Loading...
163 Jamestowne Dr (2) DAVIE COUNTY HEALTH DEPARTMENT +�O _IMPROVEMENTS PERMIT AND, CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a anitary SewageSystems i �' S Permit Number Name ki �., r':; //� f '''� U .ti Date 3"�� N 5 8 8 1 Location Subdivision Name Lot No. - Sec. or Block No. Lot Size House n �MobiWHome _ Business Speculation No. Bedrooms No. Baths Z No. in Family _ Garbage Disposal YES ❑ NO p' Specifications for System: 7 Auto Dish Washer YES ;❑ NO Auto Wash Machine YES,❑ NO p" ©off -fir' Type Water Supply _ / G X s�► /;� *This permit Void if sewage system described below isnot installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. I' i 1 Improvements permit bye *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 l Certificate of Completion G Date� ` p —z--r *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. s !� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 RECEIVED MAR 0 9 Mocksville, NC 27028 1 . Application/Permit Requested By M.0S - C 157q:r4N L CARiAA5L.,v Mailing Address L • o �Vl -�- (.[/ 'y- C- Home Phone �01 gl Business Phonc@9 - 1 / 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 5k 4A) �- C t21STt/4NSe� 4. Application/Permit For: 0 General Evaluation (/S/Tank Installation 5. System to Serve: 0 House u Mobile Home 0 Business 0 Industry 8-0ther 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions 3 O X ( d No. of Bedrooms Basement/Plumbing No. of Bathrooms I Basement/No Plumbing 0 Washing Machine J Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type WML s4v W: 5 �•UiN 4Ual� No. of People Ser'v'rd 5" A) No. of Sinks a No. of Commodes /-- �- No. of Urinals No. of Lavatories I No. of Water Coolers No. of Showers 8. Type of water supply: Q Public @, Private 0 Community 9. Property Dimensions 5- 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? @-Yes 0 No e If yes, what type? .-e� P ee v� V�ul *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to , the best of my knowledge, and I understand I am responsible for all charges incurred from this application. /17�- 24 Date Signature Directions to Property : Gt92 N�it7—Z Pte- �� DCHD (10-89) t;r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION / Name �� 1tu� Date Z -2,Ag Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S SP �S�` S CU U 2) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) Np- <N� A --�Psx U U U UJ 3) Soil Structure (12-36 in.) S S Clayey Soils b. U U 4) Soil Depth (inches) epw 6925 U U U 5) Soil Drainage: Internal S S PS PS aw U External SS P U U U 6) Restrictive Horizons �-- 7) Available Space �S P PS ` 'pS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification 1/ U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by Title Date SITE DIAGRAM / 2 X DCHD(6.82)