333 Granada Drive Lot 99OA
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section V"
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name �� �S Date Z 7
Address Lot Size
,
CAelTnoc APPA 1 APPA 9 ARFA I ARFA d
Topography/ Landscape Position
S
S
ceK::>
S,
PS
S
PS
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)Ful
PS
PS
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
S
19
S
S
PS
S
PS
U
U
U
1) Soil Depth (inches)
S
S
,Gr
S
S
PS
`--a
U
Up" U
U
i) Soil Drainage: Internal
�
�
S
PS
S
PS
U
U
U
U
External
S
S
(fp
S
PS
S
PS
U
U
U
i) Restrictive Horizons
') Available Space -
S
S-
S
PS
U
S
PS
U
3) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
3) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
S—SUITABLE PS—Provisionally Suitable)
- rte,,,,. 4 a �'Y'�• Date z 7—"
Described by �r0 Title
SITE DIAGRAM
DCHD (6-82)
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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 /- o u,i p
2. Address P D /--? D X /
3. Property Owner if Different than Above
Address
Home Phone
Business Phone 9 91rd• / 6 U
—L load
4. Permit To: a) Install Alter Repair
b) Privy Conventional YOther Type
Ground Absorption q
c) Sub -Division) -A i 1vV VYIM Secl� �' Lot No. /
5. System used to serve what type facility: House Mobile Homes
Industry Other
b) Number of people 4-
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions / VX70
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 urinals
lavatory showers �-
garbage disposal
washing machine
dishwasher / sinks /
8. a) Type water supply: Public I---- Private 'Community
b) Has the water supply systom been approved? Yes i,'� No
9. a) Property Dimensions
AS -06—
b) Land area designated to building site eo-w, r4
c) Sewage Disposal Contractor a r N R TL
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? A—
What type?
This is to certify that the information is correc the best of my knowledge.
4_ _gam- - --
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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P DCHD (6.82)
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