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P4796 Marchmont Plantation-.__ .:..r...-t-, vw,r..�_�..yT_.. .. ..',..•�aT i .. ✓a.y -. V-'-. -� .= . _ . - \r .._.v - r..w:-., .... .. --..r. 4'J.• c.. 'f'u'�;:i,,p,;n:•r i:ai; ..i: s,.iJ-�'K : <.r.;a.f�;'.t, L.. Y.,e. 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 a. C_"o��\ �� Date 4 Location _IAL J �._ � ;��.-�.",_�.__�,-��_,-��,.,- �� v3 - S _ 1 1��'�, `_' _ '1-1r^) C�«` =� _�_•_\� .i__,..�},... �, -.�7��;. �\\ L- 'ar�J, `�r'1��c-�t�-�\., SUbdiviSiUH Ndll Lot No. Sec. or Block No. Lot SizeHouse �''� Mobile Home _ _ Business __ Speculation No. Bedrooms _ No. Baths 2 No. in Family Garbage Disposal YES NO°❑ Specifications for°System: _ Auto Dish Washer YES �.NO / C)CZ) 1, c Auto Wash Machine YES NO,;❑ `l_ Type Water Supply 2 + CaU \ x 1 „r "This permit Void if sewage,system described below is not installed within 36 months from date of issue. 7 i Y . 1, , oo 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. R� a&0-7"- b Installed stem Final Installation Diagram: =�J System y y� z o° a� o Certificate of Completion �_-� �C,`;' 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. 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 Location Subdivisiorr-Nam Lot No. Sec. or Block No. Lot Size ` �� House Mobile Home _ Business Speculation No. Bedrooms '-� No. Baths �`> No. in Family 1 _ Garbage Disposal YES Z NO ❑ Specifications for -System: Auto Dish Washer YES NO Ej Auto Wash Machine YES NO ❑ ,1' X Type Water Supply �� ,�"C \J __— `This permit Void if sewage system described below is not installed within 36 months from date of issue. .T r- Improvements permit by l r. *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. e Ca Final Installation Diagram: System Installed by i IL � o0 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Ott 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. Home Phone �� 7FI 1. Permit Requested By �� ' v� ��✓ Business Phone 2. Address 7 S A,V° -a /D 3. Property�JOwner if Different than Above s er' r Address f�Prledl+ ('Zg L +,r ��e- «� N L Z 7 fO i � ma aL m0^h-r 1rb;6CFN) 2.3 Qr-rf- 4. Permit To: a) Install ✓ Alter Repair b) Privy ConventionaliZ Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business Industry Other b) Number of people s 6. a) If house or mobile home, state size of home and number of rooms. ;ZA a 7 57"P. 4 Afs'O d&74 House Dim 8 �aX a5 GnRo�e, ;,, ;4A Ovh;4i Raam !/ ,Oue_ 34 X 3 f Bed Roo s Bath Rooms ? Den w/Closet IGS / C/o5efs �'a�cj b) If Business, Industry or Other, State: Nr ber 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 Z washing machine dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes_AZ_No 9. a) Property DimensionsF , o dLY6` risL+ s;Je f i '[s IP-4 sfde. 6nr. 49z-5- b) Land area designated to building site 0�� ower` le"e'( 01 C) Sewage Disposal Contractor e 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of mycknowledge. shi h7 len , _�) D to Owner Sign re OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 1J DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPER]�1l 9vi e LjoU� DATE RECEIVED lUechex,o f-A 1A//�IS/Th`T�O/V (office use only) 1' yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of %e abov:Pte-5SIAN scribed property, however, I certify that I have consent from 0 e1e , owner to obtain a owner's nam site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. . yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. ATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: f owner only T Owners designated representative Anyone requesting results Only those listed below � 7 t AT SIGNATURE DCHD(11/84) i t r` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name- �+.. Date �� — Address Lot Size 3 FACTORS ARE 1 ARL-,Z ARE AREA 4 1) Topography/Landscape Position SP PS U U U 2) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) P PS PS U U U 3) Soil Structure (12-36 in.) S S Clayey Soils P P PS. U 4) Soil Depth (inches) S S S PS-) (PSS PS PS lT' U 5) Soil Drainage: Internal S S S p� PS PS U U U External S S pg PS PS PS U U U 6) Restrictive Horizons 7) Available SpaceS S PS PS U U 8) Other (Specify) S S S S PS PS PS PS U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Prov)sionaliy Suitable Recommendations/Comments: Described by Title Date �$ SITE DIAGRAM {� T DCHD(6-82)