157 Riddle Circle Lot 1DAVIE 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) Permit Number
Name^.c..'' \ <,., F� Date'" ` l�' Gi `i";
E:., 4 603
Location I `,'7.— V-
- a
Subdivision Name 5 D 'A�N\ y Lot No. Sec. or Block No. >'
Lot Size House. Mobile Home _ Business Speculation
No. Bedrooms No. Baths No.. in Family
Garbage Disposal YES p NOx
Auto Dish Washer YES vd Specifications for System:
NO p
Auto Wash Machine YES B ,NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
L
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:
1
System Installed by
J
Certificate of Completion Date n 2,-7J
*The signing of this certificate shall indicate that the system describ2d 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 T
Davie County Health Department n�'
Environmental Health Section RECEIVED MAR 0 a 1587
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone c/ f *-S-0 6 -2,
1. Permit Requested By ArT&e Q ' �De � ° �1 r � "" 5���"`r rN�'Business Phone -57J 6 7--
2. Address V 6 0 3 r> Lr c /I/G Q 7e, 0 6
r
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ✓ Alter Repair_
b) Privy— Conventional_V'�Other Type—
Ground Absorption
c) Sub-Divisionspa-1,", DAI K Sec. T Lot No.
5. System used to serve what type facility: House ✓Mobile Home— Business—
Industry— Other—
b) Number of
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 2 8�1 4 (-
Bed Rooms 3 Bath Roomsy Den w/Closet 1Vo
b) If Business, Industry or Other, State: Number of persons served —
What type business, etc.
Estimate amount of waste daily (24 1
7. Number and type of water -using fixtures:
commodes
lavatory _
urinals D garbage disposal 0
showers 17— washing machine
dishwasher I sinks 1
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved?„Yes ✓ No -
9. a) Property Dimensions 3 o X 22
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipgte anydditions or
What type. QNk.12-E f �
zz
of the facility this sewage system is intended to serve?
This is to certify that the information is correc he bes of my knoavledge
�3- 1—'9:7 f
Date Ow er Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH LL STATE AND LOCAL LAWS
Directions to property:
sK (447
DCHD (6-92)
Allow 5 days for processing
CKr D D Le C�Q.c%� e ' 4 4-p” Rb,
j
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name ^T a0S �` Date
Address Lots
F
ff
E
- 2 -gr
FAr..TnRc AREA 1 AREA 2 AREA 3 AREA 4
Topography/ Landscape Position
fD
S
S
S
PS
PS
PS
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
0
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
PS
U
U
U
U
I) Soil Structure (12-36 in.)
_ e�
S
S
S
Clayey Soils
PS
PS
PS
PS
U
U
U
U
Soil Depth (inches)
®
'&.
S
S
PS
PS
PS
PS
U
U
U
U
Soil Drainage: Internal
S
S
S
PS
PS
PS
PS
U
U
U
U
ExternalS
S
S
PS
PS
PS
U
U
U
U
t) Restrictive Horizons
_
)Available Space
S
PS
S
PS
S
PS
U
U
U
U
t) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
I) Site Classification
U—UNSUITABLES—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by Title Date
SITE DIAGRAM
1, 227. /s''
W 10T A
r
DCHD (6-62(