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1149 Hwy 801N Lot 11 ..r i- � ._Y .ii+:.s �reu�,•�:. St:Y.^c;:a" • C"'../;..t b.'.;.�t�. ^"` y.' l� -x 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 1�t / { r / Location ri'r� '� ' ;/! _ r e•' r f�� �i. ,, ! ,./ �i / Subdivision Name ` -% ' � � ��� -�- Lot No. Sec. or Block No. Lot Size House f'�� Mobile Home _ Business Speculation No. Bedrooms No. Baths cV No. in Family Garbage Disposal YES ❑ NO g— Specifications for System: Auto Dish Washer YES [] NO ❑ -� - X ,, Auto Wash Machine YES Eb NO ❑ Type Water Supply __— *This permit Void if sewage system described below is not installed within 36 months from date of issue. r % E 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 41* Certificate of Completion _ Date k2_ *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. 1 •'� c +` 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 p BEEN ISSUED. r/ Home Phone /6 1. Permit Requested By e &_ Business Phone 9 2. Address �' v 3. Property Owner if Different than Above `- Address 4. Permit To: a) Install ✓Alter Repair b) Privy Conventional Other Type Ground Absor tion ���' �-7,�� _),�- r (26-7k I c) Sub-Division 2 e� Sec. Lot No,��� 5. System used to serve what type facility: House Mobile Home VV Business Industry Other b) Number of people 1:2- 6. a) If house or mobile home, state size ofhome and number of rooms. House Dimensions 66 X 1_22 Bed Rooms Z6 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 Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions gy�-A 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. 6- 3- /98--1 Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOROMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: rs �' DCHD(6-82) -` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name �����' ` Date (J Address Lot Size /i�W FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S j - PS PS PS -�T11 U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils CAP PS PS PS U U U U 4) Soil Depth (inches) S S S S PS PS PS U U U 5) Soil Drainage: Internal S S S S PS PS PS PS U U U External S S S PS PS PS U U U 6) Restrictive Horizons 7) Available Space SS- S S C P PS PS PS U 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 SITE DIAGRAM DCHD(6-82)