513 Ratledge Rd .y�:�.,,y. --may_,;... >.r.az-.':,1' �-.,j•1y A.,,y-.:v •:s' .i ._.....-::il t...,.:/._. r.. .. .t.... _ r i ..s • . •_ .. .-. . ..r -." . .- '" n`ir'vu.- _ ..
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 Tre tment and Disposal
Rules (10 NCAC 10A .1934-,1968 Permit Number .
Name J64D/_� ��.7�''— .X /•� � Ile, Date / �''� �c�_ A0
Location ✓Pl. � � /� ' �f�'✓ `rJi'y.�- �°`' %;'i9 l `r � n
:Subdivision Name Lot No. Sec. or Block No.
Lot Size (> 10 ' House A,""" Mobile Home _ Business Speculation
No. BedroomsNo. Baths -� No. in Family
Garbage Disposal YES p NO 13 Specifications f r System:
Auto Dish Washer YES NO ❑ �';
.Auto Wash Machine YES E NO
r`✓� /�� /�
Type Water Supply _ _
*This permit Void if sewage system described below is not installed ithin 36 months m-dat�ssue. >
Improvements permit by
*Contact a representative of theDavie Qounty.Healih Department for final inspection of this system between 8:30-
9:30 A.M. 0 1:00-1:30 P.M. on da of completion. Telephone Number: 704-634-5985.
Final Instal atio Di ram: System Installed by
r
r
lot
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.
I/
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ,
Davie County Health Department
' Environmental Health Section `���► �, Q�j
P. 0. Box 665 J �� G
Mocksville, N.C. 27028 7/
�o 0 6ro/�
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Il -
1. Permit Requested By Business Phone
2. AddressLgoilk
3. Property Owner if Different than Abdve I,
Address _
4. Permit To: a) Install ✓Alter Repair
b) Privy Conventional-A Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House-,C Mobile Home Business—
Industry—
usiness Industry Other
b) Number of people lM
6. a) It house or mobile home, state size of home @nd number of rooms. L) Ll \�
House Dime sions n g(,Kir� �' e.+ AwrN.&,akly 1�
Bed Rooms Bath Room Den w/Closet
b) If Business, Industry or Other, State: Number of persons served A)
What 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 I sinks
8. a) Type water supply: Public Private Community
b) Has the water supply-system eb en approved? Yet No ✓
9. a) Property Dimensions—(.
imensions (
i
b) Land area designated to�building site
c) Sewage Disposal Contractor
10. Do you nt cipate any additions or expansions of the facility this sewage system is Intended to serve? )5�):_
W
t ty a
This is to certify that the information is correct to the best of my knowledge.
7
DateOwner Signature
OWNER IS SOLELY RESPONSIBL FOR COMPL ANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
cn,
4% 'O.r .� �.�
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r a� Irl
DCHD1642)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
IL/SITE EVALUATION
Name � � Date A97
Address Lot Size "
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S( S
PS PS
U
2) Soil Texture (12-36 in.) Sandy, I� S S S S
Loamy, Clayey, (note 2:1 Clay) 1 Q" PS PS P PS
y / U U
3) Soil Structure (12-36 in.) XIVS S S S
Clayey Soils J P PS P PS
U
4) Soil Depth (inches) S ds S S
PS PS � PS PS
r U U U U
5) Soil Drainage: Internal S S S S
PS PS PS PS
U
External S S S S
A95 PS
U
6) Restrictive Horizons
r
7) Available Space S S S S
g PS
U U U U
8) Other (Specify) S �^S", S
PS S S PS
U U U U
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments: ("o el4lt2—�
Described by Title Z Date
SITE DIAGRAM
' h
DCHD(6-82)
�tt�ie fl�oun#g �ettl#� �epttz#men#
ttnb (Rome Aett1#4 �genru
P. O. BOX 665
AVChsbille, 'North (gurolinu 27828
CONNIE L.STAFFORD,BA,MPH July 10, 1087 TELEPHONE
Health Director (704)634.5985
(704)634-5881
Jackie H. Hall
How a.r'd Realty
330 S. Salisbury St.
Mocksville, NC 27028
Ms. Hall:
On July 8, 1987, this office evaluated 3 sites on a 20 acre tract of
land located on Ratledge Road in Davie County.
The soil conditions on all 3 sites is heavy clay to a depth of 12-14"
then saprolite or weathered rock is encountered. The soil conditions are
unsuitable; however, due to the size of said tract this office feels a
modified, oversized system can be installed. The proposed system will be
designed at a .2 application rate or 200 linear feet per bedroom.
`Before any permit can be issued the exact house location must be
staked and that immediate area evaluated.
If you have any questions, feel free to call.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health
Enclosure
RH/wd