The URL can be used to link to this page

988 Hwy 801N DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION c' *NOTE: 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 Date ��—� _ G �(3 17 i sai Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home — Business Speculation No. Bedrooms No. Baths No. in Family---f Garbage Disposal YES NO ❑ Specifications for Systema: r' Auto Dish Washer YES NO ❑ // i Auto Wash Machine YES ❑ NO ❑ a Type Water Supply _— *This permit Void if sewage system descfibed-below is not installed within 36 months from date of issue. � v ' t 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 1 n Certificate of Completion %' �' Date ��- t *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. A DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name "t(PE F6LDS Date 3 — Address ZIS Lot Size t-J L FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) 0S) (2� PS PS U U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS PS PS U U U U 4) Soil Depth (inches) ( S S PS PS PS U U U U 5) Soil Drainage: Internal �P S S PS S PS PS U U U U External Gb S S S PS PS PS U U U U 6) Restrictive Horizons 7) Available Space S S. S S PS PS PS PS U 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 P — rovisionaliy Suitable Recommendations/Comments: W t�� - e.rr— Syr•r�...� �- �'S STi�.(L CA04h- Described by Title SArfj17*,TZ-'A.+j Date SITE DIAGRAM DCHD(6-82) MAYTNA ' j APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section �z-(K 1P.5, P. O. Box 665 M Mocksville, N.C. 27028 �. >/n CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. ' N Home Phone 99g " go/6 1. Permit Re sted By1 Ile / / �7�)� /_o 1d S Business Phone ��a� 'a 2. Address u' e_ Ad yarn P fid 3. Property Owner if Different than Above J.S 15j-nn A Zzm ry1&-cro a n s r . Address Dk©Ufe ' Ll 130-A' ill 1=�d U(aI)e 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House_.,,CMobile Home Business IndustryOther b) Number of people t 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions4✓ 11400 sa • �-�_ Bed Rooms—, 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 J lavatory showers washing machine dishwasher / sinks y 8. a) Type water supply: Public Und e ldre Community b) Has the water supply system been approved? Yes No,/ 9. a) Property Dimensions 1 � �i0ce b) Land area designated to building site c) Sewage Disposal Contractor 12 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? 0e What type? This is to certify that the information is correct to the best of my knowledge. -- Is - 8� rA 0 Ab1ta Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIAN E WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: l t+k 15 8 40 w ar d S rvrn A� G-r o 0 e fur n make 0. �N 3 h+ on 80l r SA- -�-urr, 'in on Z) rY,merrnan b e-rorTz Q o n9 one J 4o 44-)e �J ro erl� . and 5 �ow d� V � DCHD(6-82)