181 Joe Myers Rd R DAVIE COUNTY HEALTH DEPARTMENT
_IMPROVEMENTS PERMIT AND CERTIFICATE' .OF COMPLETION;
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se
wage Treatment.•and Disposal Rules (10 NCAC 1.OA .1934-.1968) Permit Number
Name Date T [9ib8 - 002
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Location-} r� Q X �;�� . �c� 1$1\V1
Subdivision Name ` Lot No. Sec. or Block No.�
Lot Size 1 - (,7 ,House iWobile Home 'Business, Speculation
No. Bedrooms _ No. Baths*—) No: in Family
,Garbage Disposal ,,, - YES .0 -NO „ l
Specifications for System:
Auto Dish Washer YES 0, NO. 0
Auto Wash Machine YES... NO 0 I ;
Type Water Supply
*This permit Void'if.sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by R.
*Contacta 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 �il= 111
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Certificated 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 Ishall in NO way be taken as a guarantee'that the system will function '
satisfactorily for any.given period of time. Jl
.� 41#
PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
L/ Davie County Health Department
Environmental Health Section
J/0 P. 0. Box 665" Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEE' ISSUED.
u /J Home Phone �' ,V Q
1. Permit R ested By Business Phone
2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ✓Alter Repair
b) PrivyConventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
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 4—.
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions —
b) Land area designated to buildin site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of th 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)
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SOUTHERN RAILWAY' r
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AR = I . 299 ACRES x
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sa.ss orAL iron _ -
T1.53 di.c•d Ir.lt� _
n es•al'>w-E ' 155.06 — 15' EASEMENT
uNti.9 iron in _ __ —— NEW
nnt.r of drive 15' _ _ _ _ — — — F
_ fOR EXISTING eErdu NEW o
70 CORNAT2ER ROAD SEE 08129 PG.605 I EASEMENT
15' EASEMENT noo
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AREA = 0.551 ACRE = "
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BILLY MYERS S
- I 08. 125 PG. 222 fry
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iron168.91 eu.pnp
S 86°39 45 W
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TOTAL AREA = 1. 850 A
JOE HENRY MYERS I
OB. 109 PG. 833
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name �� ftM CM1 Q, v Q�l ci \ a Date
AddressS Q j 3 3 x jjC�
Lot Size
FACTORS AREk 1 AR AREA 3 AREA 4
1) Topography/Landscape Position S S
PS PS
U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) + �I PS PS PS
U U
3) Soil Structure (12-36 in.) S g S
Clayey Soils PS PS
U U U
4) Soil Depth (inches) S S
PS PS PS PS
U U U U
5) Soil Drainage: Internal S S S S
PS PS
U U U
External S S
4e-P4 PS PS
U U U U
6) Restrictive Horizons
7) Available Space S S
PS PS PS
U U
8) Other (Specify) S S S S
PS PS PS PS
U U
9) Site Classification S
U—UNSUITABLE — BLEPS— ovisionally Suitable
Recommendations/Comments: \-jj
Described by � ' Titleti Date1
SITE DIAGRAM
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