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343 Ivy Lane Lot 18DAVIE 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 ,� / _- i"i! /t'c' �`�_ 'F -iJ/ c Date Location Subdivision Name r '' ' `� ' " 1 - Lot No. Sec. or Block No. ;,. Lot Size House— Mobile Home _ Business Speculation No. Bedrooms —_S-' — No. Baths -1 7- No. in Family Garbage Disposal YES ❑ NO B' Specifications for System: Auto Dish Washer YES NO p g Auto Wash Machine YES NO F -I Type Water Supply C" "This permit Void if sewage system described below is not installed within 36 months from date of issue. I Improvements permit by =- — — "Contact aP•repres nntative of theVaie County Health Department for final inspection of this . system between 8:30- 9:30 A.M. or 1:00-1' 3 P.M. onof completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion `' ��"'—� Date / - 1 - z';' "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 0 Davie County Health Department Environmental Health Section CGy`V P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 6u: _ 6pezo 1. Permit Requested By MiZ .4 M ��°� L C"C��2-- Business Phone Qi q- 1 ¢4-56 2. Address I �'30 C I R--cA-z` r't uC , h� GfG� �i _!✓ rJ G , 2^TO2� 3. Property Owner if Different than Above Address 4. Permit To: a) Installer Alter Repair b) Privy Conventional ✓ Other Type Ground Absorption c) Sub -Division i00141'Lf "t-Lli� Sec. Lot No. 5. System used to serve what type facility: House ✓ Mobile Home Business Industry Other b) Number of people 2 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions -70,y-J K Bed Rooms 3 Bath Rooms S �2 Den w/Closet / I-.1TG14zJ I 1✓l�/1'•1� I DI�i�1Co 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 S lavatory. 4 dishwasher urinals ki 0Q15 -- showers 2 - sinks sinks Z garbage disposal washing machine 1 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? Yes ✓ No 9. a) Property Dimensions A7m�GRSc b) Land area designated to building site 4t -1— c) Sewage Disposal Contractor IJOT DrrQII El*D A, --V 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? Q -f D What type? This is to certify that the information is correct to the best of my knowledge. Z- 46-9b: 01_&_ Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: Dn"ar`y, �2o�oG,E,p �42sDW00 fl L,c�.ti1E: tD � r S 52 ° 35' 59"E S �4S W nip 1p4.34 nip 3°•32 R SRC, 24 cy S:8 F ANGELL BROTF CV 0^ i '48 96 D.B. 44 PG. 126 Q Q nip ar 2 .00 AREA= 1.022 ACRES so J I nip O -�s o s: oi op, 354: 72 �O nip ` +— N 51.55 32' W nip ` ANGELL BROTHERS DB. 44 PG. 12G i� A ETOLERAINICES REVISIONS '`w'_ S S ovcol OAT[ •T ANGEL 1. GR.;ET L TItT?ERC'•W. C'7RMY THATTH;, :� sc BEING 1.022 ACR BROTHERS PROPE 2 THE MOCKSVILLE • 40 Name_ Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size FAr.TORR AREA 1 AREA 2 AREA 3 ARFA d 1) Topography/ Landscape Position S S S S PS PS PS U U U ?) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils P i PS PS PS U U U t) Soil Depth (inches) S S S PS PS PS U U U �) Soil Drainage: Internal S S S PS PS PS PS U U U External S S S PS' PS PS PS U U U 1) Restrictive Horizons Available Space © S S S PS PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U i) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: .y -- Described by vim! / Title" Date SITE DIAGRAM 14 1 DCHD I6-82) ... ,, :.: �.,...�.V`.. Sqi�"., t+,.'..�'..: .., c:'Ga �^:. °.+.,,�.._y`+^2 y.+_•�s.4 .,.--";'.��_ ....r�..�y zt'.�'i4»..�.�r `.. .., spy: .w-.-:`.+✓� `r. ' 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,NC�AC�OA .1934-.1968) Permit Number rJ 4i Name ?%/lr�/a/!�>f,r.) ,v�� ;: r%"Date �t"5123 Location %4 ZII tf% Subdivision Name Lot No. l� Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms `� No. Baths No. in Family _ Garbage Disposal YES ❑ NO E5 Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO ❑ Type Water Supply *This permit Void if sewage system described below is n t inst Iled within 36 months from date of issue. Improvements permit by *Contact a representative of the Davie County Health Depaftfnent or final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Tele hone tuber: 704-634-5985. Final Installation Diagram: 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 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 1.0A .1934-.1968) Permit Number Name ✓ ,rr� r �;.? �� r -- r ,"_Date 7F ?�/" t q ! �. 3 . Location /�.�'+' i `::/�T �yY�,� ��,�,l;v� r',° J; Subdivision Name Lot No. l Sec. or Block No. Lot Size House '�' Mobile Home — Business -- Speculation No. Bedrooms �� No. Baths No. in Family -J — Garbage Disposal YES ,E] NO .[ j Specifications for System: Auto Dish Washer YES NO Auto Wash Machine YES g NO p Type Water Supply__— "This permit Void if sewage system described below is n t ?nstlied within 36 months from date of issue. Iw I B Improvements permit by __'1 �" `"-/ 'Contact a representative of the Davie County Health Department or final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone>mber: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion ,l 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.