P4493 Deadmon RdDAVIE 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 D'isosaI Rules (10 NCAC 10A .1934-.1968) / Permit Number
Name t N, % -, %/1//' ,/ Date
Location %� r� r < .c� ,✓i _�' /.
i
Subdivision Name Lot No. - Sec. or Block No.
Lot Size� `Z, House Mobile Home Business Speculation
No. Bedrooms– No. Baths - 2 No. in Family %='✓ =
Garbage Disposal YES p NO p-' Specifications for System:
Auto Dish Washer YES] NO fl, , ` /f ►C./ �Ch�-�
Auto Wash Machine YES q] NO p v
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
- --------f
Certificate of Completions' 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.
r APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section �f
R 0. Box 665
Mocksville, N.C. 27028
.1
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. P10
Home Phone 919-528-1337 (after 8 p
1. Permit Requested By Donald G. Hinkle Business Phone9i 9-996 4045 (9:10-5:30)
2. Address Rt. #7, Mocksville--on Dedmon Road just off of Hwy. 601
3. Property Owner if Different than Above Donald G. Hinkle
Address Rt. #1, BOx 261, Creedmoor, N.C. 27522
4. Permit To: a) Install X Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No
5. System used to serve what type facility: House Mobile Home X Business
IndustryOther *WOULD LIKE TO HAVE SEPTIC TANK SYSTEM THAT
b) Number of people 3 to 6 WILL ADEQUATELY PROVIDE FOR DISPOSAL OF
6. a) If house or mobile home, state size of home and number of roomsTE FROM TWO MOBILE HOMES.
House Dimensions Unknown at present time
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimat amount of waste daily (24 hours)
7. Number at
of water -using fixtures:
commodes 2 or 3 urinals
lavatory
dishwasher
showers 2 or I
sinks 4 to 6
garbage disposal
washing machine 2
8. a) Type water supply: Public XCOUNT41vate Community
b) Has the water supply system been approved? Yes No -
9. a) Property
o9.a)Property Dimensions See attached plot of land --- PLOTT #3 IS MY PROPERTY 1.172 ACRES OF LAND
b) Land area designated to building site two mobile home spaces approximately 14 X 70 each.
c) Sewage Disposal Contractor Probably Terry Deadmon-----not sure yet
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 co ct to he best of my kpqwlee.
8/22/86
Date Owner e
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
Take hwy. 601 south out of Mocksville past the high school to next paved road to left,
Deadmon Road or SR 1801 and.property will be on immediate right. After turning left on
Deadmon Road there is a drive approximately 215 feet up Deadmond road to the right. If you
turn in this drive there will be a marker (as show on the attached plot) and the property
is located between this marker and another marker which is 103.83 feet further up the road
just beyond a row of trees which goes down the edge of the property line.
*I have drawn up a brief sketch of how two mobile homes may be placed on the portion of the
plot that is approximately 103.83 ft. X 120.73 ft.. I WOULD LIKE TO PUT IN A LARGE ENOUGH
SEPTIC TANK AND DRAIN FIELD TO TAKE CARE OF TWO MOBILE HOMES. I am not sure if I will have
one or two mobile homes but want the system to be installed to take care of two if needed.
One mobile home will be placed on the property facing Dedmon Road as indicated in green ink
and if another is placed on the property it will be in approximately the position shown
directly behind the first mobile home allowing 20_.to 60 feet between the two ---depending
on how you layout the septictank system. PLEASE SPECIFY A LARGE ENOUGH TANK AND DRAIN FIELD
TO ALLOW FOR TWO MOBILE HOMES -TO BE CONNECTED TO THE SAME TANK AND STILL BE ADEQUATELY TAKEN
CARE OF.
DCHD (6-82)
a DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name .�cr Date
Address Lot Size
FACTORS
ARFA 1 ARFA 9 ARI=A.q APPA A
1) Topography/ Landscape Position
S�
PS'
��
(PFJ
S
PS
U
S
PS
U
i
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey,1(note 2:1 Clay)
S
S
"[T
S
PS
U
S
PS
U
I) Soil Structure (12-36 in.)
Clayey Soils
�pS�
S
��
S
PS
U
S
PS
U
i) Soil Depth (inches)
S
S
S
UPS
S
PS
i) Soil Drainage: Internal
S
��
S
PS
U
S
PS
U
External
PS
PS
S
PS
U
S
PS
U
i) Restrictive Horizons
Available S ace
p
U
S
5
U
S
PS
U
S
PS
U
1) Other (Specify)
S
PS
U
S
PS
U
S
PS
U
S
PS
U
►) Site Classification
`
U—UNSUITABLE
Recommendations/ Comments:
S—SUITABLE PS—Provisionally Suit
Described by Titled Date
SITE DIAGRAM
t'
V
I
_ l
DCHD (6-82)