Loading...
782 Greenhill Rdk DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:`Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems I I Permit Number Name %i> J1 :, J .;'1� l •; i/" ='� t�') NO R LocationSr '_-�/ ; A • r Subdivision Name Lot No. Sec. or Block No. Lot Size House— Mobile Home -T^ Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES p NO p-- Specifications for System: Auto Dish Washer. YES NO p Auto Wash Ma shine YES f77 NO 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. U 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. or 1:00-1:30 P.M. on day, of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by !f'� F , ti Certificate of Completion Date 7 "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. 1. Application/Perry Mailing Address �/ Home Phone _ 7 FSY Business Phone % Y �a 2. Name on Permit if Different than Above APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department lrta- ".1 C tE N E Environmental Health Section P. O. Box 665 J U N 3 Mocksville, NC 27028 I 3. Application/Permit for: 4. System to Serve: ouse ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People ❑ General Evaluation ❑ Mobile Home ❑ Other No. of Bedrooms 3 No. of Bathrooms a a Dwelling Dimensions V x, 70 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories Aseptic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing Basement/No Plumbing D - Washing Machine El ishwasher ❑ Garbage Disposal No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public 21"Private 8. Property Dimensions 7 4rC-e S Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes ❑ Community '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: 1 // quo 411-e>°^ , /�il, r/'I �e5 >rl 7V bn� O �r echo /cryo /Sa /✓ j�uii9 p/4/l �tii/,� 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. 9 DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. M-2—TDO 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 he Davie Cog�n y Healthpepartment to enter upon above described property located in Davie County and owned by �y i// C5-4 �V 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) i/ i. �J. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME% oZ ADDRESS PROPOSED FACIILTY Water Supply: DATE EVALUATED 4 /n PROPERTY SIZE LOCATION OF SITE On -Site Well Community Public Evaluation By: Auger Boring L___� Pit Cut FACTORS 1 2 3 4 Lands -cape position R Sloe % 77 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group' Consistence Structure 97 Mineralogy 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: �A, C1 f Y,1J' EVALUATED BY: ,,oazlll LONG-TERM ACCEPTANCE A REMARKS: DCHD(01-901 OTHER(S) PRESENT: 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 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 ■ommommomm■ MEMEM■■■EM■ ■ENEEMENN■■