171 Tailwind Dr Lot 15 J
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE:Issued in Compliance With Article II of G S.Chapter 130a
Sanitarysp. ag ystems a0 9 g9,oe"a Permit Number
Name O A�`.Cs 0?7//Tbate g-1012 NO 6900
Location eW " /57
T ilw u
Subdivision Name ���n���� Lot No. Sec.or Block No.
1
Lot Size House—ktff:� Mobile Home— Business Speculation
No. Bedrooms 3 No. Baths 62 No. in Family
3
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma,:hine YES ❑ NO ❑
Type Water Supply
'This permit Void if sewage system rib w is nbt installed within 5 years from date of issue.
This permit is subject to re t.
if si a o the intenoed use change.
d�p � rEX:-r7%nA
,Z d
1'
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—,"Zq'nW9 & L
i
�y
J '
i
1
I
f
tti
7
/ E
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.
" t� i�y,` �R"r;-` � .zi;.t?—.*i^-:+r'.w:+ir '^'iW�•wv•rc".'fr+�.c7�:z+�-.uar- -w+F�•:i'•'-"p:-r:�r-va^.rr�i .....-„��,�,-�.pr.i--fir-.�,-.� '.-...,--: --..y- ;- --,�•
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF. COMPLETION
*NOTE:Issued in Compliance With Article II of G S.Chapter 130a
S�a^nitary Sewage Systems a0 ���A�'7 ��”a Permit Number
Name Date ND 69,00
Location /��/�'�i>>�.r/� �l "G'.�� W
i 1N� A
Subdivision Name /�,l/Y�i,�o�/• Lot No. xg� Sec. or Block No.
Lot Size House /� Mobile Home _T Business Speculation
No. Bedrooms No. Baths _02 No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma:hive YES ❑ NO ❑
Type Water Supply —+----
*This permit Void if sewage system rib w is nbt installed within 5 years from date of issue.
This permit is subject to revocat' if si a o the inte"toled use change.
�a L
od
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between
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
Certificate of Completion - '� Date of this' certificate II indicate that the system described above has installed in compliance with
The signing o this cert ficate sha y p
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.e q.:; �,4 �2 .;-tv' t r` ,a;"' r yr " zC'•:^`rr.°1••'r•� fiK a:'�r 1:•�'.,-•��..t....r�r��;•',,..*-r. ` .s -S>� �.r:- . ,. .?�w ,.,.. ,
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of S.Chapter 30a
. 7::
Sanitary Sewage Systems _a0 9 Ir�('���'T ��'�'e Permit Number
Name JD h C.��r '< J� ! 7/� Date " � NO J Q
Location /�7,i';"fi,// �/T /5'
Subdivision Name ,���`���'� Lot No. Sec. or Block No.
Lot Size House Mobile Home —T Business —_ Speculation
No. Bedrooms No. Baths 02 No. in Family —
Garbage'Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ v ��
-Auto Wash Ma.hine YES ❑ NO ❑ /��� �t r ��
Type"Water Supply — __—
'This permit Void if sewage systema rib b ow is nbt installed within 5 years from date of issue.
This permit is subject to revoca ' n if si a o the intehoed use change.
/dal d
i
sf
4
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
Joe)
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"
r
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*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 �� -/�. r •;' t .
Location
Subdivision Name ��`%r ��rfl r` Lot No. Sec. or Block No.
Lot Size House �J Mobile Home _ Business Speculation
No. Bedrooms -131-7— No. Baths _ No. in Family
Garbage Disposal �! YES ❑ NO Specifications for System:
Auto Dish Washer YES I NO ❑
Auto Wash Machine YES NO ❑ fJ
Type Water Supply
. c
*This permit Void if sewage system described below is not installed within 36 months from date of issue.-
. �
V
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
Certificate of Completion '(/ i -r 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.
RECEIVED
2 0 2F'o
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
.rHome Phone yS— 99 4/0
1. Permit Requested By - ote k n P_".14 l�i' t 5 Business Phone 7eU "/y47
2. Address 7 Del Zea P +vt S7r%Ve_ 1)-)', Y gA:13 . fir.-.prnI bj @ ? -71 n 3
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional�G'Other Type
Gro "nd Abssorptioqq�
I�cuyle- rnrav�
c) Sub-Division. loMk .-�r.�,L Sec. Lot No.�
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people -3
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions '16^2 V- 5 011 IL-5 ha pe-) 7-3 3'45'
Bed Rooms 3 Bath Rooms—Den w/Close
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 W0AtV_-5_AV2✓ urinals garbage disposal
lavatory showers waa'hmg machine
dishwasher sinks asZ
8. a) Type water supply: Public Private Community—
b)
ommunity b) Has the water supply//s""ys' tttembe""en approved? Yes✓No-
9.
o 9. a) Property DimensionsS1�a�`z2r ) 35-Z,' X 33V >(A50' )( 1 D D A q L 3 l
b) Land area designated to building site �"
i k. C D'rAve"'A
c) Sewage Disposal Contractor v
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to erve;.
What type?
This is to certify that the information is correct to the best of my knowledge.
sly �'1 '
1
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Ilow days for processing 1 Z �h
w nl
Direc ions to property:
g, A-V Vo`- v-Da" ult- +LL ,-f-br- AAA-j Io � Ctj-t- Ck �5,0_0-,
f ro P 2V �I g i w\,✓rt-t?a-'( a: l h -v -'r`�C..� Y l l pct 4A., Y-u 5+-- bl Dre�.
Hyl- ' y oraE� J
� DCHD(6.62)
s
DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position SSS-- S S S
PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) PS PS PS
U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils d5f::) PS PS
U U U
4) Soil Depth (inches) S S
PS PS PS PS
U U
5) Soil Drainage: Internal S S S
S –P$ PS PS
U U
External S S
PS PS
U U
6) Restrictive Horizons
7) Available Space 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 P, '51- P
U—UNSUITABLE S—SUITABLE PS=Provisionally Suitable
Recommendations/Comments:
Described by Title Date 4
12�
SITE DIAGRAM
DCHD(8-82) -
��T�tP (�IIUYCt�1 �EtIIt� �E�J22X�1ttEtit
M2�t� �IItttP �PMIf� ��PXCt�
P. O. BOX 665
Iflachsiiille, North ( arolina 271128
OFFICE OF THE DIRECTOR TELEPHONE
March 27, 1987 (704) 634.5985
Mr. John Mullis
209 Regent Drive
Winston-Salem, NC 27103
Mr. Mullis:
The on-site sewage disposal system serving your residence in
Marchmont Plantation was installed by Mr. Seabon Cornatzer on March 5,
1987. The installation was inspected and approved by Mr. Buck Hall
of this office on the same date.
Please advise should this office be of further assistance.
Si erely,
('e. ' ' ` 1 R. S .
Joe ando, R. S.
Director of Environmental Health
JM/wd