The URL can be used to link to this page

153 Cherokee Trail s DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article .13c ( Se ge Treatment and Disposal Rules (10 NCAC 10A .1934-.19 8) Permit Number Name \ /Il��i% Date _� N2 3514 Locations <�s✓�� Subdivision Name Lot No. Sec. or Block No. Lot Size House �obile Home _ Business Speculation No. Bedrooms No. Baths _ No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for S stem: Auto Dish Washer YES ❑ NO ❑ ",, R 1 � v Auto Wash Machine YES ❑ NO ❑ Type Water Supply *This permit Void if sewa system described below is not installed within 36 months from date of issue. op 4- til�1� 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 '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 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 ,/ / 1� �� i� Date �/� , ��/- 3 5 3 S 1 4 Location Subdivision Name Lot No. Sec. or Block No. Lot Size House —L------Mobile Home _ Business Speculation No. Bedrooms— No. Baths _ No. in Family-- Garbage amily _Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO ❑ ��` `✓ ��` Type Water Supply 'This permit Void if sewage system described below is not installed within 36 months from date of issue. /J Improvements permit by i '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 '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. .J�'' DAVIE 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 �, �� 1. — Date f j, /'/ ,i :: 3 J '14 Location 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 ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO ❑ , Type Water Supply 44 - __— "This permit Void if sewage system described below is not installed within 36 months from date of issue. t _ r / /42 Improvements 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 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 ' Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name 05w 'e'- Date Address � c%�7� Lot Size ?� FACTORS. A�REEAA�1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position 'LSi S S PS PS PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS P PS _ 3) Soil Structure (12-36 in.) S S S S Clayey Soils PS PS PS PS U 4) Soil Depth (inches) S S S S p PS P PS U 5) Soil Drainage: Internal S S. S S p j �PS PS PS C'_% <T:) U External � C> <ff> S PS PS PS PS U U U U 6) Restrictive Horizons 7) Available Space S PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification U—UNSUITABLE S—S ITABLE PS—Provisionally Suitable ' Recommendations/Comments: Zz Describedb Title fL Date A A CHD(6-82) APPLICATION FOR SITE EVALUATION/IWIPHOVEMENTS PERMIT } Davie County Health Department Environmental Health Section P. 0. Box 6(35 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENI'S PERMIT HAS BEEN ISSUED. Home Phone__ '� k 1. Permit Requester! By 6V 1Business Phone 2. Address , /'%' ' �' 3. Property Owner if Different than AboveAddress. __- 4. Permit To: a) Install Alter Repair b) Priv Conventional Other Type._— Ground Absorption c) Sub-Division-------- Lot No.—.- 5. System used to serve what type facility: House JMobile Homs Business Industry_—...Cther____ b) Number of people. 4 6 a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms__c2..—.__ Den yr/C!oset_—..___ _ b) If Business, Industry or Other, State: Number of persons served Whet type business, etc. -- Estimate amount of waste daily (24 hours)_—.__ 7. Number and type of water-using fixtures: commodes '� urinals_—_ --_.. garbage disposal lavatory � showers—`� _— —___._ washing machine— dishwasher _ sinks 3. a) Type water supply: Public Private—�__Community b) Has the water supply system been approved? Ye, No 9. a) Property Dimensions -1�.C�_L__ �.-- ---.----- _ — 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 th(. best of my knowledge. ? _ 2 _ Date towner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL.. STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ~— ---------- ---- --..--_ �. /�'/;�� -G'�-� Cc?�C�t=' �-I r�'�-1�E h►eiv� ��i �/<<<� S� �au n,J�t��r s � c�t✓ 0 /,-tl d1l t, 7� De 4_r9 r wed t OCHO(8.32) r