471 Austine Lane Lot 35g
AVIE COUNTY HEALTH DEPARTMENT
0 -IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
f 'Note:°4esued in Compliance with G S..of North Carolina Chapter 130—Article 13c.
Permit Number
,s Name `770 Date % �Z ~" F'®72 .
Location
Subdivision Name eleE4 "' IV ilk
. Lot No. if .3 Sec. or Block No.
Lot Size House Mobile Home Business Speculation.
J,
No. Bedrooms-___ _ No'., Baths, No. in�iFamily
Garbage Disposal YES C] NO pr --tA„
Specifications for System:. g �
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO -
y u
>Va "Nfi
Type Water Supply; •
*This permit Void, if,sewage system described below is Inot installed within 36 months from date of issue..,,,
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 Diagrpam: ";. �� System Installed by
i1 ok �YFiCCS
.r bo
a Certificate;, Completion mama( Date
*The signing of this certificate shall indicate -,that the s stem describe ' above �.. y e 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
P. O. Box 665 (�
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
{� Home Phone !� C1 6 33'�f
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1. Permit Req a ted By E � n 40rl y po-e/` Business Phone
2. Address % %? 4 M, C, A?() d X
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 h 2 -Cle 9,; ; -4- 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 l d d S'O
Bed Rooms— Bath Rooms 1 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 - coma.
lavatory O C'A(rr
dishwasher
urinal
showers CL 4 (4 �
sinks " k4c�_Qn
8. a) Type water supply: Public Private CQrnmunity—
b) Has the water supply system been approved? Yes � Nc
9. a) Property Dimensions j b6 \f 2 Uo/
garbage disposal
washing machine M-Q�
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? h0
What type?
i
This is to certify that the information is correct to the best of my knowledge.
�-'dwner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD (6-82)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Ari- wn�, Date 7- 2.6 -0 -
Address F"6 2gti Lot Size 2 -TO
Adu co\e e , n C- 27 att,
CArTf1RC AREA 1 AREA 7 ARFA R APPA A
Topography/ Landscape Position
S
SS
S
PS
U
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
CR>
S
®
S
®
S
PS
U
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
ap
S
<LIEW
S
PS
U
U
U
U
)Soil Depth (inches)�
&
A
S
PS
U
U
U
U
i) Soil Drainage: Internal
S
la��
S
PS
PS
PS
U
U
U
U
External
-,�P
1'a5
a)
S
PS
PS
PS
PS
U
U
U
U
i) Restrictive Horizons�,�
Available Space
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE S—SUITABLE (-PS—Provisionaliy Suitable
Recommendations/ Comments:
Described by % - ry� Title 9110 - 4t-104 ""L- Date 7 -& -_-
SITE nIAr.RAM j 1d<
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DCHD (6-82) '� 3 a.�
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