319 Granada Drive Lots 96-98 (3)6�lel Z&,,�
' DAVIE COUNTY
A PLICATII�ON P
J
ADDR
DIRECTIONS TO SITE
W
/IRONMENTAL HEALTH SECTION
MPROVEMENT PERMIT (REPAIR)
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3_0"'IM001
V/gf— 0 / l i `zo
PHONE NUMBER -
TO SIO NAME
--
LOT # "
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY &Y NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING 5aJSCgv 5a0i7AUAG
DATE REQUESTED 1i� �!' INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193 J
AUTN,(IZA'1:ION NO �.:' : DAVIE COUNTY HEALTH DEPARTMENT
Environmental .Health Section 'PROPERTY (INFORMATION
Petmitte ,s , ( (l ,, ,.� 130 . Box 848
Name: ta`t . ! t�Tf �' ' 1 'T �' `ra- `T +? o ss 11 e C 27028 Subdivision Name: f1+� 11�
�1
Phone # N
"I v C�W,147 x f ��v 0�4{-4348760 i
Directions to property: iC Section: Lot:
AUTHORIZATION FOR
L7 DdcCI.Id�v+�� LFr U,.I WASTEWATER
r'Tax Office PIN:#
SYSTEM CONSTRUCTION
t � G►U t i � 1 �E � � a � t " .MI A (,/ fl "C t " we ' nl� v�+l to � 7 Road Narrte �'-C��.i l�,r,A V Zip, 'Zr%CX7(r�
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior.
to issuance of any Building Permits. This Form/AuthorizationNumber should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I 1of iG.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
r
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
<'�!• � ,,....� `'�- �___� ����� j - . IS VALID FOR A PERIOD OF FIVE YEARS. '
VIRO AL HEALTH SP IAL( T DAT IS UED
M F1�
Is � � � "'y, T_`. F'� �. -, µ k ;y ? Tt Ar z ,,�. F'. — s. � .� -' ,. :. -•-`
4-7 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERT INFORMATION
Permtt e's " "
Name: �J .7, ° {ctC,b.-ln.-I% .,1 �'•� Subdivision Name:'�;r�i1tl_tt.~'
r Directions to poperty. "� 1 r i; c 1 ` .., r ;�-
- ` Section: I ' Lot:
' , , i `'IMPROVEMENT
L-G_fiJ.J,!t.�r1.►g� tT U PERMIT /(TaX f`c�tPIN.#t-� _
-�r-1 ��U t►�! + `, , .0 f is r {, g�'+tY` '� 1� f
tot i -c " '� G. t3'c i.) C -e +� T Road Na e 'l'+► !"` - t'�� zip:
**IDTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
�PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRO�iM1 N`fAL HEALTH SPF�CIALIST ~ DA ISSUED INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE M H # BEDROOMS # BATHS r- # OCCUPANTS GARBAGE DISPOSAL: Yes A o
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS - INDUSTRIAL WASTE: Yes or No
LOT SIZE x�� r TYPE WATER SUPPLY (fir. 7V DESIGN WASTEWATER FLOW (GPD) 31 7 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 'S r ROCK DEPTH I$1 t LINEAR FT. e 02[ 1 t
OTHER 1 j-
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
q
Q � r
rD ys
'kill,Slr�k�E
"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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
l.�
OPERATION PERMIT 4 j �
SYSTEM INSTALLED BY: � r! Quw, `
?v'
0 P r
tN�t.'T�aS
c
fI
AUTHORIZATION NO. _ OPERATION PERMITBY: fL�DATE: -7 —1 r
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT SYSTEM DESCRIBED E HAS BEEN INSTALLED N COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
74
4 DAVIE COUNTY HEALTH DEPARTMENT � f
- IMPROVEMENT AND OPERATION PERMITS PROPERTINFORMATION
Pegcnittee's ''•`,
Name ��1��'`' � � ��� � � � -�., � 1Subdivision me
e
Directions to property: A
-t Section: p.. Lot:
IMPROVEMENT
,'7c.'rPERMIT ,Tax Cf f'ce PIN:
1 c e r C r „` / L; ',� i
d. c f : y , ¢. Road N e Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the "
constructionlmstallation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
-4-�, ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
" SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRONMENTAL HEALTH SPF�CIALIST DA ISSUED INSTALLING THE SYSTEM. , �ii
RESIDENTIAL SPECIFICATION:'BUILDING TYPE # BEDROOMS # BATHS #OCCUPANTS "'7 eGARBAGE DISPOSAL: Yes
i
"COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE X��f� I TYPE WATER SUPPLY &1,;kq Y DESIGN WASTEWATER FLOW (GPD) `5t NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 77''J ROCK DEPTH ��>LINEAR FT.'��'
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: "�t+�K-'TA44� fC"t� ��`A�7 �I C 1D '00 t`C.&e_eWt 4jte
• �' `: 1.r J . (� r ' (! �1 ( ( 3G rt•i' /' fid . t . ��
IMPR6 ENT PERMIT LAYOUT I'4.
