
Structure
Mineralogy
HORIZON II DEPTH `3
Texture group
Consistence h- S
Structure �'F �-
Mineralogy f > > D
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON r'
SAPROLITE
CLASSIFICATION •S .
LONG-TERM ACCEPTANCE RATE I 1A ,
SITE CLASSIFICATION: Q EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: \� OTHER(S) PRESENT:
REMARKS: 4� .�
GEND
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-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
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• ' Dade County Nealt!i department
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and .dome ,.7�ealtFr � yency
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634.5985
September 21, 1994
Glenn Johnson Builders
Rt. 3, Box 19
Country Circle
Advance, NC 27006
Re: Site Evaluation
Underpass Road/10 Acre Tract
Dear Client:
As requested, a representative from this office visited the aforementioned
site on September 21, 1994. Based upon the information provided on the
application for a site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable on the upper portion for the
installation of an sewage disposal system.
If you have any questions, please feel free to contact this office.
Sincerely,
Charles E: Little, R.S.
Environmental Health Section
CL/wd
Enclosure