P5574 Granada DriveDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION JB�b
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NC
AC 10A .1934-.1968)
Name �fi�trt �cr�1��o`�3/a2 �'��i!��!acL% D�a�y Date
Location
_ pelk-1
Permit Number
N° .5574
%0- '4��l
Subdivision Name V– Lot No. Sec. or Block No.
Lot Size C!94 House Mobile Home Business Speculation
No. Bedrooms No. Baths l No. in Family
.,Garbage Disposal YES p NO. 0- Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES [� . NO p
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
Certificate of Completion Date J /
*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.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Q
"*NG
TE:''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 �Aq��l �er/1, ,102�.�,�/i� c���"i�y Date/l /?9 No 5 74.
Location %//ODS/dr'r ,%y' � .%s����'r G �`zih.Z��L
".,_ _%Ie
Subdivision Name J Lot No. Sec. or Block No.
Lot Size r- House Mobile Home _,j,"' Business Speculation
No. Bedrooms No. Baths
__Z No, in Family
_.,..-Garbage Disposal YES 0 NO p'
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO �]
Type Water Supply
Specifications for System:
I'd
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by 'I -la- / /
*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
Certificate of Completion Z 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.
V ` APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section RECEIVED
P O. Box 665 MAY 0 8. 09
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED../
Home Phone
1. Permit Requested By Business Phone��
2. Address a
3. Property Owner if Different than Above—
Address
4. Permit To: a) Install Alter Repair -
b) Privy Conventional -,k! Other Type
Ground Absorption
c) Sub -Division Sec. Lot N
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a1 If house or mobile home, state size of home and number of rooms.
House Dimensions i (/' 2 e
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 urinals
lavatory
dishwasher
showers
sinks
garbage disposal
washing machine
d
8."'a) Type water supply: Public_Z Private Community
b) Has the water supply system been approved? YesyNo
9. a) Property Dimensions �? t
tz—
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.
'�'/J7
Date Owner Signatur
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
041d,
E
Name—
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size�L°
FAr.T()R:4 AREA 1 AREA 2 AREA 3 ARFA d
1) Topography/ Landscape Position
S
S
S
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
3S
U
S
S
S
U
3) Soil Structure (12-36 in.)
Clayey Soils
PS
lu
�'
S
b
U
I,) Soil Depth (inches)
S
PS
(
(PyY
U
ep�
S
U
U
i) Soil Drainage: Internal
SS
`P
S
S
U
U
External
S
PS
P
bU
-
U
i) Restrictive Horizons
') Available Space
SS
0
P
U
U
1) Other (Specify)
S
PS
U
S
PS
U
S
PS
U
S
PS
U
1) Site Classification
U—UNSUITABLE S—SUITABLE _2,5 --Provisionally Suitable
Recommendations/Comments: 47 j y
Described by Title Date
7`J - - - Date
SITE DIAGRAM !x
�2x
yX
VCHD (6-82)
-? Jr