232 Haywood Dr i+Y.-.r_d•. _„:. -..�•;-., ,.;;. :.:•-:._M,,,..rte'. .:.:s,- � - .,. a._.. < .. .... ....
DAVIE COUNTY HEALTH DEPARTMENT
11MPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: ss in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules(10 NCAC 10A .1934-.1968) Permit Number
7--
Name
- r
Name Date - - L `t NO 5465
Location
.- 1 \ - f
"c �.... '�^'..� S•.to r�L.J\ \V \•..� ...�.. `l f ;•••��i\�2 •�C'� \\\) s\ '����\ `
Subdivision Name\Sl , Lot No. Sec. or Block No.
Lot Size L `� House Mobile Home _ Business Speculation
No. Bedrooms Lj No. Baths No. in Family
Garbage Disposal YES p! NO ❑ Specifications for System:
Auto Dish Washer YES NO fl / r_ > Z ` K` .. ` ,
Auto Wash Machine YES p- NO
Type Water Supply < ' -
*This permit Void if sewage system described below isnot installed within 36 months from date of issue.
-
Improvements p r 't b�y -
*Contact a representative of the Davie County Health Department for fi I ' s p ion of this system between 8:30-
9:30 A.M. or 1,00-1:30 P.M. on day of completion. Telephone Numb r: 04 4-5985.
Final Installation Diagram: Syste n all Xdy
27
Certificate of Completion Date 11)1/K),f
*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
k Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone,l, ��l' '�'/�'�(-s9�'�
1. Permit Reque ted By ��° Business Phone
2. Address
3. Property Owner if Different than Above
Address
4. Permit To:a) Install Alter Repair
b) Privy Conventional.ZOther Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House 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
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 urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public t/ Private Community
b) Has the water supply system been approved?Yes �o
9. a) Property Dimensions ! 7WG
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.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
i
y
DCHD(6-82)
S
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION t
Name `\ Date—
Address
ate Address Lot Size l
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S U S \ �
2) Soil Texture (12-36 in.) Sandy, S
Loamy, Clayey, (note 2:1 Clay) P PS C=S S
U U U
3) Soil Structure (12-36 in.) S
Clayey Soils b
U U U
4) Soil Depth (inches) S
U
5) Soil Drainage: Internal S S
PS �
U U U U
External
P (�tb -4
U U U
6) Restrictive Horizons
7) Available Space Q1 S S
PS S 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 g Title '��*n— Date
SITE DIAGRAM
DCHD(6-82)
(Davie County Nealbf De artment
tl Men
and .dome ..peal y cy
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634.5985
March 1, 1990
Martin Craig Carter
c/o Craig Carter
Rt. 6, Box 100
Advance, NC 27006
Re: Sewage System Installation
Valley View Farms
On Yadkin Valley Road
On Left Past Haywood Drive
Dear Mr. Carter:
The septic tank system that serves this residence was designed,
inspected and approved by this office on October 10, 1989.
With proper maintenance and use it should function properly.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health Section
RH/wd
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*N qTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date 4107
�
Location %
Subdivision Name Lot No. Sec. or Block No.
Lot SizeG House Mobile Home _ Business Speculation
r � -
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES p NO p Specifications for System:
Auto Dish Washer YES Ca NO fl
Auto Wash Machine YES NO p
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1'
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.
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