214 Sparks Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTr- Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
'' Sgwage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Nfte _T/ �. Date
Location,i_`r' -- ,/-'y"',
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House Mobile Home= Business Speculation
No. Bedrooms _ No. Baths _ No. in Family
Garbage Disposal YES ❑ NO_p Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES)❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit bY -'���✓G �� -
*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
1
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11
Certificate f 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.
- APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
` Davie County Health Department
Environmental Health Section
P. 0. Box 665 `
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone q q S- `//�10
1. Permit Requested By Thomas R Su�sa �A I(�IewC aft- Business Phone7$'2795 Susan
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2. Address M I -OX Z109 RdWan ce , n C. 27001v
3. Property Owner if Different than Above 1)(3 n `i Wk") t'y--\
Address R- - SOX 3104 A ckjance . 11 � C. 001P
4. Permit To: a) Install Alter Repair (eqv 2S-� �-o
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: HouseJ,00' Mobile Home Business
Industry Other
b) Number of people W O �
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions ) 14 X `7 (P
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 a urinals garbage disposal
lavatory a showers washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No "�
9. a) Property Dimensions 'nom-\K aAZX\-K�-h\R, 2 -k-\S 5
b) Land area designated to building site IV1A f
c) Sewage Disposal Contractor I �` t\�� �oc�����-k Jh��\ ���K- eyAk\jaA_-`o i5 a DOro JOU.
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? €- -2-10 —
What type? ')I)e- a� -1 0 b V i l c� c3 ho U s e. w 't ih ak l e as-�- zoo o ' s pare)
O� \�.1► c�� Si�aC�
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
Allow 5 days for processing
Directions to property:
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C.27028
SOIL/SITE EVALUATION
Name /lF�f,'�' � .oL�l�rJ /�� Date
i
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position SS S S S
�-- PS PS
U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) _ PS PS PS
U U
3) Soil Structure (12-36 in.) S S
Clayey Soils (PSi' PS PS
U � U U
4) Soil Depth (inches) S S
PS PS
U U U U
5) Soil Drainage: Internal S S
SPS PS PS
U U
External S S
PS PS PS
U U
6) Restrictive Horizons
7) Available Space Q S S
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:
Described by Title Date
SITE DIAGRAM
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�M11iE (�IIlirif�T �EIiC�I� �E}JMXtltiEitt
anb Pomo pealth ' $Benry
P. O. BOX 665
urkstbille, �qorth ( aratina 27II28
OFFICE OF THE DIRECTOR TELEPHONE
May 16, 1986 17041 634.5985
Mr. Thomas A. Newman
Route 1, Box 368
Advance, NC 27006
Dear Mr. Newman:
As per your request a representative from this office visited your site
on May 15, 1986 in order to determine the soil/site suitability for the
installation of a ground absorption sewage system. Unfortunately, due to the
following reason we were unable to conduct the evalutaion. Please notify this
office as soon as the item or items below have been completed. Upon notifica-
tion, this office will place your application back in the active file and
again be placed on our work schedule.
No proposed location for a house was staked off.
Sincerely,
610A� 8.
Robert B. Hall, Jr. R. S.
Environmental Health
RBH:sg