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P4857 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT C'' 'Vs IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION // d *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"1 e; " Location `� f '\ s_ .-, - Subdivision Name Lot No. Sec. or Block No. Lot Size 0 r) HoHouse Mobile Home _1— Business __ Speculation No. Bedrooms ~ % No. Baths —_ No. in Family r-. Garbage Disposal YES ❑ NO Ej. Specifications for System: Auto Dish Washer YES ❑ NO © Auto Wash Machine YES 0' NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. s.. 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 C( (,, i--)- 0 Certificate of Completion Date 1 *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. 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 Sec. Lot No. 5. System used to serve what type facility: House Mobile Homed Business Industry Other b) Number of people q 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Z�X 70 Bed Rooms— Bath Rooms /e2 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 urinals lavatory a showers dishwasher sinks 8. a) Type water supply: Public /--- Private Community b) Has the water supply system been approved? Yes��No 9. a) Property Dimensions add TX' SeO b) Land area designated to building site c) Sewage Disposal Contractor garbage disposal washing machine / 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? ,fid What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: / f7 4- h� (,t!.L k S TO a° DCHD (6-82) APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department `1 6 U Environmental Health Section Q f P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 3� Home Phone 1ir"Zy69ZV_51- ted By j' 1. Permit ReMW '— Business Phone 2. Address 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 Sec. Lot No. 5. System used to serve what type facility: House Mobile Homed Business Industry Other b) Number of people q 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Z�X 70 Bed Rooms— Bath Rooms /e2 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 urinals lavatory a showers dishwasher sinks 8. a) Type water supply: Public /--- Private Community b) Has the water supply system been approved? Yes��No 9. a) Property Dimensions add TX' SeO b) Land area designated to building site c) Sewage Disposal Contractor garbage disposal washing machine / 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? ,fid What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: / f7 4- h� (,t!.L k S TO a° DCHD (6-82) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section, R 0. Box 665 Mocksville, N.C. 27028 \ - SOIL/SITE EVALUATION Name_ w ��- Date r> Address Lot Size U2 i FA1:T(1RC AP1= 1 ) ARFk 9 AREA 3 ARFA A 1) Topography/ Landscape Position S © S PS S PS U U U U ?) Soil Texture (12-36 in.) Sandy, S PS S PS Loamy, Clayey, (note 2:1 Clay) P U U U 3) Soil Structure (12-36 in.) Clayey Soils S --yyam SPS) S PS S PS l�T U U t) Soil Depth (inches) S PS S PS j U U U i) Soil Drainage: Internal S P PS U S PS U S PS U External S PSPS S S S PS U U _ U i) Restrictive Horizons } , OII ON Available Space S PS S PS U S PS U 1) Other (Specify) S PS S PS S PS S PS U U U 1) Site Classification S U—UNSUITABLE S—SUITABLE �-Provisionally Suitable Recommendations/Comments: Described by Title Date - S% SITE DIAGRAM ?aa DCHD (6-82) /0b)