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P4331 Ridge Rd 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 �� fL��4!7.r,/fit Date ✓ F Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home �� Business Speculation No. Bedrooms _ No. Baths Z�./� No. in Family Garbage Disposal YES E] NOr"❑ Specifications for System:-` Auto Dish Washer YES ❑ NO ❑�� / �� ` ,:';G Auto Wash Machine YES ❑--NO '❑ _ _ Type Water Supply *This permit Voi i ewage system described fo is no nstalled within 36 months from date of issue. i 6 � `� R•_+ala - _7 Improvements permit by r ' *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 � lu .� CL7--- <� �3: �1 Certificate of Completion Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with t.Pe standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function vatisfactorilylor any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENI* ,4 IT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 -' CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. + Home Phone �191�- / �d 1. Permit Reauested By Business Phone 2. Address O 3. Property Owner if Different than Above - Address ' 4. Permit To: a) Install 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 Homed Business 1 ' IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 4'A SP S Bed Rooms—Bath Rooms-LY-al, 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 dishwasher sinks 8. a) Type water supply: Public Private_ Community b) Has the water supply system been approved? Yes NoV0, 9. a) Property Dimensions LA cx(, 'S 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? O What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Sign re OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 6AWQ -�ws - �13 -°R7 L6 .L /n LCJ - DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT •' Environmental Health Section P. 0. Box 665 Mocksville,N.C. 27028 _ SOIL/SITE EVALUATION NameDate Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position SS S S U � � US 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) P PS PS PS ' - U 3) Soil Structure (12-36 in.) S S S S Clayey Soils � �f?S � PS c '-D U 4) Soil Depth (inches) S S S S PS PS _SPS PS U� U 5) Soil Drainage: Internal. S S S S PS _ �S PS External S S S --P PS U U U 6) Restrictive Horizons /� l 7) Available SpaceS' S LJ S S S PS PS U U U U 8) Other (Specify) S PS PS PS PS U U U . U 9) Site Classification U-UNSU B E S—SUITA E PS—Provisionally Suitable Recommendations/Comments: , C��{" 1"© Described by 2LWZ Title Date SITE DIAGRAM ocHo(s-az)