157 Mockingbird Lane Lot 108-111r Y.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
ewage Treat ent nd /D1' osal R �{(10 NCAC 10A .1934-.1968) Permit Number
Name �FCPC ` Dater`.'
Location _
157/41oa;. L1J
Subdivision Name Lot No. Sec. or Block No.
Lot Size House v.
No. Bedrooms -� No. Baths
Garbage Disposal YES ❑ NO p --l"
Auto Dish Washer YES NO ❑
Auto Wash Machine YES (� NO C1
Type Water Supply
Mobile Home _ Business ___ Speculation
Jo. in Family _
Specifications for Syste 11
'This permit Void if sewage system described below is not installed within 36 months from date'of issue.
{
t
I
i
1 \
pfovements 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: 704-634-59".
Final Installation Diagram:
i
System Installed by
Certificate of Completion Date
*The signing signing of this certificate shall indicate that the system described above has been installed in compli nce 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 HEALTHDEPARTMENT :
IMPROVEMENTS PERMIT AND CERTIFICATE .OVCOMPLETION
'NOTE:. Issued. in Compliance: with G.S. of North Carolina Chapter 130. Article 13c.
Sewage Treatment 'and Disposal Rules (1r0 NCAC 10A .1934-.1968) . Permit .Number
Name , `, _ �,�✓� >.:� A/ Date c _� Ir, b 11242
Location
P5-7 AoekrAjh;r-d11v
Subdivision Name �V' t)'d'i17iiLot No. ' Sec. or Block No.
Lot 'Size' House Mobile Home — _ Business .Speculation.
No.• Bedrooms'. Baths'{ No. in Family
Garbage Disposal YES ' E] N�O .
Specifications for System:
Auto Dish Washer. YES NO p�•'�r-
Auto Wash Machine , YES' NO -El r
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
17
Imp ovements 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 indicatethatrthe system described above has been installed'in' compliance with:
the standards set forth, in the above regulation, but shall in NO way be 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 ,� f
Environmental Health Section 2 %9
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requested By
2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install `� Alter.
Repair
Home Phone
Business Phone
b) Privy Conventional ✓ Other Type
Ground Absorption
c) Sub -Divisions Se Lot No. /p`�o;�/°�
5. System used to serve what type facility: House -*' Mobile Home Business
IndustryOther
b) Number of people �
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions SF
Bed Rooms—_ Bath Rooms .Z Gz 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 3 urinals
lavatory
3
showers 2
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yesy" No
9. a) Property Dimensions 2 C> --o x 7
b) Land area designated to building site
garbage disposal
washing machine /
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.
L iii2,I
atecaner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE TH ALL STATE AN OCAL LAWS
Allow 5 days for processing
Directions to property:
�k
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name_ Lifestyle Home - Woodland Beech St. Lots 108,109, 110, 111 Date
Address Lot Size -.:227z)
FACTORS AREA 1 ARFA 9 AREA R AREA A
1) Topography/ Landscape Position
S
PS
U
S
PS
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
(PSS
�tT
S
PS
U
S
PS
U
1) Soil Structure (12-36 in.)
Clayey Soils
PS
Q,
J P
S
PS
U
S
PS
U
1) Soil Depth (inches)
S
S
S
PS
U
S
PS
U
)Soil Drainage: Internal
S
S
S
PS
U
S
PS
U
External
S
S
PS
U
S
PS
U
1) Restrictive Horizons
Available Space
S
P
S
PS
U
S
PS
U
1) Other (Specify)
S
PS
UU
S
PS
S
PS
S
PS
U
i) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments: �--
Described by _
SITE DIAGRAM
DCHD (6.82)
Title Date