One/two Family Subgrade Verification Form printable pdf download

One/two Family Subgrade Verification Form

ONE/TWO FAMILY SUBGRADE VERIFICATION FORM

FOR MECKLENBURG COUNTY CODE ENFORCEMENT USE ONLY

CHECK AS APPROPRIATE:

[ ] RESIDUAL SOILS

[

] STRUCTURAL FILL

Approx. Depth: _______ft.

Date: _______________

Project Information:

Subdivision:

______________________________________________

Lot Number:

______________________________________________

Street Address:

______________________________________________

Building Permit #:

______________________________________________

Builder/General Contractor:

Company Name:

______________________________________________

Address:

______________________________________________

Phone Number:

_____________________________________________

Soil Engineering Company:

Name:

______________________________________________

Address:

______________________________________________

Phone Number:

______________________________________________

Project Manager:

______________________________________________

Project Number:

______________________________________________

Allowable Bearing Pressure: ________________psf

Personnel from our firm have verified the bearing capacity of soils intended to support the residence noted above.

Where appropriate, we have monitored proofrolling of residual soil prior to fill placement, conducted laboratory

Proctor and field density tests on fill soil, and/or conducted dynamic cone penetrometer tests on subgrade soils.

This work performed in accordance with accepted engineering practice as required by the North Carolina State

Building Residential Code for One and Two Family Dwellings.

_______________________________

Signature/Seal of licensed professional engineer

Form revised:

March 23, 1999

May 20, 2005

May 6, 2015

One/two Family Subgrade Verification Form

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