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P5128 Hwy 601S �,-^�wvcSFr.•:w7:ytxw -,r.. ��,., e" �. ,.:y .. . .- ..' . "+ rfca .. ,, - t +�i . .} .i, ....,... DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'U *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 ► f( E Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home — Business _ Speculation No. Bedrooms No. Baths — No. in Family — Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES E] NO E] Auto Auto Wash Machine YES ❑ NO ❑ ri Type Water Supply __— *This permit Void if sewage system described below is not installed within 36 months from date of issue. >C 1 L� Improvements permit by -- *Contact a representative of the Davie County Health Department for final inspection ofthissystem 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 kQt' Oil- G�( 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department �.. Environmental Health Section 8t " P. O. Box 665 p41- Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested By Business Phone 2. Address rrr < �3 %�t� �tf D �)�l�r,C�y�..''llT/� )�/�, 170 Z 3. Property Owner if Different than Above Lzr-f r11,e- � Address til 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 � c Industry Other— b) ther b) Number of people ay S 6 3 0 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 3 Bed Rooms Bath Rooms Den w/Closet 35 I I U b) If Business, Industry or Other, State: Number of persons served I 0(3 pyt' K What type business, eta r� c*' p•� �'r%�"^�= Estimate amount of waste daily (24 hours) T 7. Number and type of water-using fixtures: commodes -3 urinals , garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Corpmunity b) Has the water supply system been p oroved�?�f@,S No 9. a) Property Dimensions � n v_ L_� b) Land area designated to building site 5� it.Gt2.� c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? /)1r✓ 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: r VD r r DCHD(6-82) - � V LOT, S TZ T .�M a ix j'b DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name,=a- -r Date Address Lot Size- FACTORS izeFACTORS A A l A A AR6� AREA 4 1) Topography/Landscape Position S S S S C---P6> © PS U U 1P U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) 1 _� PS U U U 3) Soil Structure (12-36 in.) S S S Clayey SoilsC4L U PS `'CJ--� U U U 4) Soil Depth (inches) S S ' <Z:PS > Q:nPS U U U 5) Soil Drainage: Internal � SSS C Vv�� PS U U U External <\' S PS 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 9) Site Classification U—UNSUITABLE S—SUITABLE PS— ovisionaliy Suitable Recommendations/Comments: k- Described by ` ' Title Date -� SITE DIAGRAM DCHD(6-82) Davie Caz( rt Xealtl De arlment an .ala Nealtli �n d me ye cy 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE:(704)634-5985 February 9, 1988 Mr. Eugene Bennett Rt. 3, Box 540 Mocksville, NC 27028 Dear Mr. Bennett: As per your request, representatives from this office visited your site on 601S. to determine the soil suitability for the installation of a ground absorption sewage system. At that time we found the soil provisionally suitable for a ground absorption system. Before we can draw the system off we must know the exact corners for your building and parking lot. When you have these done, please call us to return to the site. Sincerely, Qw� k.. `� Xs. Charles E. Little, R.S. Environmental Health CL/wd Enclosure