P3102 Farmington RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Date
Permit Number
14�
Location :f")
0IJ I
i Y It, ut? V
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 E] NO E] Specifications for System:
Auto Dish Washer YES E] NO F]
Auto Wash Machine YES E] NO -E]
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
it 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
2- FALL,
3 - �
Certifrl'alof i
*The signing of this certificate shall indicate that the s
the standards set forth in the above regulation, but sha
satisfactorily for any given period of time.
stem Installed byRS, SALLA,-. -z
Date
has been installed in compliance with
a guarantee that the system will function
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 130.
- Permit Number
Name Date
Location Lti b, -70 W- 1-'j !_� (� (�r.I ?c:��� �< < ;�: s t_> o,z-
12iC-0 /;,J C'U,7V�
Subdivision Name Lot No. Sec. or Block No.
Lot Size ` House `, Mobile Home _ Business Speculation
No. Bedrooms No. Baths 7 No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System: love f i/�ti5rf'�-c 7+tip
Auto'Dish Washer YES ❑ NO ❑ %< < //ti , ir ('urr•/ i r./I-y ,, --
Auto Wash Machine YES ❑ NO F] 6 A3 X �1" � roc
Type Water Supply ly tC- _ Z i vN
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
_ �,fYCit, tjiC .-._I D ltj su)"i'cv L!Ni
a ^ r/LUtJ i.l+dt�z lc p, VALV;L
1�j4•rJ
mprovements 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:
7
L�-ystem Installed by 1-1. - 51�1-
Certificate of Completion
*The, signing of this certificate shall indicate that the system describe
the standards set forth in the above regulation, but shall irMO wa� be
satisfactorily for any given,period of time.
Date
above has been installed in compliance with
<en as'a guarantee that the system will function
`Do�
•
DAVIE COMITY HEALTH DEPART'
ENVIRONMEI4TAL HEALTH SECTION
SOIL/SITE EVALUATIOU
VAME`DATE Zit_ Z� 2
ADDRESS 4703 &ceag(JILIL 1kJC-
�L S 27o t ?/ LOCATIO.14
s FRc-rs,. G3CrOT /0 S (G«.ti`
LOT SIZE
TOPOGRAPHY: -S
SOIL TE',,'TURE :
e.
SOIL STRUCTURE:
DEPTH:
RESTRICTIV: HORIZOVS:
PERCOLATION RATE:
1.
2.
3.
V,*ra1.
boa X3X/Z
wN
GACK (r Lc
R�0 S)ti
Presoak
I•lark & time
Drop
Time
Pate iiin. Inch
r.
to'. V3
***CLASSIFICATIOIT:
Suitable Provisionally Suitable Unsuitabl
} C0I1:,1EITTS :
SANITARIAIT
SITE DIAGRAM
vx� x
fit
X,
03 0 2 v'
&4CI, -Tb), 1"Auty C•.4e,
Z,'( At $a
SAPxAar. Ar Iq"
XZ Yt&K• 0/ut, It -M,3 C `,,i ws",
2 1 r1vV)040C-. AT a
L447 `jD�!•-
- "
A 14�AT-
a8 /r
t�cf SAeiAlrg AT. Jo"
DAVIE COUNTY HEALTH DEPAMMENT
SITE EVALUATIO14 CONSE14T FORM
INSTRUCTIONS/PREREQUISTES
1. Complete the form below and return it to the Davie Co. Health Department.
2. Along with the fora, remit the amount due as shown on enclosed statement.
3. Carefully follow the procedures as outlined in the enclosed "Information
Bulletin".
4. Notify Health Department upon completion of item number 3.
NOTE: ALL THE ABOVE 14UST BE DONE BEFORE A SANITARIAtd WILL BE ABLE
TO BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO THE(DAVIE COMM HEALTH DEPAR7LBIENT,P.0. BOX VWP&s
(MOCKSVILLE, N.C. 27028)
DAVIE COUNTY HEALTH DEPARTMENT
SITE EVALUATION CONSENT Fuji
LOCATION OF PROPERTY:
DATE RECEIVED
(office use only)
yes no (1.) I am the owner of the above described property.
yes no (2.) I an not -the owner of the above described poperty, however, I
1:1.
� certify that I have consent from _,owner to
II awns 's name
obtain a site evaluation by the health Department for the purpose
of determining the suitability for a ground absorption sewage
disposal,system.
yes no (3.) I hereby give consent to the authorized representative of the
l Davie County Health Department to enter upon the above described
i property.and conduct all testing procedures necessary to
determine its suitability for a ground absorption sewage
disposal system.
-82 l�
DATE SIGNAT
(4.) I hereby authorize the Davie County Health Department to release
site evaluation results from the above described property to the
follcwina:
-076 --8a-
DATE
SIGNATURE t'
i,
i
0 Owner Only
E3 Owner's designated representative
C),Anyone requesting results
Only those listed below
,P �z
OFFICE OF THE DIRECTOR
��ti�iE C�9nn#� �.Ett1#1� �e�rttr#mEn#
uub CEO=
P. O. BOX 57
l lotkoville, worf4 Olarulirtu 27928
�hc KGitL(Do f4oT Ust
NsA+I y ct.h4)
12'/ C�*Vc - MAXinxuhti
O G
b O l: u-� O C) �� n
STZINIL
n
D ' 411, Ft- J,
C 6 C• c Y� l a e
_ . ,•' ,' Sj'� G.1kStttta R�JiR 1hND
i
TELEPHONE
704/ 634.5985
pttbYe Cnnnn#U Peal#I# P.epartmen#
ttn�once �Ettl#l� c��Enc�
P. O. BOX 57
Parkstxille, Nart4 (garalinn 27028
OFFICE OF THE DIRECTOR
September 10, 1982
Dr. Teck Penland
6703 Cockleburr Trail
Clemmons, NC 27012
Dear Dr. Penland:
Enclosed please find an improvements permit for the installation of
your septic tank system. Since this is an elaborate system, I have
enclosed some more information which gives some details of this system.
I would like to recommend a mercury float switch as opposed to the
magnetic float control switch shown in the di.aoram.
This system should be installed as soon as possible while the ground
is extremely dry. This will help to increase the .life of the system.
I would also like to meet with your septic tank contractor on the site
before he begins installation so that we can make sure there is no
misunderstanding concerning the specifications for the system.
If you have any questions or we may be of further service, please feel..
free to contact this office.
Sincerely,
Ed Spa s
Sanitarian
es
TELEPHONE
704/ 634-5985
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Figure 7. Details of pumping chamber
15
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144� %%/X MR
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Figure 7. Details of pumping chamber
15
61
Figure 7. Mercury float control switch.
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