147 Haywood Dr Lot 5 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
.'NOTE: Issued•in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se age Treatment and Disposal Rules (10 N AC 10A .1934-.1968) Permit Number
Name �D � � C a Date !9 - e- 97 - `t 4 9 1 3
__� _
Location .� ^C t�.• _ �1•.) a t,. r> ti» w , i 1 �t
L /. � ti� \ .r:C\ �� V �` f` _"'. ,`\ "Vii'\ , ? . i�•r __ \ \�\�k ,
Subdivision Name ? 1 ";1tK Lot No. "" t Sec. or Block No. a
Lot Size House Mobile Home _ Business -- Speculation
No. Bedrooms No. Baths _ No. in Family _
Garbage Disposal YES NO El Specifications for System:
Auto Dish Washer YES [:' NO'E] ! ;�,,0 L.
Auto Wash Machine YES „�/ NO {] Ow
Type Water Supply 1.,� -- 40
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*This permit Void if sewage system described below is not installed within 36 months from date of issue.
�J U W W
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 _��
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1�*
a
i
• 1
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Certificate of Completion J Date
*The signing of this certificate shalll 'i dicate that the system desc ibed above as been installed in compliance with
the standards set forth in th abova regulation, but shall in NO way be taken as guarantee that the system will function
` satisfactorily for any given period of time.
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department a1
'Sic?Environmental Health Section O 0
P. O. Box 665
Mocksvil►e, N.C. 27028 ,
PIP
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 919-768-1461
1 Frederick M. Morrison, Jr. Business Phone 919-744-3163
1. Permit Requested By
2. Address 435 'Lynn Avenue, Winston-Salem,. Nc 27104
3. Property Owner if Different than Above Same
Address Same
4. Permit To: a) Install-2L Alter Repair
b) Privy Conventional X Other Type
Ground Absorption
Dalley View Farms #2
c) Sub-Division Sec. - Lot No. 5 (Plat Book 5, page 122)
5. System used to serve what type facility: House X Mobile Home Business
Industry Other
b) Number of people 4
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 3,100 sq. ft.
Bed Rooms 4 Bath Rooms— 1/2 Den w/Closet
b) If Business, Industry or Other, State: Number of persons served N/A
What type business, etc. NJA
Estimate amount of waste daily (24 hours) N/A
7. Number and type of water-using fixtures:
commodes 5 urinals 0 garbage disposal 1
lavatory 5 showers 1 washing machine 1
dishwasher 1 sinks 4
8. a) Type water supply: Public X Private Community
b) Has the water supply system been approved? Yes X No
9. a) Property Dimensions 3.5 acres f; See attached copy of Plat for dimensions
b) Land area designated to building site -Approximate sicrh�--t marked on a aned plata
c) Sewage Disposal Contractor Not determined
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? No
What type?
This is to certify that the information is c rrect to t best of m knowledge.
September 1, 1987
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
Take N.C. Rt. ,801_ North from its intersection with 1-40. Turn right on Yadkin Valley Road
(the first'paved road-to the right; about 300 yards frau I-40) . Go approximately 8 tenths
of a mile and turn left onto Haywood Drive. Property is on the left side at the crest
of the hill.
DCHD(6-82)
/ C�1 l comply with such criteria and conditions except
set forth in such evaluation. For details of this
��• ` ation and for limitations see the written report o
tom ` y S
a �� Q file of the said Department.
\\ ao IMPORTANT NOTICE — This certificate does not
O Q
stitute a pee%it or approval of individual Iota
J/ �Q said subdivision for installation of sewage tocili
' SO2
Date
99 \ ` \
6, .0 ,QS =,..,r+.
"_ ��•, �� �Q , `` Counf 'Health Officer or his
Legal Representative
/
40
E �� � DtO
x,03 CH
$.14�ARC �, OO? Gii' 17riVeway
s 380.00 .
V:440•00 (1(190
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o ti 5A
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p
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90 �� F
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3.535 AC 6 es
17 Apevoy C,*
19
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0� tfouse . coy V'-elrs o \
loj+t,- -81JUE WRITE
20' Utility Easement `95
— — — -- • 172.6 5 /h °\f
o t a 32.0`21,/
Node : Cu ee�t PIa�S w,e- N 44 08 21 W N 330��47„ ��J.H. WALKER
-}o YuK uta+e,v elecr+vic DB 62 PG 197 .
DELMER G. HOWARD
a ielePt%-O,,e� DB 105 PG 387
�oN OJO kos i-L`e sl&e.s SUBDIVISION FOR
+l,e- &V1Vew6.1 fro>ti. JARV I S ENTERPRISES INC.; J.W.R. BUILDING, C'
tom, ,Ayw0CA l�Y. +0 VAL_L_�. EVJ #
house. . PI(.A-s SCALE : I"= 100' SEE 09 118 PG 105 r=636"W: M
INEB u= DATE: 11/10/84
0.I so +0 i�,4c k c_
closed, too P (0.PProx. loo o loo 200
2,000') U3a.i-cr to a:o- FARMINGTON TOWNSHIP DAVIE COUNTY NORTH CAR
e—OUNW keo� Wu -S SA-SATWINis CATES/BENNE T. ASSOCIATES DRAWING NUM
Wou�� b2 lf�i ire -4815 COUNTRY CLUB ROAD 1235
STON-SALEM.NC 27104 765-2377
Opet, -t=i el c e, Yeo.:►' d 4,,e Pro perky .
•, DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION Q
Name � Date
Address M— Lot Size- J �l
FACTORS AR 1 A AREA 3 AREA 4
1) Topography/Landscape Position S S
P
NP
PS PS
U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) < PS PS
U U U U
3) Soil Structure (12-36 in.) S S
Clayey Soils <� PS PS
CPS
� U U
4) Soil Depth (inches) S S S
QZP PS PS
U U
5) Soil Drainage: Internal S S S
PST PS PS
U U U
External S S
PS PS
U U U
6) Restrictive Horizons
7) Available SpaceS S S S
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 CP Provisionally Suitable
Recommendations/Comments:
Described by \ ,� Title Date 4 r
SITE DIAGRAM
DCHD(6-82)
Davie County Nealtli De artment
ealtli men
and .�lvme . y cy
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE'(704)634-5985
June 17,, 1988
Mr. Tom Rice
Sunbelt Mortgage Co.
3069 Trenwest Dr.
Winston-Salem, NC 27103
Re: Sewage System Installation
Frederick Morrison .
Valley View:Farms-Lot 5
Dear Mr. Rice:
The septic tank system that serves this residence was designed,
inspected and approved by this office on September 15, 1987.
With proper maintenance and use it should function properly.
Sincerely,
Charles. E. Little, R.S.
Environmental Health
CL/wd
Enclosure
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