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P5840 Woodlee Dr .fir;3rt�t ;i,r DAVIE, COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name r Date. Location Lot No. Sec. or Block No. Subdivision Name ' Lot Size House Mobile Home — Business -- Speculation No. Bedrooms No. Baths — — No. in Family Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES ❑ NO ❑ f Auto Wash Machine YES [) NO ❑ Type Water Supply --- f *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. 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 a Certificate of CompletionDate ��2s "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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section FEB Q ' 1990P. 0, Box 665 RECEIVED Mockaville, NC 27028 1 . Application/Permit Requested By -r -��� . Mailing Address 14-' Home Phone T�,� �/�f ��� Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 9 . Application/Permit For : General Evaluation M,--S/Tank Installation 5. System to Serve : ' House J Mobile Home Business Industryu OthQ�ro (�� Unknown �wJ �l �- 6. If house, mobile home : Subdivision ' Sec . p Lot# No. of People Dwelling Dimensions No. of Bedrooms ";J_ - Basement/Plumbing No. of Bathrooms - Basement/No Plumbing O' Washing Machine Dishwasher 0 Garbage Disposal 7. If business, industry, other : Specify type No. of People Served No. of Sinks No. of Commodes _ No . of Urinals _ No. of Lavatories No . of Water Coolers No. of Showers S. Type of water supply : V Public O-Private 0 Community 9 . Property Dimensions „ 10 . Sewage Disposal Contractor _49N'-r 11 . Do you anticipate additions/expanuions of the facility this system is intended to serve? C Yes 2-No If yes, what type? r �NOTEs Improvements Permits shall be valid for a period of 5 years from date issued . Improvements Permits are subject to revocation, if site plana or the intended use change . Effective October 11 1989. This is to certify that tine information provided is correct to t:lf! Lest of my knowledge, and I understand I am responsible for all ch;, ges incurred from this application . f Date Signature UirE�-'. )n� to Property : >� , 1�a ' oh �ecl/fly l /T: dyt �0/� ,�7` / n`1J G�aodle�-, ra i h-f- to(I-k - DCHD (10-89) _ y ~} DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section, P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name �/ �S Date c � Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S dp S (k) - /'P U U U 2) Soil Texture (12-36 in.) Sandy, SS Loamy, Clayey, (note 2:1 Clay) J-- I'.�U 3) Soil Structure (12-36 in.) Clayey Soils U U U U 4) Soil Depth (inches) U U 5) Soil Drainage: Internal S� S�-g U U U U External X)S pS ©S PS U U U U 6) Restrictive Horizons 7) Available Space S 'PS PS PS S U U U U 8) Other (Specify) S S S S PS PS PS PS 9) Site Classificationd`- U—UNSUITABLE S-SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by e/l - Title 5�vo�i2 Date SITE DIAGRAM �1 DCHD(6-82)