413 Georgia Rd (2):-) _. u U
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION) '3 6
'
*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 Date00
N2 IZ505
Location Vt
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business - Speculation
No. Bedrooms No. Baths No. in Family ---
Garbage Disposal YES 0 NO 0/ 1 S
Sp mications or Sys em:.
Auto Dish Washer YES p NO T" 06
Auto Wash Machine YES Cq- NO C]
Type Water Supply y 3
*This permit Void if sewage system described below is not installed withi 36 mo hs 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 AMor-t-.00-4-30_�.M. on day of completion. Telephone Number: 704-634-5985. '# 4"""'w,
Final Installation Diagram:
System Installed by
Certificate of Completion Date
certificate shall indicate that the system described above has been installed in compliance with
rth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
DCHD (6-82) -given period of time.
-DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`NOTE:; Issued in Compliance with G.S. of North Carolina. Chapter 130 Article 130'"
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number.,
Name TZ,\J ., v � *-. Date f� I (� `� N2 ) 5
Location
��� � _ � .. Yrl'.. � h�� 1 ? f--�. � }+F,1.. •t7 .S ^ i r \t �\y. 'M •4.�.
Subdivision Name Lot No. Sec. or Block No
Lot Size ? 2). , -:I, `. House Mobile Home Business Speculation
No. Bedrooms No.Baths No. in Family
Garbage Disposal YES p NO a Specifications for System: r:
Auto Dish Washer YES [j, NO o3' oC�_
Auto Wash Machine YES NO..:�
Type Water Supply
*This permit Void if sewage system described below isnot installed within 36 months from date of issue.
1
arca .�
L.
Improvements permit by 3` a
*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. •,..F�
Final Installation Diagram:System Installed by,
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Ira
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Certificate of Completion ����. ZSi�— Date _F)
'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:
r
' APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P O. Box 665 RECEIVED MAR 2 8 1989
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requested By (f, &A
2. Address - 4, -7-7 C
3. Property Owner if Different than Above
AHr4racc
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
Home Phone '/ 92 - 62- 7&
Business Phone
rlv,w.a_ iZ:c1�a1dS
,uGrut l4, n [.
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Bs
Industry Other
b) Number of people -71
6. a7 If house or mobile home, state size of home and number of rooms.
House Dimensions /4/ X 7
Bed Rooms Bath Rooms `L 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
dishwasher sinks
8. a) Type water supply: Public Private ✓ Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor `Z'J
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
garbage disposal
washing machine
This is to certify that the information is correct 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:
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WN
7-17&1--.(-
Directions
-leKc
DCHD
r DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028 �-�–
SOIL/SITE EVALUATION b
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Name Date O J
Address Nc--e Lot Size
FACTORS ARFW 1 \ ARCA 2\ A EFS) ._AR"1rA dl
1) Topography/ Landscape Position
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2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, 2:1 Clay)
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(note
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3) Soil Structure (12-36 in.)
Clayey Soils
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1) Soil Depth (inches)
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i) Soil Drainage: Internal ,
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External
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I) Restrictive Horizons
Available Space
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1) Other (Specify)
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q Site Classification�w
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U—UNSUITABLE S—SUITAB E ` PS—Provisionally Suitable _
Recommendations/Comments:►
%-j
Described by \- - Title Date --�
SITE DIAGRAM 1
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 3
'NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sage Treatmeand DispNoos Rules (10 NCAC 10A .19 1968) Permit Number
�-
Name , (',t�. (r p . �, p �.Q- Date v +J O (�f �
Location � � V
'� C s v ��Q f" rl
Subdivision Name �'�-��• o✓ iLot No. Sec. or Block No.
Lot Size > House Mobile Home —L/ Business Speculation _IJ\
r,
No. Bedrooms - No. Baths =- No. in Family -
Garbage Disposal YES {] NO (,14
S ecifications for System:
Auto Dish Washer YES E]NO Q'. Auto
Auto Wash Machine YES g— NO fl
e b jC
Type Water Supply
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by A
'Contact a represen ive of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A;Nt: b((i! 3� n day of completion. Telephone Number: 704-634-5985.
Installation Diagram: , System Installed by \�--) , _s 1;?
F
Certificate of Completion �`� = �. -- �. 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. .
` DAVIE....COUNTY HEALTH .DEPARTMENT
4. 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 . \y> Date y - �� . i N2 0
Location tj�� G C• ,� Ll \\
Subdivision{ Name Lot No ,� Sec. or Block No.
4
Lot Size House Mobile Home _/ Business s Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES -❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO [D'U ; a_ ` K,-
Auto Wash Machine YES W NO ❑
Type Water Supply y
*This permit Void if sewage system described below is not installed within'36months from date of issue.
1 , I
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, \Q
1
It CN
Certificate of Completion �:N Date
The signing of this'dertificate sha`TI"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.
'^ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P O. Box 665 RECEIVED MAR 2 8 1989
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
This is to certify that the information is correct to the best of my knowledge.
9 s/
�r Date
Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
C
AV
Home Phone '41 9-�Z - 67 2 7S
1. Permit Requested By' �� -�
Business Phone
2. Addresse
J �-
3. Property Owner if Different than Above
t4n'"a.'sz:a^a^dfc•-
Address
as-"
4. Permit To: a) Install Atter Repair
Yn° �• tt� oc'
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
Industry Other
b) Number of people
6. ay If house or mobile home, state size of home and number of rooms.
House Dimensions X (3
Bed Rooms I- 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 -I)- urinals
garbage disposal
lavatory -3 showers /
washing machine
dishwasher sinks
8. a) Type water supply: Public Privatey Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions a3 eL c -a
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? XOAC-e-
What type?
This is to certify that the information is correct to the best of my knowledge.
9 s/
�r Date
Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
C
AV
a,
h
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028 l
1 SOIL/SITE EVALUATION '` p
Name l 'R N3 -k Date
Address A Lot Size
FACTORS
A FIR A l \� A A6 9 --NC A FC�� e
1) Topography/ Landscape Position
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U
2) Soil Texture (12-36 in.) Sandy,
Loamy, (note 2:1 Clay)
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U
U
3) Soil Structure (12-36 in.)
Clayey Soils
pS
PS
SC
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U
l) Soil Depth (inches)
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S
•
U
U
U
i) Soil Drainage: Internal
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P
PS
ExternalS
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PS
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i) Restrictive Horizons
Available Space
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PS
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Lsp-sll
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1) Other (Specify)
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PS
S
PS
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PS.
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1) Site Classification
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Recommendations/ Comments:
Described by
SITE DIAGRAM
UCHD (6-82)
S—SUITABLE
�� n
Title
sionally Suitable
11 3A_ -
Date O /