161 Brookdale Drive Lot 7 Section 2DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS 'PERMIT AND CERTIFICATE OF COMPLETION
*N E. in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatmen-t and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date
Location
]13_rookc cel e, 7r.
Subdivision Name Lot No. Sec. or Block No<& &6nk
Lot Size House b� Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES :[] NO ❑ Specifications for System:
Auto Dish -Washer YES E] NO -E]
Auto Wash'Machine YES ❑ NO
Type Water Supply
*This permit Void if sewage system described below isnot installed within 36 months from date of. issue.
fi
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
–r[ZANSOU S 6 P�h C, -b-Rla
4-1
(D
Certificate of Completion ile '.-'4'
*The signing of this certificate shall indicate that the system described above has been installed in complian'ce 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.
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DAVfE COUNTI( HEa►LTFi�. DEPARTMENT-` .,
�1 ti IIVIPROVENIENTS' PERMIT AND CERT9FICATE O'F COMPLETION
Issued -in` Conpiance with G.S of North Carolina, Chapfe'r 130 ,Article' 13c
-. Sewage Treatm��erit and Disposal Ru'les� (10,NCAG 10A =1934 '1',968) r Permit'Aumb&
_Name Date'pW
{
Location
r .
110a
rad e-
Subdivision Name''.' ]"
-Lot: N
b
o
Lot Size
House _ t�'� Mobile Home — Business —_ Speculation
No. -Bedrooms No. Baths ,No. in Family — v
Garbage Disposal YES:U1 N0: [] Specifications for System:
Auto D.ish'\Washer YES- E], ; . N0.:Q
-Auto WashlMaciiine YES'; NO
r _ ,.
Type Water Supply ---
*This permit Void if sewage system described bel aw`is not; installed within 36 months from date of; issue.
Improvements permit by.
'Contact a representative of the rDavie County Health Department fdr' 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:
o_
System Installed bye
Certificate.,of..Com.pletion
*The signing of this'certificate shall indicate that the system'. described above has�be'
the standards set forth in the.above regulation, but shall m;NO way be taken as aguarar
satisfactorily for any given period of time. „r
71,
. s
installed; in compliance with
'e that the system will f
unction: .
RECEIVED JAN 0 9 1966
Q` 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.
_
Home Phone ?7� zy/
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1. Permit Requested By Z: -7—J— 1 /, �' �" / G Business Phone
2. Address 3 6 `2� / SZ �/A -✓ C N�, 'z 70 a r,
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type Z
Ground Absorption 6-Alct-r-�
> 7-1 Z-
c) Sub -Division 6Agi&w Weep Sec .0"4 - Lot No. 7
5. System used to serve what type facility: House Mobile Home Business
Industry Other—
b) b) Number of people 2 Cn 3
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions _ ` k G 7 1
Bed Rooms L/ 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
lavatory q showers
dishwasher / sinks
8. a) Type water supply: Public_, Private Community
garbage disposal
washing machine
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 1 2(, 671-
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 o the best of my knowledge.
Date 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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DCHD (6-82)
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Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date Z/ i-Z/n.�
Lot Size la�'- /rQ
FACTORS AREA 1 AREA 2 AREA 3 ARFA 4
Topography/ Landscape Position
9)
S
S
S
PS
S
PS
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
PS
PS
S
PS
S
PS
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
S
PS
S
PS
S
PS
S
PS
U
U
U
Soil Depth (inches)
S
PS
S
PS
U
S
PS
U
Soil Drainage: Internal
S
PS
S
PS
S
PS
U
S
PS
U
External
PS
S
PS
S
PS
U
U
U
�) Restrictive Horizons
Available Space
PS
S
PS
S
PS
S
PS
U
U
U
U
I) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Site Classification
U—UNSUITABLE
Recommendations/ Comments: ell 171
S—SUITABLE PS—Provisionally Suitable
Described by
SITE DIAGRAM /
Q -
DCHD (6-82)
Date