Loading...
307 Rollingwood Drive Lot 4DAVIE 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 Name ii�,�✓J /;'i'Z-7` /�;C�,-� Date — s7 �425144 7 Location //� v �� , % f% - l ) /iii Subdivision Name Lot No. ' -2-' Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms �, No. Baths No. in Family— Garbage Disposal YES ❑ NO 0--' Specifications for System: 1 j Auto Dish Washer YES NO ❑ ✓r . /' Auto Wash Machine YES j NO ❑ (l �wX3X/� Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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: t= System Installed by gS� ' Certificate of Completion �/✓�% Date 9/ *The signing of this certificate shall indicate that the system 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. J z 4 y� APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT�1 ppR i Davie County Health Department SID, Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. y1 n/ c n Home Phone 1. Permit Requested By y��rV� ¢ • /ITS'/.5 TN C Business Phone 2. Address 119 ,FPD% 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter— Repair— b) Privy_ Conventional— Other Type_ I j Ground Absorption \ c) Sub -Division ; 06UTIIAMe S S c. Lot No. +� 5. System used to serve what type facility: House Mobile Home— Business— Industry— Other— b) Number of people 3 6. a) If house or mobile home, ystate size of home and number of rooms. House Dimensionsg`a'P XZg Bed Rooms 3 Bath Rooms 5- Den w/Closet b) If -Business, Industry or Other, State: Number of persons served �0_14 What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes 3 urinals a' garbage disposal lavatory 3 showers 3 washing machine dishwasher ! sinks 8. a) Type water supply: Public Private °� munity b) Has the water supply system been approve ? Yes No— :fd. a) Property Dimensions 2- 1—f' I� �'EA:g ,Re S 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? J?/y What type? This is to certify that the information is correct to the best of my knowledge. 112- )iR 2. Date wne ' nature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-62) I Address DAVIE COUNTY HEALTH DEPARTMENT, Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 _ SOIL/SITE EVALUATION Date Lot FACTORS AREA 1 ARFA 9 ARFA R ARCA A 1) Topography/Landscape Position S S S S PS PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils PS PS PS <y�$/j U U U 1) Soil Depth (inches) S S S S PS PS PS lye U U U i) Soil Drainage: Internal S S S • PS PS PS may/ U U U External S S S PS PS PS U U U i) Restrictive Horizons G— Available Space S 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 S—SUITABLE PS—Provisionally Suitable l�1 Recommendations/Comments: - // �• -jiR ,— Described by f � SITE DIAGRAM DCHD Je.e2i Title Date