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226 Rollingwood Drive Lot 1 Section 3f 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 `� } Date `� - Hl 5184 Location l�ar�44N,. \?msse•:J� Subdivision Name " S i t.. , o, as Lot No. Sec. or Block No. Lot Size y House Mobile Home — Business. Speculation No. Bedrooms No. Baths ^> No. in Family Garbage Disposal YES p' NO ❑ Specifications for System: Auto Dish Washer YES ❑p/ NO ❑ p U ., -, ` •� _ �\ \_ p� Auto Wash Machine YES 0i NO,❑ l Type Water Supply_— *This permit Void if sewage system described below is not 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 c'o`mpletion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion Date *The, signing of this certificate shall indicate that the*'sy'stem described above has been installed in compliance with.. the standards set forth in the above regulation, q.ut shall in NO way be taken as, a guarantee that the system will function satisfactorily for any given period,of time. } Certificate of Completion Date *The, signing of this certificate shall indicate that the*'sy'stem described above has been installed in compliance with.. the standards set forth in the above regulation, q.ut 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 P@R 25 Environmental Health Section C CC rQ P. O. Box 665 RFCF,v G Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 63q —�60 1. Permit Requested By Dda Business Phone G 3 —oZ7gQ 2. Address 3�a TDi O! su e ,A4C a�oa�` 3. Property Owner if Different than Above Sa m aS p D ✓ e Address 4. Permit To: a) Install Alter_ Repair_ b) Privy— Conventional ✓Other Type — Ground Absorption ff �D�� c) Sub-Divisiorr �au�s Sec Lot No. 5. System used to serve what type facility: House'�Mobile Home— Business— Industry— Other_ b) Number of people 6, a) If house or mobile home, state size of home and number of rooms. House Dimensions 24r ox a 2_ sa +F F Bed Rooms 3 Bath Rooms 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 3 urinals © garbage disposal lavatory showers 3 washing machine dishwasher sinks 8. a) Type water supply: Public vl� Private Community b) Has the water supply system �een approved? Yes '�No_ 9. a) Property Dimensions QGrP- b) Land area designated to building site , a ct_c re c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? N 0 What type? This is to certify that the information is c7"�L t to the best of my knowledge. Z/a S-.0 g- �1' "" Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: I' 1"'N t l� / / N 'D4il e `1'`ti p k J (3 IS,IOL"+k'_0000 ter 1gQre T� �-..,.t �., i p n� Lt I, i rS� nil T C Vt' .Y@ C f � p �o $kc -ll �e�`1F o� ��ere `i e road ;s Pro Posed 9O �}IZrO h �1_/� iS IOQLt ed �pme QT�tE }^Or1% h9 p�Wc n( CL -(:7 b b DCH (s -s S • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Address Date Lot Size FACTORS AREA 1 ARFA 9 ARFA 3 APPA e 1) Topography/ Landscape Position S S 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) PS PS PS PS U U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils PS PS PS PS U U U U 1) Soil Depth (inches) S S S S PS PS PS PS U U U U i) Soil Drainage: Internal S S S S PS PS PS PS U U U U External S S S S PS PS PS PS U U U U i) Restrictive Horizons Available Space S 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 Q Site Classification U—UNSUITABLE S—SUITABLE Recommendations /Comments: Described by Title SITE DIAGRAM DCHD (8.82) PS—Provisionally Suitable Date DaUie County NealtIf D�epartment and .:lame Xealt!i ✓tyency 210 HOSPITAL STREET I P.O. Box 885 MOCKSVILLE, N.C. 27028 PHONE: (704) 834.5985 September 16, 1988 Lifestyle Realty Attn: Kathy Wall 818 S. Main St. Mocksville, NC 27028 Re: Sewage System Installation Joe & Brenda Holmes Southwood Acres Sec. III/Block E/Lot 1 Dear Realtor: The septic tank system that serves this residence was designed, inspected and approved by this office on September 15, 1988. With proper maintenance and use it should function properly. Sincerely, )� Charles E. Little, R.S. Environmental Health CL/wd