The URL can be used to link to this page

1092 Wyo Rd DAVIE COUNTY HEALTH DEPARTMENT _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION I `NOTE: 1tissued in Compliance with G.S. of North Carolina Chapter 130 Article 130 Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number- Name 1 Date -`"'.1i ;- i fi ^� 3821 Location Subdivision Name Lot No. Sec. or Block No. Lot Size ! f. � ' House Mobile Home —ice Business Speculation Family No. Bedrooms No. Baths —�— No. in y - —. Garbage Disposal YES ❑ NO ❑/ Specifications for System:,, Auto Dish Washer YES NO "❑ �� Auto Wash Machine YES NO ❑ 'C Type Water Supply v *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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. f Final Installation Diagram: System Installed by Certificate of Completions 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. Y I/ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT , Davie County Health Department Environmental Health Section R O. Box 665 ,I Mocksville, N.C. 27028 �Ql CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. l _...� ! Home Phone 1. Permit Requ sted By<�/"i.C�Z/�/� Ate/ Business Phone 2. Address -Z� S'' CO 7/• `' ©� �/ t� �l/ c� Z %l) ,� 3. Property Owner if Different than Above Address ET SZ M je, KSy I I.c nl R vX 7-3Z 4. Permit To: a) Install-ZAlter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile HomelGIbusiness Industry Other b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 47,KZo Bed Rooms c2 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) 'Yd ' E 0 r9k 7. Number and type of water-using fixtures: commodes Z urinals garbage disposal lavatory (0 showers ,� washing machine l dishwasher 6 sinks- 8. a) Type water supply: Public Private // Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions � C'_ 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? _ What type? This is to certify that the information is correct to the best of my knowledge. 14 - Date wrier Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: G y� DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name << .✓� Date /F� Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS U P U U 3) Soil Structure (12-36 in.) S S S Clayey SoilsPS - PS PS U U 4) Soil Depth (inches) S S S PS PS PS U U U U 5) Soil Drainage: Internal S S S S ' ,AP PS PS U 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 S 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: Described by— Title Dat SITE DIAGRAM r e DCHD(6-82)