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401 Madison Road Lot 4SU=$ Y DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name 6�/JIF vrD /� /d �4X�%%�i `0100-s�456 Date !).� �?.�— 9% N2 5901 Location �iyg/r- .e�� %r✓�t f Subdivision Name 5T16n 6, A -00k Lot No. 7 Sec. or Block No. Lot Size House Mobile Home _ Business Speculation 1� No. Bedrooms No. Baths No. in Family Garbage Disposal Auto Dish Washer Auto Wash Machine Type Water Supply YES ❑ NO ;2� YES 4 NO ❑ YES [JJ NO ❑ Specifications for System: J0 wpe /D040 'e *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 /- la ax r x/a -* XTAUS 1 *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: rl5 System Installed by Certificate 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 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. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name W Date L4 - 13 S PS PS Address PS Lot Size U U FACTORS ARFA 1 ARFA 9 ARFA 7 - APPA e 1) Topography/ Landscape Position W t S S S PS PS PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) (�S � S . PS S PS U U U 3) Soil Structure (12-36 in.) Clayey SoilsI S S PS S PS U U t) Soil Depth (inches) S PS S PS U U U U i) Soil Drainage: Internal S ©' S �S� S PS S PS U U U External S S PS S PS may/ Tf U U i) Restrictive Horizons Available Space SS S PS S PS 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 Provisionally Suitable Recommendations/Comments: T"/ Described by "� - C Title�Date SITE DIAGRAM. �J W DCHD (e-ez) 41 /OZ) X00 l 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, M Home Phone, C, Business Phone C©�kal�„x �leF CO, IIJs 1 — 1. Permit Requested By f7 I 2. Address �O 3. Property owner Different than Above �QCg5 v — Address 1,ArP 44 'PPr-;5,` t 1 4. Permit To: a) Install—Alter—Repair_ Pt Ci( ut5 I S�'��C b)Privy— Conventional—Other Type PAT }{1i `PPfflC5!✓ Ground Absorption V'1�9 j4 LF ?YOB- _E.G l�3 Seca Lot No. � Pi , X c) Sub -Division _ 5. System used to serve what type facility: House— Mobile Home— Business— System Other— b) Number of people 6. a) If house or mobile home, tate size of home and number of rooms. CPP 0100 QL< d i - House Dimensions Den w/Closet Bed Rooms Bath Rooms 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 ater-using fixtures: I commodes urinals lavatory showers - dishwasher sinks water supply: Public Private Community 8. a) Typeroved? Yes_ No— b) Has the water supply syst r been app g, s) property Dimensions a 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? ---- What type? This is to certify that the information is correct to the best of my knowledge. garbage disposal _---- washing machine --- Owner Signature Date OWNER IS SOLELY RESPONSIBLE cFOR Allw 5 COMPLIANCE for processing H ALL STATE AND LOCAL LAWS. p ocess ng —_ Directions to property: Davie County NealfFr Department and Nome Nealtli :�lyency 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 - PHONE: (704) 634.5985 April 26, 1990 Potts Realty P. 0. Box 11 Advance, NC 27006 Cie: Sewage System Installation RMF.Construction Co. - Permit 5901 Stonybrook - Lot 4 Dear Realtor: The septic tank system that serves this residence was designed, inspected and approved by this office on March 23, 1990. With proper maintenance and use it.should function properly. Sincerely, Robert B. Hall, Jr., R.S.' Environmental Health Section RH/wd