263 Overlook Drive Lots 3 & P/O 4 Section 2f DAVIE COUNTY HEALTH DEPARTMENT'
IMPROVEMENTS PERMIT AND CERTIFICATE 'OF COMPLETION i
"NOTE: Issued in Compliance with GG:S. of North Carolina Chapter 130, Article 13c i
Sewage Treatment and .Disposal Rules (10 NCAC 10A'.1934-.1968) Permit `rNumber, .
984
Name ' 1! ,A�ca, �e C A; � Date '?. – •' 'r 1 3
Location f
Subdivision Name '' Lot No. 34-4 (ec. r- lock No
Lot Size ! House `Mobile Home — Business.-- Speculation h...
No. Bedrooms ___— No. Baths`-_ No. in Family
Garbage Disposal II YES - ❑ : NO `❑ .
Specifications for System-_-_ p ` ��. ;ice
Auto Dish Washer i YES ❑ NO NO: Ilk"
lk" I
Auto Wash Machine II YES -El N0 '❑
Type Water Supply
This permit Void if -sewage system .described below is not installed within 36 months from date of issue. �
EI
*:Contact a represent
9:30 A.M. or 1:00-1
t�
Improvements permit by•Z Y�c�--
of the Davie County Health Department for final -inspection of this -,system between 8:30-'
P.M. on day Of. completion. Telephone Number: 704-634-5985.
Final Installation Diagram: stem Installed by
t APPLICATION FOF; SITE EVALUATION/IMPROVEMENTS PERMIt
• Davie County Health D,apartment
Environmental lioalth Section `
R 0. Hc,x 665
h-locksville. N.C. 21028
CONSTRUCTION SHALL NOT BEGIN UNTIL lKIPROVEMENTS PERMIT HAS 8GFN 16WI&
1. Pwmit Requested E3ustness Phone 1� A /dI
a Address O /32;L
& Property Owner If Different than Above_—
_ Address
4. Perntft To: e) Irgtatl.—i:fAher__. Repair_.—.
b) Privy Conventional � ther Type—_ -
Ground At►sor Ii jun',. /�
c) Sub -Division �pSec., ...—lot No. -l�'a D
S. SysWrn used to serve what type facility' House_k"' Moble Herne Business_
Industry_.-__ Otficr__.
b) Number of people
f3. a) If hotse or mobile home, state size of oma: and number of rooms.
House Dimensions_.+'.1Q.
Bed Rooms 3 Bath Rooms-._ 2---_ Dan w/Closet._ ..
b) N Business, Industry or Othar, State: Number of persons served
What type business, etc—
Estimate amounfof waste daily (2 4 hours)—...-
7.
ours)—... 7. Number and type of water -using fixturos:
CommAes—,,, garbage disposal —_
lavatory washing machine—
dishwasber / sinks----.�_-----..�—.
8. a) Type water supply. Public_ `�_ F'riv:de_..—_._— Cammunity__.__
b) Has the water supply system been approved? Yes �_._
9. a) Property Dimensions__Lkd ?'_.-3 v _"q-�� _ --
b) Land area designated to building sit:,._ ----
c) Sewnee Disposal Contractor _—: ---------------- ----__ —
10. Do you anticipate any additions or expansions of ttie futility tt.is sewa!Ie system is infe�ded to serve? _ --_---
What type? — — _--- —� — — - ---. _ __ _ — _ _ _----- —-----------
This Is to cortify that the. information i,. coraFj to the best of my knowledge.
Date Owner Signature
OWNER I; SOLELY RESPONSIBLE FOR (;0A4i'LIAv:;E'NITH ALL STATF AND LOCAL LXVS
Directions to property:
CCHO M-42)
Allow E, says for processing
70
IT
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Col '10 3
z6ce fe
Date
Lot Size
Ge(`TnRC ARFA 1 ARTA 2 AREA 3 AREA 4
Topography/ Landscape Position
®
S
PS
PS
PS
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
<257->
--<=>
PS
U
U
U
U
I) Soil Structure (12-36 in.)
S
S
S
—�
S
PS
Clayey Soils
zm>
U
U
U
U
Soil Depth (inches)
'�
va"���
" <�
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S
S
PS
U
U
U
U
External
�
G
S
S
PS
U
U
U
U
i) Restrictive Horizons
') Available Space
S
S
PS
U
U
U
U
S) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
i) Site Classification
�.S
'--(-
I )o9S
U—UNSUITABLE S—SUITABLE � Provisionally Suita
Recommendations/Comments:
—= tn4' Cea&L—fit; S }}�.' hum- Zn. M,a� b.. wo �Uc� a eq,=e w V-0- AAAULS
Described by 4'Ma^^c� Title �-'� Date �'tb -gs"
SITE DIAGRAM I \
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I�
5
Ouei-\ooK- —b
DCHD (6-82)
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