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P5011 Gun Club Rd . r•.,e....l'°.. ....:.4 w. , _ ., .Y'n t:-vy::'• .,V R.,+u,. •y...ev-.r '�'a -- ^•v-. tit..�ti.... ..ti.;S... DAVIE COUNTY- HEALTH DEPARTMENT 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 , J �. / r�' �; Date A1' f 1 Location Subdivision Name Lot No. Sec. or Block No. Lot Size_JZ2 _=.! House / Mobile Home _ Business Speculation No. Bedrooms l,2 No. Baths — �? No. in Family Garbage Disposal YES ❑ NO ❑.-- Specifications for System: Auto Dish Washer YES [ NO ❑ Auto Wash Machine YES © NO ❑ Type Water Supply 'This permit Void if sewage system described below is not installed within 36 months from date of issue. �1 1 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 v a � I_ N rl 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. • :'t - APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department DEC (� ►^'� Environmental Health Section R (✓�ry� R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. _ Home Phone 1. Permit Requested By l •'Z �� �������-� Business Phone 2. Address '(`ncsCKS:Y � Q;�e :WW 3. Property Owner if Different than Above -Dr-S.R &.-5 Address R�S3 �� �2� QVf���oN) C Do C. 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: Hou _Mobile Home Business Industry Other b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 24 Y. 4g (_kAC_kjA„A5 C_W�� -�5 R^'g Bed Rooms—Bath Rooms�\/_2 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 0,JQ.2,T�� washing machine—� dishwasher sinks I 8. a) Type water supply: Public—Private Community b) Has the water supply system been approved? Yes- No 9. a) Property Dimensions X dZ b) Land area designated to building site . b!S?- �5q -C-�Y1 c) Sewage Disposal Contractors�' `��F� 1 � y6L{LRY `2 l�ns"hov� a\Q 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 O ner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Efl5TAllow 5 dy�ys for processing JCo �e0- 1 ,V\\ eC,n r S1r�-Y Directions to property: DCHD(6-82) - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section, P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name t�D/1 Date Address Lot Size ��ti9G FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S PS PS PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PSJ PS PS PS U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS PS U U U 4) Soil Depth (inches) S S S PS PS PS U U U 5) Soil Drainage: Internal S S S PS PS PS U U U U External S S S PS PS PS U U U 6) Restrictive Horizons 7) Available Space S S S PS PS PS 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 A//-q SITE DIAGRAM 1 DCHD(5-82) Davie County NeallI De artin and .dome .�lealtFren 9 ent 210 HOSPITAL STREET/P,0. BOX 665 MOCKSVILLE, N.C. 27028 PHONE:(704)634-5985 July 22, 1988 W. Paul Enscore 109 Montroyal Dr. Rural Hall, NC 27045 Re: Sewage System Installation On Gun Club Road/Permit #5011 Dear Sir: The septic tank system that serves this residence was designed, inspected and approved by this office on June 9, 1988. With proper maintenance and use it should function properly. Sincerely, Charles E. Little, R.S. Environmental Health CL/wd