Loading...
P4222 Chinquapin Rdl;{ _ DAVIE COUNTY HEALTH DEPARTMENT t` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ' ;�OTE: 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 ,� �` �'/ ;�r, ,.•�2 Location Subdivision Name Lot No. Sec. or Block No Lot Size f -'%' <' House Mobile Homed Business Speculation No. Bedrooms? No. Baths % No. in Family_ Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ -/�= ..', ,�� �J �5�' Auto Wash Machine I YES NO ❑ ,.,,'� J ,, Type Water Supply"�'. ' --- _.,�-� C_,' *This permit Void if sewage system described below is not installed within 36 months from date of issue. 4: 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 M. Certificate of Completion 'UA!6 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. s APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT � •4 Davie County Health Department ©�� Environmental Health Section ®� P. 0. Box 665 /'�6 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Requested By 2. Address 5 A3 3. Property Owner if Different than Above Address 4. Permit To: a) Installer Alter Repair b) Privy Conventional Other Type Ground Absorption Home Phone (910 3 5 79 Business Phone 6OU4 /rae,. c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Homed Business IndustryOther b) Number of people A 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions -Y Bed Rooms_— Bath Rooms a 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 / lavatory / urinals garbage disposal showers washing machine dishwasher I sinks 1 8. a) Type water supply: Public Private ✓ Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions / _ I n QC b) Land area designated to building site c) Sewage Disposal Contractor 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 correct to the best of my knowledge. Date Ownergnature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 0'w 601 Al - fk - _W Ot L' v-� GA� - oD DCHD (6-82) 0�' Name Christopher Jones Address FACTORS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION AREA 1 AREA 2 Date 3 -, It - FL / Lot Size (4-e— AREA 3 ARFA d 1) Topography/ Landscape Position PS's s e ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) U Name Christopher Jones Address FACTORS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION AREA 1 AREA 2 Date 3 -, It - FL / Lot Size (4-e— AREA 3 ARFA d 1) Topography/ Landscape Position PS's S PS U S PS U ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) U S PS U S PS U f) Soil Structure (12-36 in.) Clayey Soils S S PS U S PS U i) Soil Depth (inches) p �S) lY S PS U S PS U i) Soil Drainage: Internal PS U S PS U S PS U External PS U S PS U S PS U i) Restrictive Horizons Available Space PS U is U S PS U S PS U 1) Other (Specify) S PS U S PS U S PS U S PS U 1) Site Classification - -r — U—UNSUITABLE Recommendations/Comments: Described by SITE DIAGRAM OCHO (6-82) S—SUITABLE �S—Provisionally Suitable Title Date z�v