232 Haywood Dr 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
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Name h A '+=... t�c�!cS Date u ! 3 6 7-/2
Location fled, -a ROAD ref h1`w /A:�r�►rs �l�c-e ms- :� C.- u —
Subdivision Name Lot No. Sec. or Block No.
-, Lot Size 60 A House Mobile Home 4Business —_ Speculation
No. Bedrooms �- No. Baths No. in Family _
Garbage Disposal YES :Q NO ❑ Specifications for System:/()()O
Auto Dish Washer YES ❑ NO Q �1
Auto Wash Machine YES ❑ NO .Q
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Im ements 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
i
Certificateof�tion Date �`' i
"The signing of this certificate shall indicate that-the-6yste 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
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name— Date
Address Lot Size—,!4* ,AW
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S
ck) 'V) PS
U U
2) Soil Texture (12-36 in.) Sandy, S �S S S
Loamy, Clayey, (note 2:1 Clay) P PS
�ll7T' U
3) Soil Structure (12-36 in.) S S S
Clayey Soils PPS
4) Soil Depth (inches) S S
US
5) Soil Drainage: Internal S } S S
PS < �'� PS
U "�CIIIIJ .0
External PS &� SS PS
U
U
6) Restrictive Horizons
S17#1 r-----
7) Available Space 0 S
S PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification CA r. It).—C '0
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitgble
Recommendations/Comments:
n�
Described by Title �� Date ,
SITE DIAGRAM
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P. O. BOX 665
Aucksbille, Yarth Carolina 27828
OFFICE OF THE DIRECTOR - TELEPHONE
4704) 634.5985
January 25, 1984
Dr. Landon E. Weeks
1212 Partridge Lane
Winston-Salem, North Carolina 27106
Dr. Weeks:
This letter is in regard to a 60 acre tract of land off
Yadkin Valley Road in Davie County that was evaluated by this
office in order to determine its suitability for installing
a septic tank system.
Based on the soil condition that exists the tract is
classified provisionally suitable for a septic tank system.
Two sites were evaluated on January 23, 1984; one being on a
large, grassy knoll and the other being a heavily wooded area
along a ridge. It should be noted that the soil conditions
in the wooded area are far superior for the installation of a
septic system.
When the house is staked off and your plans are further
finalized, please contact this office so the permit can be
issued.
Please contact this office if you have any questions
or if I could be of further assistance.
Sincerely, n �/
jh Robert B. Hall, Jr. R.S.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Dave County Health Department lit ls/
Environmental Health Section T
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
9/""- -7(,f,(, 5
Home Phone \
1. Permit Requested By e-r ^Atd N Business.Phone 76d 621L
2. Address / A - /0
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) OOP old t-
5.
System used to serve what type facility: House Mobile Home Business ��fp
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of ooms.
House Dimensions p 6�- 3�( O
f k,r� c�,
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 uftrt garbage disposal
lavatory showers washing machine
dishwasher sinks 4L 14 hvH
8. a) Type water supply: Public PrivateCommunity
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor uT�
10. Do you anticipate any additions or expansions of the facility this s wage sy tem is inten ed to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
%2Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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