Loading...
P3475 Sheffield RdDAVIE 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 �?-, fir!, �'A Date `� S�� 3475 Location�it�/r 'rf`id' IF,-, Type Water Supply I *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by 1^'i'��n� ()0 *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 daypf completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed 0W4 C Certificate of Completion %�`'1-� Date3- J *The signing of this certificate shall indicate that the system descri d above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way taken as a guarantee that the system will function satisfactorily for any given period of time. I Subdivision Name Lot No. Sec. or Block No. Lot Size +i House Mobile Home _ "'� Business Speculation No. Bedrooms_ No. Baths No. in Family �Z- Garbage Disposal YES ❑ NO [2 s Specifications for System: 14vo c j. a Auto Dish Washer YES ❑ NO (D - Auto Wash Machine YES ©- NO ❑ Type Water Supply I *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by 1^'i'��n� ()0 *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 daypf completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed 0W4 C Certificate of Completion %�`'1-� Date3- J *The signing of this certificate shall indicate that the system descri d above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name �o b�� �1h{i� Date Address- 2 8-)e Lot Size FACTORS AREA 1 ARFA 9 AREA .q APPA A 1) Topography/ Landscape Position S S S PS PS U U U ?) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) 259 PS PS U U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils dig> d�§' PS PS U U U U I) Soil Depth (inches)e�k �& S S PS PS U U U U i) Soil Drainage: Internal S S S S PS PS U U U U External cir, PS PS U U U U i) Restrictive Horizons Available Space S S. S S PS PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U 1) Site Classification /.S I 1--r U—UNSUITABLE S—SUITABLE (�S—Provisionally Su( a Recommendations/Comments: 0 C 't- - Described by — Title Date 3-- -H SITE DIAGRAM eve rX3�x�y �Ov I X ' DCHD (6-82) 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. Home Phone 1. Permit Request d By Business Phone S y/9 2. Address V Z 3�, 3. Property Owner if DiffVnt than Above Address 4. Permit To: a) Install After Repair b) Privy Conventional!� Other Type Ground Absorption c) Sub -Division Sec. 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 Bed Rooms— 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 l lavatory dishwasher urina showers sinks 8. a) Type water supply: Public Privateb,"" Community b) Has the water supply system been approved? Yes No_iC. 9. a) Property Dimensions -7' 0 � 14 b) Land area designated to building site garbage disposal washing machine c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? Alfa What type? This is to certify that the information is correct to the best of my knowledge. Date Own. S' nature OWNER IS SOLELY RESPONSIBLE FOR COMPLI NCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: _IX r - DCHD (6-82) � W'. 5ke.