565 Howardtown Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 4 /a; D0
*NOTE: yIssued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
r �� 5.7Name Np75
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Location ENAr "
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Subdivisioh Name ` a Lot No. Sec. or Block No.
Lot Size ��_�`� _•. ,U House! Mobile,Home Business Speculation
No. Bedrooms %' p Na`Baths No.in Family t
Garbage Disposal YES E] NO ( S ecifications for System:
Auto Nish Washer YES 2/ NO fl �a
Auto Wash Machine '`YES [/ ,NO ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 3&months from date of issue.
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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
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Certiacat of Com I tion � - (\ �'� t—�Date
The signing of this certificate shall indicatehat to system describedabove has been installed in compliance with
the standards set forth in the above regulat'6 , but shall in / O way be ta, en as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION /b; 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 V (.l) o v Date r7 + N2
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Location \::, r:�.
v� I of i� - t i s. ,�- ��_ �., (
Subdivisioh Name `' Lot No. Sec. or Block No.
Lot Size (~ Housei' Mobile,Home _ Business Speculation
No. Bedrooms - .No. Baths No. in Family
Garbage Disposal YES C) NO p' S ecifications for System:
Auto Qish Washer YES p1' NO ,❑ ��>
Auto Wash Machine YES 2 NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within r mon his from date of issue.
A t:
9
F Improve ents 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 �-
a -
Certifibate-lof Completion ��.y -�� = � ,,Date
*The signing of this certificate shall indicateAhat 1 e system describedf,above has been installed in compliance with
the standards set forth in the above regulat.6 , but shall in / 0 way be taken as a guarantee 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 O. Box 665 RECEIVED AUG 2 2
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit eq ted By r'-� Business Phone
2. Address `��C 3�-O Q
3. Prope ner if Differen than Above t`
Address
4. Permit To: a) Install 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 Home Business
Industry Other
b) Number of people
6. ay If house or mobile home, state size of home and number of rooms.
House Dimensions
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 k urinals garbage disposal /
lavatory showers a washing machine /
dishwasher sinks
8. a) Type water supply: Public Private t/ Community
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?
What type?
This is to certify that the informaticorrect to the best of my knowledge.
g ,^ I \. -Y�- on 'sQPau--) -
Date 10 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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_w `DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
NameDate r2y b
Address `p�9'- Lot Size P
FACTORS ARE& AREk-2 AREAC3 AREA 4
1) Topography/.Landscape•Position S S S S
PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Cjy) LAPS ( PS PS
U
U U
3) Soil Structure (12-36 in.) �, S S
Clayey Soils PS PS
U U U
4) Soil Depth (inches) S S- S
PS PS
U U
5) Soil Drainage: Internal S S
PS P PS
U U U
External PS (151 �S PS
U U U
6) Restrictive Horizons .,
1,� r
7) Available Space S S S
PS PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS S PS
U U U U
9) Site Classification -b -5.
U—UNSUITABLE S—SUITABLE PS—Provisionally S- a le
Recommendations/Comments: �� �-V a -0- --fit
�__�`��� � cat � ` `�� �-�A1�s'iv c��\R�•_-.
Described by — -��`�- Title- Date"
SITE DIAGRAM
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Daae' County Nealtli Department
and dome .�lealtli A 9 en
Y
210 HOSPITAL STREET/P.O.BOX 888
MOCKSVILLE.M.C. 27028
PHONE:(704)834.5985
August 29, 1988
Larry Ashley
Rt. 3, Box 591
Mocksville, NC 27028
Re: Site Evaluation
Off Howardtown Road
Dear Mr. Ashley:
On August 24, 1988, as you requested a representative from this office
visited your site and found the soil provisionally suitable for the
installation of a ground absorption sewage system. The system will need
extra line when the system is installed.
If you have any questions, please feel free to contact this
office.
Sincerely,.
Charles E. Little, R.S.
EnVlronmental Health
CL/wd
Enclosure
cc: Betty Potts Realty
Rt. 3, Box 320
Advance, NC 27006