118 W Renee Drive Lot 35lon-._ fl �` . DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued►in: Compliance with G.S. of North Carolina Chapter 130 -Article 13c.
kI!Permit'.Number
z'/-Name /�4,, i Date V142
Location
Subdivision Name/%' Lot No. . - Sec. or Block No. !!
Lot l Size House Mobile Home'— Business Speculation
I
No. Bedrooms ii No. Baths _ No. in Family
Garbage Disposal YES ;E] NO
p Specifications for System:
Auto Dish Washer YES NO ,� x Q� ,�, ,x-�.
Auto Wash Machine YES NO
Type Water Supply w it
it ,
*This permit Void, if sewage system described below is not installed within 36 months from date of issue.
n
!.
e fd
• '
f,
M, 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
i Certificate of Completion �C:� Date�`T
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 p
eriod of time.
_J' APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
v
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 -9 19 - % (o C- (Doll
q
1. Permit Re sted B �� d F �� S Bu 'Hess Phone SAN(
2. Address O
3. Property Owner if Different than Above jomokqu OU W iff?AQ N i'tbosy
Address 5 a Mt
4. Permit To: a) Install ✓ Alter Repair
b) Privy Conventional Other Type—
Gro
ype
Groru'�d Absorption r
c) Sub -Division w 0O D LEf' Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
—
7 IndustryOther
b) Number of people
6. a) If house or mobile home, state size of,home and number of rooms.
House Dimensions 48')r Zb
Bed Rooms Bath Rooms Z 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 garbage disposal
lavatory y showers Z washing machine SES
dishwasher sinks 1
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved Yes No
9. a) Property Dimensions 2 1
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? tj
What type?
This is to certify that the information' is correct to the best of my knowledge.
Z C_40ee�� a�_Zw
Date N Owner ignatur
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
3,
DAVIE COUNTY HEALTH DEPARTMENT o+ ON
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name �/ ohm ti �/loru Date /a -- 2 7- 8 2
Address�/a P t g 3 Lot Size /2-17 X 1 /O
Cr" f 7o/2 -
FACTORS ARFA 1 ARFA 9 ARFA R APPA A
1) Topography/ Landscape Position
S
S
S
PS
S
PS
U
U
�) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
S
S
S
U
U
U
U
3) Soil Structure (12-36 in.)
Clayey Soils
S
C��
S
c±r
(t)
S
U
U
U
I) Soil Depth (inches)
S
S
S
S
i) Soil Drainage: Internal
S
S
P
PS
U
S
External
S
�
U
®
S
U
U
i) Restrictive Horizons
e
06
Available Space
P
U
C�r
I) Other (Specify)
S
PS
S
PS
S
PS
S
PS
•
UU
U
U�^
UU
1) Site Classification
'100-1
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments: N«cp7k- �?E- Someke ek S;7/G - Gf
oSee
.•So: G s-%2ue4^--172-Y7a-/lE CvE,ec 1,w.& k ,>1ee h AW,
Described by" -V- //I"-" Title
SITE DIAGRA
DCHD (6-82) 1' b
.zd 6-e-
rA
Date /a - 27-P2-
° 36'- 5/F
c otitic (l.atuttu �:�c�tlt(j � ����tsttttrttt
�titl 4uttte 31 1t Ii Ca�jcltCt�
P. O. BOX 57
� lacl:sl>cllc, Nortli ( arolina 27028
OFFICE OF THE DIRECTOR TELEPHONE
April 11, 1983 704/ 634-5985
Mr. Tommy Anthony
% Village Builders
P. 0. Box 834
Clemmons, N.C. 27102
Dear Mr. Anthony:
This letter is in regard to a house under construction on Lot 35
Section 3 in Woodlee.
The septic tank permit stated that the lot must be graded in order
to remove surface water from the lot. On April 8, 1983 and on April 11
this office visited said site and it was obvious that more grading work
needs to be done in order to prevent surfaee water from pooling in areas
near the septic tank system. If this surface water is not removed from
the septic system the system will not function properly.
Please contact this office concerning said matter.
RBH/gh
Sincerely,
Ae�/ k��— ��
Robert B. Hall, Jr., Sanitarian
Davie County Health Deparment
Y