639 NC Hwy 801S Lot 30DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS• PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in..Compliance -with G:S. of. North Carolina Chapter. 130 Article 13c
Sewage Treattmeni annd,7Disposal Rules ('10 NCAC."10A .1934-.1968), Permit Number
Name r'f� �l (.� '1''1�, Date /T��/ .'s (j[`,= J -''"p
Location —
Subdivision Name, Lot NoSec. or Block No.
Lot Size. XZtQ) House Mobile Home _ - •Business Speculation
No. Bedrooms_ No. Baths= No. in Family. _ C
`Garbage Disposal YES 'NO, E] Specifications .for System:
Auto Dish Washer, YES NO E][�- -� , orf
Auto Wash Machine YES NO {j �`' '
' . Type Water Supply
*This permit Void if sewage system.described below is not installed within 36.months from date of issue.
. - , .r.lt � • rya;; . , '
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,
System Installed by
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERM
• 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.
1. Permit Requested By
2. Address
Home Phone gig -
Business Phone Z e) 6 //
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional A Other Type
Ground Absorption
c) Sub -Division Xaa XIP Sec. Lot No. KD
5. System used to serve what type facility: Housed 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 _7? x 1/7
Bed Rooms 3 Bath Rooms 3 Den w/Close L E -
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
showers
garbage disposal
washing machin
dishwasher sinks /
8. a) Type water supply: Public_X Private Community
b) Has the water supply system been approved? Yes X No
9. a) Property Dimensions ?c x -Q,5-0 - - -
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? ///X__
This is to certify that the information is
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)
Name—
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size
FAr.TOP.q ARFA 1 ARFA 9 ARFA R ARFA A
Topography/ Landscape Position
S
S
S
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)
PS
PS
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
PS
PS
PS
PS
U
U
U
U
i) Soil Depth (inches)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
PS
U
U
U
U
External
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Restrictive Horizons
Available Space
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
Described by _
SITE DIAGRAM
DCHD )6-82)
S—SUITABLE PS—Provisionally Suitable
Title
Date
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT 71
Davie County Health Department M-1
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
)PO X41) K;az.c
1. Permit Requested' y
2. Address AIZ
3. Property Owner
if�if D
Address
nt than Above
G
Home Phone
c
Business Phone l3 q
4. Permit To: a) Install ✓Alter Repair
b) Privy Conventional Other Type
Ground Absorption -I
c) Sub -Division -00 Lnl le-e—Sec. ___L— Lot No. 3 3 Y 3 Z - 3/ -
5. System used to serve what type facility: House. Mobile Home Business
IndustryOther
b) Number of people 110:)C
6. a) If house or mobile home, state size of home a d numb r of � s.
House Dimensions �� 216
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 IL urinals
lavatory
dishwasher
showers
cinkc 3
garbage disposal
washing machine `
8. a) Type water supply: Public L-� Private Community
b) Has the water supply system been approved? Yes ZNo
9. a) Property Dimensions A 60, >/,C- ';Z0, b -C)" .S-
b) Land area designated to building site a J.2- A Lo 0 s_
c) Sewage Disposal Contractor s f -e-1 � I '._�
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.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS /� U
Allow 5 days for processing
Directions to property:
1
Ile,
jP/ ) e ) I �� �' s
3'6
DCHD (6-82)
Name_
Address
F
S
FACTORS
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
AREA 1 AREA 2
Date
Lot Size 1 ."
Y 5-D �i�2tiYpY�
AREA 3 ARTA 4
1) Topography/ Landscape Position�
E.
9)
S
S
S
(PSS
PS
PS
PS
'.) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
PS
PS
PS
U
U
U
Soil Depth (inches)
S
S
S
pS
PS
PS
PS
U
U
U
Soil Drainage: Internal
S
S
S
S
�S7
PS
PS
PS
�j
U
U
U
External
S
S
S
do
PS
PS
PS
U
U
U
i) Restrictive Horizons
Available Space
S
S
S
PS
PS
PS
U
U
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
Site Classification
-
U—UNSUITABLE
Recommendations/ Comments:
Described by
SITE DIAGRAM
DCHD (6$2)
S—SUITABLE Ln --
Title " J�
Sao
Date J—
Pavie (gauutg Pea1#h cBepar#men#
nub Cnme pralth '�Senry
P. O. BOX 665
garkstjille, Tarth ( arolina 27028
OFFICE OF THE DIRECTOR
May 15, 1987
To Whom It May Concern:
The septic tank system that serves the Martin Carter residence
on lot 30 in Raintree was designed and approved by this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health
RH/wd
TELEPHONE
17041 634.5985