229 Haywood Dr Lot 1 DAVIE COUNTY HEALTH DEPARTMENT
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-.168) Permit Number
Name L3. c:`\ � Q ,�'� •;-• -I - N2 It-1402
Location
10
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 -d NO ❑ Specifications for System:
.Auto Dish Washer YES•[/ NO Q
Auto Wash Machine YESL
2 NO fl . • i X � ' � � � ��
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
*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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Certificat of C mple ion S �, Date c �> 2�
"The signing of this certificate shall indicate that a sy tem Vescribed above has been installed in compliance with
the standards set forth in the above regulation, bul shall n NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
v 1 eDavie County Health Department'er 2 9 �
y� V Environmental Health SectionD pEC
` P. O. Box 665 RF-CEIV
1 Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone R `Z Sr - ;:R G P�
1. Permit Reested By a.-y+e-�` g 1`.Q A. � Nc Business Phone 7
2. Address A , b - $ e`�
3. Property Owner if Different than Above
Address
4. Permit To: a nstall Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.//
5. System used to serve what type facility: htous U Mobile Home Business
IndustryOther
b) Number of people
6. a}If house or mobile home, state size of home and number of rooms.
House Dimensions -32 X -5-5-"'
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 3 urinals garbage disposal
lavatory showers a washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community v
b) Has the water supply system been approved? Yes' No-
9.
o 9. a) Property Dimensions a`-� ' a -Ye o 4.eB 1� 4 c L n-r)
b) Land area designated to building site e_lz
c) Sewage Disposal Contractor 7—I'`d 415:o d S c-
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.
,l�- � �► — �� C�� ter• ��..
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. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date / —3 $
Address Lot Size zz�4
FACTORS EA 1
AR AREA AREA 3 AREA 4
1) Topography/Landscape Position S S S
P� PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) P ck> PS PS
U U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils <ZPSb PS PS
U U U
4) Soil Depth (inches) S S S
PPS PS
U -U U U
5) Soil Drainage: Internal SS S
PS PS
U U
External S S
PS PS
U
U U U
6) Restrictive Horizons -�-
7) Available Space 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 Provisionally Suitable
Recommendations/Comments: - n S 6
eco \ Cs��• , �`)
Described by �• Title Date
SITE DIAGRAM
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DCHD(6-82)
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. Dd e County Nealtl Department
and .forme NealtI Ayency
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634-5985
July 21, 1989
Craig Carter
Rt. 6, Box 100
Advance, NC 27006
Re: Sewage System Installation
For: Ken Bud
Valley View Farms
Haywood Drive/2nd Lot on Right
Dear Mr. Carter:
The septic tank system that serves this residence was designed,
inspected and approved by this office on April 26, 1989.
With proper maintenance and use it should function properly.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health Section
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' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME / T PROPERTY ADDRESS yAYU/dfi�O �i'�"�' a DATE
LOCATION y
SUBDIVISION NAME LOT NUMBER 1 SEC./BLOCK NUMBER Sic •?I
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS& i BATHS�r # OCCUPANTS :g GARBAGE DISPOSAL:6No
COMMERCIAL SPECIFICATION: FACILITY TYPE 1( PEOPLE it PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY �) DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE/O[l(Z GAL. PUMP TANK 6R1.. TRENCH WIDTH �� ROCK DEPTH LINEAR FT. ,�
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MAST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
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IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTIMJ OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTAL TI . EPHONE # IS (704 34-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
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AUTHORIZATION NO. OPERATION PERMIT BY DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95 ,
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IPokOVEMENT PERMIT
-------------
##NOTE** This improvement permit DOES NOT,'authorize the construction or installation of a septic,tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this'Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 4
NAME , { 1 4/ 7 PROPERTY ADDRESS A .�eaz� 19t — DATE r `
v/ /
LOCATION ✓
,-
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SUBDIVISION NAME � LOT NUMBER j SEC./BLOCK NUMBER Sec.--Zr
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS,,, # BATHS # OCCUPANTS :V. GARBAGE DISPOSAL: es �o
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY �? DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE, d?, GAL. PUMP TAW GAL. TRENCH WIDTH Z"� ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
*#*THIS_ PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
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IMPROVEMENT PERMIT BV
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTI OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATI EPHONE # IS (70434-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
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AUTHORIZATION NO. OPERATION PERMIT BY �.f/l DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 13OA, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
Davie County Health Department
ENVIRONMENTAL HEALTH.SECTION
P.D. Box 665
Mocksville, N.C. 27028
' AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
issuance of.any Building Permits. This.Form/Authorization Number should be presented to the Davie County Building.Inspections
Office when applying for Building Permits.***
��/'' , J AUTHORIZATION NUMBER
NAME �//°/I/J i y!°/' �/'/i�/S DATE _ S�/3��1N b 0297
NAME ON IMPROVEMENT PERMIT (If different than above)/
SITE LOCATION c;/O( d A V i G aJ `/�/L"'1 .�'ec. 107 �
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
**WICE*m* THIS AUTHORIZATION R WASTEWATER SYSTEMCONSTRUCTION S`VALID FOR A PERIOD:OF FIVE (5) YEARS.
�ENVIRONOtif. HEALTH SPECIALIST \ DATE
�` :DCHD -10/95 J ;
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` DAVIE COUNTY HEALTH DEPARTMENT
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) T�/ Permit Number.
Name 1 - -, r� � 1� Date
Location �� % 'ir, /r;� ✓% — _
Subdivision Name f ` ' -lam r -` ' Lot No. Z Sec. or Block No.
Lot Size ��; House �'� Mobile Home _ Business Speculation
No. Bedrooms �_ No. Baths —? No. in Family
Garbage Disposal YES ❑ NO []�
Specifications for System:
Auto Dish Washer YES NO ❑ ,° t rJ �%<j'
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.
3l�
,I
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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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.