124 Tailwind Dr Lot 11DAVIE COUNTY HEALTH DEPARTMENT
=� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOT0• Issued•in Com liance with G S of North Carolina Cha for 130 Article 13c
P P
Sewage�Treatment and Disposal Rules (10 NCAC 10A .1934-..1/968) Permit Number
Name QZ' Date .C! 7, � N2 S U 5 2
Location ,•%� rr _��fi /� �i/ i/ '"' .!f rfr/ n ,✓;L
Subdivision Name 7sI % Lf'„/ /�1�� 41 &r, Lot No. Sec. or Block No.
Lot Size �L'4 House _ Mobile Home _ Business Speculation
No. Bedrooms —IF No. Baths No. in Family
Garbage Disposal YES -p NO e' Specifications for System: ��
Auto Dish Washer YES NO i]
Auto Wash Machine YES $ NO C]�oOc r' Zr f;
Type Water Supply 4.
*This permit Void if sewage system described below is not installed within 36 months” from date of issue.
0
Improvements permit by���'-41—
*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
9
Certificate of Completion Date
*The signing oi
T, K
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Q
Davie County Health Department C��-` `
I� �/ _ Environmental Health Section RE
D� P. O. Box 665
$� v 1 Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Uv
Home Phone E 3 Ll - Y 970
1. Permit Requested By ,4/e V 4. S w Business Phone
2. Address D e 1V E ;2 2006(�
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorp ion
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. a} If house or mobile home, state size of home and number of rooms.
House Dimensions 3 o X 3C. 10,< 30 L IS4 4P -9d
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 3 urinals garbage disposal
lavatory 3 showers 3 washing machine c�
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yesy' No
9. a) Property Dimensions oN 4 a •&, e/t S e 51 C/ e_
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? AIQ
What type?
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
O I Allow 5 days for processing
Directions to property:
o'h
109 rc r7 oA/
PAN 4- g 4 oN
DCHD (6.82)
w r
r
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size�C
E
FACTORR ARFA 1 AREA 9 ARFA 3 ARCA A
1) Topography/ Landscape Position
�
ctS:::a
P
U
U
U
U
2) Soil Texture (12-36 in.) Sandy,—S--
Loamy, Clayey, (note 2:1 Clay)
cpj
'-'Ds)
"U
AP_
PS
U
U
3) Soil Structure (12-36 in.)
Clayey Soils
P
b
S
91
S
l) Soil Depth (inches)
S`
�
S
PS
S
U
U
i) Soil Drainage: Internal
Se
S
S
cF
U
External
S
®
U
�
U
SSS
�t7
i) Restrictive Horizons
Available Space
S
PS
PS
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
1) Site Classification
S
�U
7.
U—UNSUITABLE
Recommendations/ Comments:
Described by _
SITE DIAGRAM
DCMD (6-82)
S—SUITABLE PS—Provisionally Suitable
Title <" Date7 �f
)(r
X2
Xy