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P4521 Murphy Rd.. -.. ✓ � :.w+t'. ..e. r wrs w. A ... a.. a... ....A'.. t ... r.. n .u.. ..':r .« ` 14. '�..A v' yP- r «• .... - _ DAVIE COUNTY HEALTH DEPARTMENT od 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 Location'7�.�7 Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home t Business Speculation No. Bedrooms - S� No. Baths ' No. in Family Garbage Disposal YES p NO p--" Specifications for System: Auto Dish Washer YES NO [:]/ ,/ �~'' ll ) Auto Wash Machine YES NOfv/ � v - Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. J 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 Diagram: System, Installed by eA ^ n 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. Name_ Address FA r.Tr1 RC DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION APPA 1 APPA 9 Date Lot Sized �l2 e ARFA R APPA A 2 ) Topography/ Landscape Position S S S eb PS PS PS U U U U ) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS PS PS U U U A 8) ) Soil Depth (inches) S S S pS 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 U U U �) Restrictive Horizons ` Available Space S S S 4)s PS PS PS U U U U Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification , U—UNSUITABLE Recommendations/ Comments: S—SUITABLE PS—Provisionally Suitable Described by Title SITE DIAGRAM DCHD (6-82) U—UNSUITABLE Recommendations/ Comments: S—SUITABLE PS—Provisionally Suitable Described by Title SITE DIAGRAM DCHD (6-82) • RECEIVED SEP APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 2 9 j',)36 Davie County Health Department Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Requested By 2. Address #%8A4'G 3. Property Owner if Different than Above AM J1 A4 4�u 4e, Address 4. Permit To: a Install Alter Repair b) Privy Conventional Other Type Ground Absorption Home Phone M_ 7_11S%SWs Business Phone 91? — 78i/- 71YO c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business IndustryOt er b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions LV X �� I 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 z urinals garbage disposal lavatory showers z washing machine dishwasher sinks 3 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions Sao 14 6 l G 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? Nlo What type? This is to certify that the information is c rrect to the best of my knowledge. Date Owner Sig ature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: _ `fitic" r,a" Ca" 'r" (Sro) 1350 Oztst DCHD (6-82)