The URL can be used to link to this page

286 Hillcrest Dr DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NDTE�Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c 'Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name ,1'%/.�,� /�ti �/ z; Date Date141s' N2 til Location r` 7 ,/ rye �y�v.��✓. Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms — _ No. Baths __ _ No. in Family _ Garbage Disposal YES p NO p'' Specificati ns for ,S ste Auto Dish Washer YES NO p / �. Auto Wash Machine YES �J NO I] o �- Type Water Supply *This permit Void if sewage system described below isnot installed within 36 months from date of issue. j 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. y Final Installation Diagram: System Installed by t 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. ,f- ` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R O. Box 665 R�CG1v Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. S Home Phone ct9P-,A-t05S 7 b 1. Permit Requested By 1Q,8 Q • 1A0,tT Business Phone Cc0 781 On Y 2. Address C± 1 Oin)( 3 04CLy a✓K.W AUC a-)Ooc o 3. Property Owner if Different than Above t c eyl . N e r mck✓-► C Aee1 k jZ Address _211 80K 110 A -Q(yq vire NC 0l onr„ 4. Permit To: a) Install Alter Repair b) Privy ConventionallOther Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Homes Industry Other b) Number of people ©riP 6. a}If house or mobile home, state size of home and number of rooms. House Dimensions X '1 Q Bed Rooms c Bath Rooms—Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals © garbage disposal lavatory showers a washing machine / dishwasher 1 sinks 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? Yesi" No 9. a) Property Dimensions � prn K 13040-M b) Land area designated to building site t A40-rQ c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? Na What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: rA DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION l p� Name Date Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S SS S PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 1Clay) pC• �` �/��/ 5P- S PS PS U U 3) Soil Structure (12-36 in.) /1 S S S S Clayey Soils PS PS PS ( q U U 4) Soil Depth (inches) S S S S PS (S PS PS `t�" U U 5) Soil Drainage: Internal S �� S S P (PSS PS PS U U External S S (� PS PS PS U U 6) Restrictive Horizons 7) Available Space S. S S o PS PS U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: •3 Described by Title Date SITE DIAGRAM r DCHD(6-82)