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892 Howardtown Rd.... - � .. Y ...•'J.•`�+•+.w'•wn us.r. . --.y.- ..`1 �• •y r c S w 'K c5 .,� a.. �, DAVIE COUNTY ,HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND AOMPLETION1 =NOTE:issued in Compliance with G.S. of"North Carolina Chapter.130,Article 13c Sewage Treatment anal Disposal "Rules (1:0 NCAC 10A..1.934- 9681 s Permit',NUilnber.: '{ ' ame' '"J'sfr ry'. ,, ! o�<-�r'.a tl•Date � T��'` 418 U6.. .. LocationJ s _ f ,•� it �; a •; ;„' i,. Al Subdivision Name - _ '.Lot No. _�� �! Sec.,or Block No. Lot .Size House �� Mobile Home* Business Speculation 1 , No. Bedrooms __ _ No. Baths _ = No. inFamily Garbage Disposal ' ,YES--❑ NO•�] Specifications for-System: Auto Dish Washer { YES NO ❑ ;I �,i` j � Au#o�lNash Machine YES NO ❑ 'f �`' �Y � i Type Water•Su pl 'This permit Void if sewage system described below is not installed within 36months from date of issue., . . `�' •_ �.��"`� �� •,,orf ., I, .�J ��.�...�. t.-.._..�:,;,•_•,��` i� .fir . r� (� .. Improvements permit by • , •Il it __ *.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 Numb�e'r: 7d.4-634-5985:: Final Installatiori Diagram: ;! System Inst alled-by Certificate of Completion �� ' Date., 7 K "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;'systbm' �will•function” satisfactorily for any given period of time ti �� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department EnvironmPenntal Health Section RECEIVED JAN 13 1986 0. 65 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. ` .{_ Home Phone q9 1. Permit RequestP-4. By l r f 01I , a e-L 1 Sl)/1l Business Phone 2. Address Q_ 6.0 ' Acl vc4 "C-e /0-e' 62:?d o< 3. Property Owner if Different than Above��� ob-'-�6L lie rS Address 4 2 804 14,7- e A)% Ci 4. Permit To: a) Insta111CAlter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile HomelCBusiness Industry Other b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 111460 rna,'/e /40rn e- Bed Rooms 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 urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Community- b) ommunity b) Has the water supply system been approved? Yes No 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? )P7 0 What type? This is to certify that the information is correct to the best of my knowledge. Ilei r5 Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: Fr-0 Inbac-S 'Ile e egsf fo - /� Na n e s Pl«i•� 0f' t{o�ar� l0wvK�� Corna�xer— �y(/ T" rh 1�Av,h L eTf" b Z3 0 tem P/ y y- DAVIE COUNTY HEALTH DEPARTMENT " Environmental Health Section P. O. Box 665 Mocksville,N.C. 27028 SOIL/SITE EVALUATION Name Date Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) S (PSS PS PS 'TAT U U 3) Soil Structure (12-36 in.) S. S Clayey Soils P PS PS PS U U 4) Soil Depth (inches) SSte-, S S '0 PS PS 5) Soil Drainage: Internal S S PS PS U U External S S S S PS PS PS PS U U U U 6) Restrictive Horizons 7) Available Space &S © S S PS PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by � Title .� Date SITE DIAGRAM DCHD(6-82)