Loading...
107 Oakridge Lane Lot 61,80,79..+aw•a a.-, -4.,-, •;,.•r ti. 5 v ,yY.,......,,c,�..c-r-�'- snn-;7-rm-'--r^�- 91 I - cl, �p�P HEALTH DEPARTMENT ID CERTIFICATE OF C OMPLETION RN'bTE. ina Chapter 130 Article 13c CAC 10A .1934-.1968) Permit Number Name — ✓y^in�' Date �G�.1 ��i'� 75 N2 J l pa Location Subdivis, Lot Size No. Bedr Lot No. C. or Block No. Home Business Speculation amily Garbage �' �" Specifications for System: Auto Dist Auto Wash Machine YES j NO Type Water 'Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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 satisfactorilv for Anv nivan ncrinrl of fir ^ P�1 • DAVIE COUNTY HEALTH DEPARTMENT � IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NbTE: 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 d �' Dae��/ No '4 a Location rif%-'����.%P,`�%�r' /� f /,.� _ j,•,l%rf ,�� 'v,`r• i���� /�`�` f,J ,�ii Subdivision Name c � ��� � �°� �'A �� Lot No. 6a% 'T�l 9 Sec. or Block No. V. Lot Size House Mobile Home Business Speculation No. Bedrooms \,-S� No. Baths No. in Family Garbage Disposal YES Q NO D' Specifications for System: Auto Dish Washer YES NO 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. r 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. + •�"IE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NGTE: 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 d/<"'It'yi;r �'�,%"�'fr1r3;;% Date �111f :?/~7, ND k d Locationir.t Subdivision Name ' •�/"%' d ,% �i'� ""',� �1^ Lot No. Sec. or Block No. Lot Size House Mobile Home —L"" Business Speculation No. Bedrooms No. Baths? Zt: -, No. in Family Garbage Disposal YES :❑ NO ,p- Specifications for System: Auto Dish Washer YES NO ❑ �,• :, - , - Auto Wash Machine YES j NO ❑ `� ��`�s��'J�-J'. �;-s Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. I 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`1`00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation'Diagram: System Installed by i 1 �r 1 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. ,.; DAVIE COUNTY'. HEALTH DEPARTMENT " IMPROVEMENTS PERMIT AND CERTIFICATE OF -COMPLETION.. `NOTE::Issued in CompIianc6.witf G. S. of North Carolina Chapter 130 .Article 13c Sewa a Tr tment' and Disposal Rules (10 NCAC OA .1934-:19 8) //// P@I'Iti1It t N.umbiq /� f./' -:=Jnr,.. Name �,r'(pGl1/1%1'7iy�A►'pe /f ' S j��JQJ� .4122 1q2 Subdivision ,Name Lot No. Sec. or Block No. Lot Size X �.�~ House .Mobile Home _ lBusiness __ Speculation No. Bedrooms "` No.' Baths No. in Family Garbage Disposal YES ❑ NO] Specifications for /ystem� - _-••� „�;`'`` __ Auto Dish Washer YES ❑ NO- Auto O Auto Wash Machine, YEE�S, ❑ NO ❑ ' �, ;ii ,/ �_ �� Type Water Supply /� "This permit Void if 'sewage system described below is not in ed Wthin months frorX date of issue. 01 J6 �? �(Z'� } it Improvements permit by 'Confact'a representative -of the Davie County Health Department for final j�Jnspection of this system between 8:30= 9:30 'A.M. or 1:00-1:30 P.M. on`day of ."completion.- Number: 704-634-5985. Final Installation Diagram:, System Installedby ii Certificate of Completion __ �' Date "The signing of this certificate shall indicate that the: system .d'escribed above has-been installed in compliance with the standards set forth in -the above regulation, but shall m;NO way betaken as;',a guarantee -that the system will function satisfactorily for any given period of time'.' `' APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department /O/j/ % Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone Sq4-743Z 1. Permit Requested By W 6 B Tr- 9- c4 -r-4 2 Business Phone 2. Address n A k /,,a n) o /'/r, r., QTS- � � 3. Property Owner if Different than Above Aririracc 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division—mak Sec. Lot No. 61 80 79 5. System used to serve what type facility: Housed 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 / ©o o 2 r A/1 Bed Rooms -3 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 Z urinals garbage disposal lavatory Z showers Z washing machine dishwasher sinks 8. a) Type water supply: Public 14 Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 3132 X dy X,2 99A- 2a 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: DCHD (6-82) Name Address DA\(IE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 2 , 'SO/IL/SITE EVALUATION Date Lot Size FACTORS ARFA 1 ARFA 9 ARFA I APPA A 1) Topography/ Landscape PositionS S S ('S PS PS PS U U U U ?) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U 3) Soil Structure (12-36 in.) S �-� S S S Clayey Soils pS PS PS PS U U U 1) Soil Depth (inches) S S S (� PS PS PS �j U U U i) Soil Drainage: Internal,s—, S S S PS PS PS U U U External S S S PS PS PS PS U U U i) Restrictive Horizons - Available Space S S S S PS PS PS PS U U U U i) Other (Specify) S S S S PS PS PS PS U U U U i) Site ClassificationX.-15" U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: 42 7 Described by _ SITE DIAGRAM DCHD (6-82) Title Date 1 �C _... __._::w*gvY-mevv.. .,;,..-a-,r r,-;. r. „., .;Yg ., s:..nz,• _--.v •r•.rr,.-arm-r;n� "xex- ___— _ ___ -- `? I loge HEALTH DEPARTMENT , ID CERTIFICATE OF COMPLETION `c*NOTE: X fi� ina Chapter 130 Article 13c CAC 10A .1934-.1968) Permit Number Name_ If`I�' / �� Date �� a!hr N2 AD 6 /-rte .,; Location > _ .. i Subdivis Lot N �7_Sec. or Block No. -�� Lot Size J � ,, J� � � � !Home _ Business - Speculation �� j( G No. Bedr P J! I ) 'amily__ Garbage P �� Specifications for System: Auto Dist Auto Wash Machine YES j NO Type Water -Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. N 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 Anv nivan ncrinri r%f fim-