329 Granada Drive Lots 96-98DAVIE 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 n,.,,, r}s Date ►h,Iwos"J
Location
1 3 2 `i 6r/ NVQ
Subdivision Name ! • N .. - s ,, I Lot No. TV 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: )oo
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑ - '= `� - '�'� z ✓' ,u,c
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
J
Certificate of Completion = �, %i l'� Date % _
'The signing of this certificate shall indicate that the system describedjabove 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
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date-�
Lot Size
FAf`Tf P -Q AREA 1 AREA 9 ARFA 3 AREA A
1) Topography/ Landscape Position
S
S
S
S
PS
PS
PS
U
U
U
?) 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
U
U
U
1) Soil Depth (inches)
S
S
S
S
PS
PS
PS
U
U
U
i) Soil Drainage: InternalS
S
S
p+
PS
PS
PS
U
U
U
U
External
S
S
S
(
PS
PS
PS
U
U
U
i) Restrictive Horizons
y
Available Space
S
S
S
S
0
PS
PS
PS
U
U
U
U
�) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Site Classification
,
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments: IV
Described by �`� Title —���yw Date
SITE DIAGRAM
I0
DCHD (6-E2)
I;; • r
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requested By
2. Address — P p
Home Phone .
Business Phone 9 9 Pry
�L 740
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional YOther Type
Ground Absorption '
c) Sub-Division�9 Iy / n/ TM Sec o 8 Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions—Z WX70
Bed Rooms 3 Bath Rooms 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 2- urinals
garbage disposal
lavatory - showers washing machine
dishwasher sinks
8. a) Type water supply: Public ''�" Private Community
b) Has the water supply sys m een approved? Yes t-'_ No
9. a) Property Dimensions X x_50
b) Land area designated to building site e0--''/ Fit
c) Sewage Disposal Contractor �o r n1 R TL A!5'1-
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is corr ct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
Pbl
Ajv00
�
DCHD (6-82)