529 Redland Rd DAVIE COUNTY HEALTH DEPARTMENT
t 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 ;.y .'. .r%:,, , ,, /_% Date ;�' �'�/`^--';� 'a`J,
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size 1,7-1% 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
'1
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
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 51,
Certificate of Completion "h� Date '
*The signing of this certificate shall indicate that the system descrit d 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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 110'��
Davie County Health Department '
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 479$" �7�9
1. Permit Requested By —&AAAdBusiness Phone
2. Address ZA-4 to L Tz.—I-- QAJ Xgt_{,AJJ l� C !)ti o&
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair—
b)
epair b) Privy Conventional Other Type-0
"
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home a5d number of rooms.
House Dimensions YoR 4
Bed Rooms Bath Rooms Den w/Closet_
b) If Business, Industry or Other, State: Number of persons served 3
What type business, etc.
Estimate amount of waste daily (24 hours)s�"
7. Number and type of water-using fixtures:
commodes 1Z urinals garbage disposaly
lavatory Si showers 7 washing machine 2ZA1
dishwasher z2ta sinks
8. a) Type water supply: Public —Private Community
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions
b) Land area designated to building sitedc�
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facilit this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
171 Z9-
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
AI ow 5 days for ce ng
67
Directions to property:
y,L
DCHD(6-82)
t _
t
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name— ,
Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S S
PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) PS PS PS
U U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils S PS PS PS
U U U U
4) Soil Depth (inches) S S S S
PS PS PS
U
U U U
5) Soil Drainage: Internal S S S S
PS PS PS
U U U
External S S S S
PS PS PS PS
U U U U
6) Restrictive Horizons
7) Available Space S. S S
PS PS PS PS
U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title Date
SITE DIAGRAM
DCHD(6-82)