687 Riverview Rd (3) e ..::. _ . .•.oar .y..1^h L t-s. :: . .. ._. < .. . ,
r " [ DAVIE COUNTY_HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
! NOTE: Issued in Compliance with G.S. of North Carolina ha
� p a C pter 130 Article 13c
-Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
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Na �7
72 met �if� ,C /t/ Date ,Ll� l N2
Location ',{/ ,+��1 '�.1- ,/�' J .r r. .>���:r.- �1� /�/tS er �•c�L
Subdivision NamG,e� Lot No. Sec. or Block No.
Lot Size_ice lJ� House Yf Mobile Home _ r Business Speculation
No. Bedrooms� No. Baths �'-�= �- No. in Family /
Garbage Disposal YES ❑ NO g, Specifications for System: ..;
Auto Dish-Washer ,YEt; ' NO ❑ ,/�d� 1r y'. .�a k
Auto Wash Machine SYES l NO fl
Type Water Supply
*This permit Void if sewage system described below is not installed within 38'months from date of issue.
-1
,f' �+
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:
. is
r _` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department ]
Environmental Health Section ( �(
P. O. Box 665 1 "
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
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0106Home Phone
1. Permit Requested By >LBusiness Phone 999A/o 0
2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional - Other Ty e
Ground Absorption. 9 K TrF4 e 7-7v—,-
c)
7v—,-c) Sub-Division J_ Sec. 8 Lot No./
5. System used to serve what type facility: House Y Mobile Home Business
Industry Other
b) Number of people
6. ay If house or.mobile home, state size of ho number of rooms.
House Dimensions
Bed Rooms Bath Rooms �L 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 e3 showers 1A washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes �o
9. a) Property Dimensions -�Io A e—r
b) Land area designated to building site Z-ra jvT e4 ..t'�_
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 c ect to the best of my knowledge.
Date Owner Signatu
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size t1
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position 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) 09 C y ZW.
U U U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils /X ��/c p,
U U
4) Soil Depth (inches) II6 I��aS
U
5) Soil Drainage: Internal S S S S
U U U U"
External S S
ralfs _®
U U U
6) Restrictive Horizons
7) Available Space
PS 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—SUITABLE PS—Provisionally Suitable
Recommendations/Comments: o
Described by &42� Title Date t,
SITE DIAGRAM
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DCHD(6-82) -
Davie County NealtI De artment
F
and dome .dealt yeney
210 HOSPITAL STREET/P.O.BOX 665
MOCKSVILLE,N.C. 27028
PHONE:(704)634-5985
November 16, 1989
George F. Wilson
c/o Potts Realty
P. 0. Box 11
Advance, NC 27006
Re: Site Evaluation
Riverview Road
Dear Mr. Wilson:
On November 16, 1989, as you requested a representative from this
office visited the above mentioned site. The soil was found provisionally
suitable for the installation of aground absorption sewage system. When
the house is staked off, the permit will be issued.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health Section
RH/wd
Enclosure