174 Granada Drive Lot 1-CDAVIE 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 —Date
Location
/7q
7 but
Sec. or Bloc No.
Subdivision Name Lot No. V�
Lot Size House — Mobile Home __ Business __ Speculation
No. in Family
No. Bedrooms ', T- No. Baths' L,
Garbage Disposal YES E] NO E],- Specifications for.System:
Auto Dish Washer YES 0 NO
Auto Wash Machine YES [h N 0
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
A
I
ED
-17
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 byC0RtjA,-7-"Z_ -F�"((L
0-4 ti�vi C
Certificate of Co I mpletion DatA
*The signing of this certificate shall indicate that the system de�scr �ed 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.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
,Name' SOIL/SITE EVALUATION Date
lo,
Address Lot Size
FAr.TOP.q ARFA 1 ARFA 9 AREAS ARFA 4
1) Topography/ Landscape Position
S
S
S
S
<9>
PS
PS
PS
U
U
U
U
Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
<!5)
PS
PS
PS
U
U
U
U
Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
/7
PS
PS
PS
U
U
U
Soil Depth (inches)
S
S
S
S
O'SD
P S
PS
P S
LT-
U
U
U
i) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
U
U
U
External
S
S
S
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
PS
PS
PS
U
U
U
9) Site Classification
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS—Provisionally Suitable
Described by Title Date
SITE DIAGRAM
DCHD (6-82)
APPUCATION For-,, SITE EVALLIATION/IMPROVEMENTS PERMIT,
Davie County Health Dopartment
Environmental Health Secdon
P. 0. (k)x 665
Mockaville.N.C. 27028
CONSTRucTION SHALL NOT BEGIN UNTIL lKIPROVEMENTS PERMIT HAS 1WFN 1814101
Home pho -
re
a Property 0 ff DMerent I A I& & I
WW thi e
Address
4. Permit To. 8) Install-kf- AtW— Repair—
b) Privy— Conventional_�� Other Type_
Ground Absorplion
c) Sub -Division LA&Q a�- Sec. -
5. System used to serve what Mm f2cility: House—_ Mobile Homa_�=f Elusinefs—
I A
b) Number of people___='9-_
a) 0 h0L89 or mobile home, state size (if home and number of rooms.
House Dimensions 2- 2 X4 a
Bed Rooms Bath Rooms_ 2-- Dan w/Closet
b) If Butsiness. Industry or Oth4r. State: Number of permis served
What type business. etc.
Estimate arnountof wasto daily (2-4 hours)
7. Number anq Mm of vlar-uping fixtures:
coinmAes 21- urinals--.— garbap Osposal
lavatory 7-- showers waW*V muhine
dishwasber sinks
8. a) Type water supply. Public- F'rivaje-- Community—
b) Has the water supply sys%m been approved? Yes—_ No --
9. a) Property Dimensions
b) Land area designated to buildingjit:1
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility Wis sewalle system is Intended to serve?
What type?
t to the best of my knowledge.
This Is to cortify that the. information i qlco4rre Z'7 11 —
1 NAM
0�A,F.
/V_ 1
7177 -
OWNER IS SOLELY RESPONSIBLE FOH COMP)JA,4--,E Wfly�i AL"TATE AND L
Allow 9.1 days for pi og
Directions to Property.*
CC40 (0-42)