428 Woodlee Dr (2) •
`. 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�%c : ..Z_57 Date •�'/�/ '� r�`"~� 1; ` 4106
Location �/ i� /' / -
Subdivision Name Lot No. Sec. or Block No.
Lot Size_, _6 House Mobile Home Business Speculation
No. Bedrooms No. Baths Z No. in Family `?_
Garbage Disposal YES ❑ NO p- Specifications for System:
Auto Dish Washer YES NO ❑ y��`f?=-
Auto Wash Machine YES NO ❑
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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
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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
HomePhone
1. Permit Requested By Business Phone
2. Address .27 C
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ZAlter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Bs
IndustryOther
b) Number of people 3
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
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 -Z urinals garbage disposal
lavatory f showers f washing machine
dishwasher sinks—�
8. a) Type water supply: Public t'_ Private Community
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor
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 my knowledge. .
A/- _
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD(6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name /<S Date
Address Lot Sized
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position Ste, S S S
dp PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) j PS PS PS
U U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils PS PS PS
U U U
4) Soil Depth (inches) S S S S
PS PS PS
'14P U U U
5) Soil Drainage: Internal S S S S
PS PS PS
U U U
External S S S
PS PS PS
U U U
6) Restrictive Horizons
7) Available Space 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 D
U—UNSUITABLE S—SUITABLE �PS—Provisionally Suitable
Recommendations/Comments:
Described by TitleDate
SITE DIAGRAM
DCHO(6-82)
WoodLee V7"Zve,
' Proposed 60' Public .R/"W
EX�st�n9 ZC�+�
Pavement
` 124.27'
J 82.3 ' i 1 22.42,
w O Propo$ed`Well ?A
1 -o° 1 (Located 100' minimum A9.
vdistance from septic system)
CD
o� Proposed 6699,
in., House
i co t 2 Bedrooms
Bath
--------------------------------------
i
1 i
OT 2 N '
LOT , 3
of Tax Lot 89
,x Map C-7 °'- Part of Tax Lot 89 Proposed N
has an existing td
eptic system Tax Map C-7 Septic N
1.54,0 Acres +�— Area
l
THIS PUT Is INIOT A..
l x203.19' '
r 1
F0 lLLU TRA T ION
C
p% d