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135 Rupard Trail (2) - DAVIE 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 Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name 61sc ac-c-_ 71 ,n?4 R.QDate 5. )2 9 8. Location Subdivision Name Lot No. Sec. or Block No. Lot Size 6u, House Mobile Home _ Business Speculation No. Bedrooms 3 No. Baths 3 No. in Family_ Garbage Disposal YES ❑ NO S for Specifications stem: Auto Dish Washer YES E] NO p- ^p y Z Auto Wash Machine YES ❑ NO2- Type Water Supply Vic 0• _ S *This permit Void if sewage system described below is not installed within 36 months from date of issue. hT1 enc.,.. Improvements permit by �� •\1` �..Q., *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-p5985. Final Installation Diagram: System Installed by 1n^ ^ Q /neto a• _ �_Y�' 3-4 f C. �.3P c:f L%Nc,1 ��iNcr Cn..vhl� � kof dCer �� t '=--- 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 Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name 00,Af�LAU- �� - Date 3 1 -' Address 6:4 &o Lot Size rnd FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position �cS`� S S PS PS PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) CnFs--> <3� PS PS U U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils <--:i� PS PS U U U U 4) Soil Depth (inches) F---> -(f F-> S S PS PS PS PS U U U U 5) Soil Drainage: Internal S S S S ® ® PS PS U U U U External <:� CZf:> S S PS PS PS PS U U U U 6) Restrictive Horizons 7) Available Space S S S PS PS U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: C'XIZ41 "- Described by /� TitleDate SITE DIAGRAM �2 DCHD(6-82) Lf APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Qavie 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 �•� _ 1. Permit Req d By Business Phone 2. Address 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 Home Business IndustryOther b) Number of people -� 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions s29,X 40 Bed Rooms_Bath Rooms a Den w/Closet�� b) If Business, Industry or Other, State: Number of persons served What type business, etc. ��II Estimate amount of waste daily (24 hours)- 7, Number and type of water-using fixtures: commodes urinals garbage disposal lavatory showers washing machine,,hp�� dishwasher zjV4&_ sinks 8. a) Type water supply: Public Private 11""' Community b) Has the water supply system been approved? Yes t' No 9. a) Property Dimensions- -- -/7 © . r':nS b) Land area designated to building site ./ . Gt�� c) Sewage Disposal Contractor -seU=' 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 correc to the best of my knowledge. 'P t17 Date Owner Signatur OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6-82)