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!t'- .r. _-.1 Ems. ....._/' l �. / _•�..'i ijt... .. _. � / ,.r`. ,0Z.
A
fir% �,�
ra �% ,, c
1 Olw
i
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
y BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT,. tt /�'
, A!!
SYSTEM INSTALLED BY: t'I t z c,
to
�o %ta' /0"
tic 1Jc�t
moo, �7 •
AUTHORIZATION NO. Z OPERATION PERMIT BY: DATE: 1 f
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
_ DCHD 05/96 (Revised)
it
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
a)Tr,
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
n N AS
NAME 'R' t RP 64 U PHONE NUMBER 607-Z'00
ADDRESS 31nl? � nIA �(L, 2.7001. SUBDIVISION NAME L
LOT # I-)
DIRECTIONS TO SITE tom, 000TA -Tio �P�a . }-bw
6"CD Cor- IM , t E)kw
DATE SYSTEM INSTALLED Irl �S NAME SYSTEM INSTALLED UNDER RDq PLITiS
TYPE FACILITYPPML NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY Cis► rL)- SPECIFY PROBLEM OCCURRING 5LXA4U'j0,, 01,3114
' s, AL CAL LWIE w tLr ( PAIDIAb l� T" _T4> e�a�
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
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 10K.1934-.1968) Permit Number
Name Ru, ids - Date' tO - 14 Ar N2 4076
N2
Location
`Subdivision Name ti,�.•-•• ��, �•< <��,r Lot No. q-1 Sec. or Block No..
Lot Size House Mobile Home ^ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES Q NO ❑ Specifications for System: kava
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO ❑ ''e ` Z -a
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: System Installed by cAOr
it'fv
1
Certificate of Completion Date A"/f
"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 ken 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
Name �,..:,� `
` 6
Date
Location
Subdivision Name , . �,
- -- .D
Lot No. q -1 Sec. or Block No.
Lot Size
House
Mobile Home _ Business Speculation
No. Bedrooms
_ No. Baths
No. in Family _
Garbage Disposal
YES
❑ NO ❑
Specifications for System: le.7,
Auto Dish Washer
YES
❑ NO,0
'
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.
rr r^�
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
rl ' rl
l.'
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.
Name_
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size
FAr.Tr1RA ARFA 1 AREA ? AREA:3 ARFA 4
1) Topography/ Landscape Position
S
S
S
S
PS
PS
PS
U
U
U
U
?) Soil Texture (12-36 in.) Sandy,
S
S
S
S
'Loamy, Clayey, (note 2:1 Clay)
4:.J5
PS
PS
PS
U
U
U
U
3) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
b
PS
PS
PS
U
U
U
U
1) Soil Depth (inches)
S
S
S
S
PS
PS
PS
U
U
U
i) Soil Drainage: Internal
S
S
S
2V
PS
PS
PS
U
U
U
U
External
S
S
S
PS
PS
PS
U
U
U
i) Restrictive Horizons
Available Space
S
(TP
S
PS
S
PS
S
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 S—SUITABLE e
Recommendations/Comments: o -GZ
Described by
SITE DIAGRAM
DCHD (6.82)
Title ��L Date
a
I5-2,