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166 Alamosa Drive Lot 22DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. (In compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME �' PROPERTY ADDRESS !'/arnbS0. • DATE ✓��r� LOCATION SUBDIVISION NAME Ayy LOT NUMBER �_ SEC./BLOCK NUMBER RESIDENTAL SPECIFICATIONI: BUILDIF#i TYPE d? & E # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: YeIko COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE / /S (� TYPE WATER SUPPLY , DESIGN WASTEWATER FLOW (GPD) 3l D _ NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE aD GAL. PUMP TANK GAL. :TRENCH WIDTH .k lid, ROCK DEPTHy yLINEAR FT. OTHER REQUIRED SITE MODIFICATIRINS/COND)ITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED'USUCHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INJSTALLING THE SYSTEM. 1� i IMPROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY A/,/. 0Lf. AUTHORIZATION NO. 619n 9 OPERATION PERMIT BY DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL. SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 :ti.; y:.:)(,, r.: ;:-��yr .,.,f. ,•-' 7.r-�:. .5.rf, 'a rfi—r-3 y- 3 t; __... 4.. ..�:-. ..:a ., ., r<'.. <, .-. ... .. . .. 4 ""'Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.O. Box 665 " - Mocksville, N.C. 27028 AUTHORIZATION FOR WAGMIATER SYSTEM CONSTRICTION (Issued in compliance with Article 11 of 6.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fore/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** DATE �O ' �' 9r AUTHORIZATION NURSER N.. f1 !y 9 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE*** THIS AUTHORIIATION FOR WA WATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. /; ENVIRONMENTAL HEALTH 95ECIALIST DATE- DCHD.10/.95. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 �Z APR ' 0 D 1. Application/Permit R7quested By Mailing Address JJII� �� Home Phone A /J.- � AJ P_VS N. C' , Business Phone 2. Name on Permit if Different than Above 3. Application for: O General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House O'Mobile Home f� ❑ LPlace of Public Assembly ❑ Business ❑ Industry -r,9 ❑ other B�� UnknownD -I- 5. 5. If house, mobile home: Subdivision A Q�li / /V _ Section/91 M s ALot # as B -F ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms 3 0 Washing Machine No. of Bathrooms 215ishwasher Dwelling Dimensions G� ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures ---- - 7. Type of water supply: ©-Fru-biic ❑ Private ❑ Community 8. Property Dimensions /DD X /S 0 .Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the Intended use change. Effective October 1, 1989. Directions to Property: Alamo � IAY- 7) 16- 4� � This is to certify that the information provided is correct to incurred from this alication. DATE of my SIGNATURE I am responsible for all charges CONSENT FOR 9iM EVALUATION IQ BE DONE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 QW( the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located In Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE DCHD (1/93) SIGNATURE Address i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date�� Lot Size FACTORS ARFA 1 ARFA 9 ARFA A ARFA A 1) Topography/ Landscape Position S S S dip PS PS PS U U U U Z) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) • (255) PS PS PS U U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils 85) PS PS PS U U U U t) Soil Depth (inches)/ S S S (t PS PS PS U U U U i) Soil Drainage: Internal S S S PS PS PS U U U External S S S PS PS PS U U U i) Restrictive Horizons Available Space S S S PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U O Site Classification U–S U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments:�� Described by /i`l� Title Date SITE DIAGRAM DCHD (6.82) .n7