197 Granada Drive Lot 66DAVIE 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)
Name F)TT5 10EA L-[�/ & - -'�-o - �� Q/
Date
Location
/ . I
Permit Number
NQ � 3604
Subdivision Name LA Q U1 �JTA - Lot No. ED — Sec. or Block No.
Lot Size . House — Mobile Home Business — Speculation
No. Bedrooms No. Baths Z- No. in Family
Garbage Disposal YES El NO E] Specifications for System: /00 0
Auto Dish Washer YES � NO F]
Auto Wash Machine YES NO -E]
Type Water Supply
*This permit'Void if sewage system described below is not installed within 36 months from date of issue.
I
Improvements permit by
1(�� P S I S -1 �'j"
'SNA-Gt,,,,
*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 indicate that the system described ove 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
-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
TT-->
Name Date 2-0 -K Qf
Location
Subdivision Name- Z -A C.PUIULA Lot No. �o (n Sec. or Block No.
Lot Size - House - Mobile Home Business Speculation
No. Bedrooms No. Baths -Z- No. in Family
Garbage Disposal YES E-] NO El
Auto Dish Washer YES � NO C] Specifications for System: /000
Auto Wash Machine YES N 0 -F-1 2 (D 0 33 'A
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
I
Improvements permit by
k� P S'l 1 -1 � k"
*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:
50
System Installed by a-cof.
Certificate of Completion Date
*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.
4 t
Name—
Address
6
8
9
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
6-7--o-
Date
Lot Size
FACTORS ARFA I ARFA 9 ARFAR APPA A
1) Topography/ Landscape Position
S
S
S
(it)
&P
PS
PS
U
U
U
U
2) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
i2s,
PS
PS
U
U
U
U
3) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
csip
cl�!D
PS
PS
U
U
U
U
t) Soil Depth (inches)
S
S
S
S
(20
cli9�
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
Restrictive Horizons
Available Space
S
S.
S
S
PS
PS
PS
PS
U
U
U
U
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 (6-82)
S—SUITABLE
Title 5��
00
Date(�- 2-0
APPLICATION FORSITE EVALUATION/ IMPROVEMENTS PERN41f,
Davie County Health Department
Environmental Health Section
P 0. Box 665
Mocl(sville. N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPRoVEIVIENTS PERMIT HAS BEEN ISSUjill
Ho r4one
1,., Permit Requestad Rw —pusiness hone
2.1 Address P 'J3 cy-
3., Property Owner if Diftent than Above
4. Permit To: a) InstaII_!�-__AIter_ Repa i r—
b) Privy— Conventlonal_t�Other Type --
Ground Absorplion
c) Sub-Divislo'4j. - I,-, . Sec. -OL Lot No.
S. System used to serve whatwp;e facility: House— Mobile Home. Husliiio_
Indust, -y— Other
b) Number of people
6. a) If hoLse or mobile home, state size of home and number of rooms.
Hou'seDImension3l
Bed Rooms Bath Rooms-. Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Esilmate amountof wasto dally (2-4 hours) ---
7. Number anq type of witer-using lIxturos:
coMmAes-_ 7__ urinals--- garbage cOsposal
lavatory 2— showers washing machine
dishwasber sinks
a. a) Type water supply: Public Privale— Community
b) Has the water supply system been approved? Yes_e�No__
-'9. a) Property Dimon X&�_
SIOM jgt7 &
Ildi
b) Land area desIgnatedto bul n�Lsia
c) Sewage Disposal Contractor - -
10. Do you anticipate any additions or expansions of the facility this sewaue system Is Intended to serve? _A:�L_
What type? 41
This Is to cortify that the informai;ion is, Acorre t the)best owledge.
c9t
w ignature
Date ()��nerSignatu
OWNER IS SOLELY RESPON!31BLE FOR COMPLIANC-E WITH ALL STATE AND LOCAL LAWS
Allow Vdays for processing
Directions to property:
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