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493 Duke Whitaker Rd (2) _ .. ...-.r - �.-:1-.-.r.sir sL•.i'._0. +IV"—.✓ `4.�'y:�µ�' - 'i!:✓'+�--+a.i.2.-r�.rt.1e-/.rAi�yr..j..✓titai+!Y.-4yw ,:,�.y-.m' :bra u. a..a:-sr.:... .-r:-..—..-r .R.'• Y\..._ .. ii 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 Date Location �a - Subdivision Name Lot No. Sec. or Block No. Lot Size f U. � House Mobile Home _1/ Business /Speculation No. Bedrooms - ' No. Baths -'- No. in Family f Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES ❑ NO ©! Auto Wash Machine . YES [j NO ❑ ��, J` ,� if Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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 IQ) - Q 0 Certificate of Completion Date 1 V *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. + _.. :-v.�'-�.I'.-.._uJ.i••:a..yaaY-...-..=,tea,-wr..--a'_.' 4,_CsJ -..>.s.--N-f:...^.i�lW.L--'..aaN.:rw Y..nw-.lh....-:w.f'-a..v �.- ..--..,.. a .. -.-. .-.,_.l•...-. -. a .t DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION A- *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. , tom. Date Location l 1 �t it Subdivision Name Lot No. Sec. or Block No. Lot. Size 1 L _ < (0 House Mobile Home _� Business /Speculation No. Bedrooms No. Baths — No. in Family Garbage Disposal YES ❑ NO p' Specifications for System: Auto Dish Washer YES ❑ NO ❑/ Auto Wash Machine YESv❑ NO ❑ Type Water Supply _ *This permit Void if sewage system described below is not installed-with in 36 months from date of issue. 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 -^ *-1�-�� o 5u Certificate of Completion �' �'' '-'�'.'�� 4 Date �1 V '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. PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 23 Davie County Health Department ✓�� Environmental Health Section �GG�•`y P. 0. Box 665 ,fp Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone iT 7161 1. Permit Req u s d By -S e Business Phone 2. Address Sa g-70 3. Property Owner if Different than Above 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 q 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Lj �< 7 0 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 urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Com munit b) Has the water supply system been approved? Yes No 4 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 Owner Sig ture OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6-82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section, R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION aa Name m�-S �' `�S Date �� a Address Lot Size FACTORS ARA ARA AREA 3 AREA 4 1) Topography/Landscape Position S S 4�* 4:�� PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S LoansyzQ&ey, (note 2:1 Clay) P PS PS U U U 3) Soil Structure (12-36 in.) S S. Clayey Soils P PS PS U U U 4) Soil Depth (inches) S S S S PS PS PS U U 5) Soil Drainage: Internal pS PS U U U U External S S p P� PS PS U U U 6) Restrictive Horizons --- 7) Available Space 1 ,h S S V 1'� PS PS U U U 8) Other (Specify) S S S S PS S PS PS U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS rovisionally Suitable Recommendations/Comments: 1 :to ,\ Described by Title Date SITE DIAGRAM a � v o � DCHD(6.82)