P3519 Granada Drivei.
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DA�E COUNTY �� ����������� � ]
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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°NOTE: |oouod in Compliance with G.S. of North Carolina Chapter 130 Article 13o
Sewage Treatment d Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date
Location
D4 IQ,
Subdivision Name. Lot No. Sec. or Block No.
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Lot Size House Mobile Home -- Business —.__—_—_ Speculation -----__—_
No.Bodroomo No. Baths No. inFamily
—_—_____'
Garbage Disposal YES O NO 1/ Specifications for System:
Auto Dish Washer YES NO [�
Auto Wash Machine YES
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit bv
°Contaota representative of the Dave County Health Department for final inspection of this oyabam between 8:30'
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final |nobu|aUon'D� 'ram:
installed by
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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 vegu|sdion, but shall in NO way be taken as aguarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Ph nA fu —
1. Permit Requested By i� _A, Business Phone -!W'o
2. Address Jge,- 40 Q Iva
3. Property Owner if Different than Above
Address
4. Permit To: a) Install-ZAlter Repair
b) Privy— Conventional— Other Type—
Ground Absorption
c) Sub -Division ec - Lot No — '
5. System used to serve what type facility: House Mobile Home-AMusiness
b) Number of people I Industry— Other
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions—
Bed Rooms 'I Bath Rooms Den w/Close
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 garbage disposal
lavatory. showers washing machine
�dishwasher sinks
8. a) Type water supply: Public— Private— C 'munity__ZZ
b) Has the water supply system been approved? Yes_(,7No_
9. a) Property Dimensions
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?
What type?
This is to certify that the information is correct to the best of my knowledge.
Date
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Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
1:Ar.Tr)P.Q APPA 1 A PPA 9 ARFA.1 ARPA A
1) Topography/ Landscape Position
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S
S
S
PS
PS
PS
ILI
U
U
U
Soil TextLfre (12-36 in.) Sandy,
S
S
S
Loamy, (note 2:1 Clay)
PS
PS
PS
U
U
U
U
Soil Structure (12-:36 in.)
S
S
S
Clayey Soils,
PS
PS
PS
U.
U
U
1) Soil Depth (inches)
S
S
Ps
PS
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S.
PS
PS
-PS
U
U
U
U
External
S
S
S
PS
PS
PS
PS
U
U
U
U
Restrictive Horizons
Available Space
S.
S
S
PS
PS
PS
PS
U
U
U
U
1) Other (Specify)
S
S
S
PS
PS
PS
:'PS
U
U
U
U
1) Site Classification
IM
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by
SITE DIAGRAM
DCHD (6-82)
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