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324 Grannamon DrJ HEALTH DEPARTMENT RELEAS Davie County Health Department u� 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Megan Maryanna Favre Address: 324 Grannamon Dr City: Mocksville State/Zip: NC 27028 Phone #: (336) 492-2602 Address 324 Grannamon Drive Road # Mocksville NC 27028 'Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 'Water Supply: N/A Basement: F1 Yes F—] No 'Proposed Improvement: Replace Home For Office Use Only *CDP File Number 197473 - 1 County ID Number: Evaluated For: HDR/WWC PERMIT VALID 1 0 1 5/.1 0 a 0 UNTIL: Property Owner: Megan Maryanna Favre Address: 324 Grannamon Dr City: Mocksville State/Zip: NC 27028 hone #: (336) 492-2602 Property Location & Site Information Subdivision: Township: Directions Hwy 64 West, right on Sheffield Rd. right on Ijames Church Rd. and Right on Grannamon Dr Phase: Lot: Type of Business: Total sq. Footage: No. Of Employees: Tie into existing septic system. Maintain 5 foot setback to any portion of the septic system This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? O Yes O No Applicant/Legal Reps. Signature.. *Issued By- 2140 - Nations, Robert Authorized State Agent: -Z� *Date: *Date of Issue: 1 0/ 1 a ID 0 1 5 **Site Plan/Drawing attached.** �$► Hand Drawing 0 Import Drawing Characters Remaining 658 Drawing Type: HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release CDP File Number: 197473 - 1 County File Number: Date: 10 / 1a/a015 O Inch Scale: O Block ",:_ft. O N/A Drawing Type: HEALTHDEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release Page 2 of 2 CDP File Number: 197473 - 1 County File Number: Date: .1.0, / 1 a/ a 0 15 Davie County Health Department q�18 ,O�nvironmental Health Section _1 P.O. Box 848 _ 210 Hospital Street I J i U Courier # : 09-40-06 n 1 Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: J ' A OA M f e-- Phone Number �3 3 ( q922 2(00'2 (Home) jN� L '6% 909 2 ID (Work)Mailing Address:ZG OP M� LJs LI' I LP i if(_ 2-702- 2� Email Address: Detailed Directions To Site Property Address:gi, ►'✓L W f r D r L Please Fill In The Following Information About The EXISTING Facility: U Name System Installed Undert-� �.� , �1 Old n � ay �� Type Of Facility: mo b � 1 e ` '�' ,n , Date System Installed (Month/Date/Year): OU Number Of Bedrooms: Number Of People:_ Is The Facility Currently Vacant? Yes 0 If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Hvuse/ Number Of Bedrooms: Number of People_ Pool Size: n p� may(/Yv- `, Garage Sizel 57 X to " nn Other: Requested By: y,— o Date Requested: (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash /Checkl Money Order # Paid By: Received By: Account #: 1­5Invoice #: t � <«. r out;; s Printed:Sep 23, 2015 All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website. • DAVIE COUNTY HEALTH DEPARTMENT { IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 1'$ *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 Date Location Subdivision Name Lot No. Sec. or Block No. Lot Size t y House Mobile Home _� Business __ Speculation No. Bedrooms _ No. Baths _ No. in Family Garbage Disposal YES ❑ NO El? Specifications for System: Auto Dish Washer YES El NO ❑ �' �, - Auto Wash Machine YES 0'. NO -❑ Type Water Supply 'This permit Void if sewage system described below is not installed within 36 months from date of issue. i Y 0 i• v 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: l00 System Installed by ."I n �7 2 7/Gg 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. G 'DAVIE COUNTY HEALTH DEPARTMENT v^ -^ -' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION � | *NOTE- |ouUod inCompliance with G.S.of North Carolina Chapter 130 Article 13n ' ,SewagoTreatme6tand Disposal Rules (10 NCAC 10A .193Permit10O8) ��J�� ��|MNber _ Name ` ` ` ` DoteLocation Subdivision Name -Lot No. Sec. or Block No. T� Lot Size House _______ Mobile Home Business --- Speculation No. Bedrooms __��----_ No. Baths No. in Femi|y-_-_-___ Garbage Disposal YES [] NO 0' Specifications for System: Auto Dish Washer YES NO [� Auto Wash Machine YES NO [] Type Water Supply *This permit Void if sewage system described below in not installed within 36 months from date of issue. , ' - / . ' ` .`_ `` -. |mpnovemen�pnnniibv — *Contact a representative of the Davie County Hoo|1h 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 ' 6// Certificate ofCompletion Date *The signing of this certificate shall indicate that the system described obova 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. ' .`_ `` -. |mpnovemen�pnnniibv — *Contact a representative of the Davie County Hoo|1h 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 ' 6// Certificate ofCompletion Date *The signing of this certificate shall indicate that the system described obova 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. 1. Permit F 2. Address 3. Property Address APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT �P�tj Davie County Health Department �c`��,d Environmental Health Section �� P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN, ISSUED. ' Home Phone �r'"�J oxrested By -a7 t �� - ��� Business Phone !tel` 4. Permit To: a) Install Alter 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 I usiness Industry Other 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— �r 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 urinal lavatory 6�1 - showers 3 dishwasher sinks / 8. a) Type water supply: Public Private ✓ Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions ' a- CALL b) Land area designated to building site -' c) Sewage Disposal Contractor garbage disposal washing machine 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 3- 119 Date rrect to the best f my knowledge. Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: klAuIIle , _T3 vies T - _Z //,) Jove - /L J 10 k(Y) 5+4 -ion . Go l Y2, cam- ij kj,-, vnt"o DCHD (6-82) t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 \ SOIL/SITE EVALUATION Name 1� �s �'�'-�`� Date 3 Address Lot Size Y� FACTORS ARFA 1 1 ARFAI? -) ARFJ1 3 I AREA A 1) Topography/ Landscape Position SS� p PS U U 2) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S PS S PS U U 3) Soil Structure (12-36 in.) Clayey Soils S � S PS U U U 1) Soil Depth (inches) S S S PS U U i) Soil Drainage: Internal S �PSp U S `l "!) ) U ExternalS PSD--, U PS U i) Restrictive Horizons Available SpaceS PS �PS U PS U {) Other (Specify) S PS S PS S PS S PS U U U U 1) Site Classification S U—UNSUITABLE S—SUITABLE PS—Provisionally Si Recommendations/Comments: ��� �6 )� 1z�-,� �0 Described by Title Date SITE DIAGRAM C DCHD 1682)