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779 Duke Whitaker Rd DAVIE COUNTY HEALTH DEPARTMENT • ''7�` 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 N0 h � Y'c� Location _ -_ i ion NamR Lot No. `' Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES ❑ NO Eg/ 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. r --- Improvements 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 0aflatiorr gram: D System Installed by n � J ------------- i- 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. f� 7 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 Phone 762—�9 cZ 1. Permit Requested By Business Phone 2. Address – 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 Homed Business �7 IndustryOther v b) Number of people �. 6. 4 If house or mobile home, state size of home and number of rooms. House Dimensions Bed Roomso—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 7tin lavatory f showers I washing machine 2� dishwasher 2?�V sinks 8. a) Type water supply: Public PrivatP�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 information is correct to the best of my knowledge. Date Owner Signature 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 Name S?'Sb� Date Address Lot Size— FACTORS. ize FACTORS AR 1 AREAb AREP AREA 4 1) Topography/Landscape Position _ AS S P PS PS U U 2) Soil Texture (12-36 in.) Sandy, S Loamy, Clayey, (note 2:1 Clay) PPPS ( ZZZ777"' V U 3) Soil Structure (12-36 in.) S Clayey Soils PS PS PS U U 4) Soil Depth (inches) S S p PS 'S PS U U S 5) Soil Drainage: Internal S � S S PS PS U External S S S S PS PS U 6) Restrictive Horizons 7) Available Space S S PS PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U 9) Site Classification `� S 4L U—UNSUITABLE S—SUITABLE ` -Provisionally Suitable Recommendations/Comments: — ^ Described by Title Date SITE DIAGRAM �y • Davie County NeaM De artment and Notre Xealtif Ayency 210 HOSPITAL STREET P.O.BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 January 12, 1989 Donald E. Harrold Rt. 6, Box 143-2 Mocksville, NC 27028 Re: Complaint Dear Mr. Harrold: On January 5, 1989, this office received a complaint about two mobile homes being hooked up to one septic system. The location of this complaint was on Duke Whitaker Road. Upon investigation of this complaint, we found that this new mobile home is indeed connected to the septic tank of the older mobile home. According to state law, it is illegal to have two mobile homes or houses on one septic system. Unfortunately, we must insist that you install a system for the new mobile home. The procedure for this is to apply for a site evaluation and permit from this office. You must have a permit to install the new system. This must be done within thirty days from January 13, 1989. If you do not comply with this notice, we will be forced to have the electrical power shut off to the new mobile home. If you have any questions, please feel free to contact this office at 634-5985. Sincerely, Charles E. Little, R.S. Environmental Health Section CL/wd -