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2039 Milling Rd (2) l d' CP DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT ANOI-CERTIFICATE OF COMPLETION *(COTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC�1DA .1934-.1968) Permit Number `Name r Date � NO to Location ,C,/%�;� �' Zf rl r7-,, 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 Sem: Auto Dish Washer YES NO Auto Wash Machine YES NO p ?ex Type Water Supply /-�'�'C%� __ x � *This permit Void if sewage system described below is no m iaf(ed within 36 months from date of issue. �p4l b Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- `4 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. ,%>, 1° Final Installation Diagram: � - ` System Installed by �_ xal 7 ell 4 r'^r — o � ,✓ 7 1 � U f 6 �� � Yr) "011 t a'1,Ql aX-� a Certificate of Completion Date t *The signing of this certificate shall indicate that the system described above has been installed in compliar the standards set forth in the above regulation,.but shall in NO way be taken as a guarantee that the system will�. satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 0 Davie County Health Department G��� Environmental Health Section �� P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. j Home Phone ZZ2 :) 751 1. Permit Requested By KENT N Business Phone 725-0594P 2. Address 2144t0A-L_>0IZF CIRCL9 Wly6Tor\- Stl_Em C. lk n0 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 Se Lot No. 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people 6. a}If house or mobile home, state size of home and number of rooms. House Dimensions S© ' 34 Bed Rooms Bath Rooms R7-!-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 O garbage disposal lavatory 3 showers Z washing machine r dishwasher sinks 8. a) Type water supply: Public Private Communit b) Has the water supply system been approved? Yes No7 9. a) Property Dimensions PRO�, ( Y4- AuEs — 2'50 X /7 ,X ,Z 7 s X ZCO (&-p-A-0 b) Land area designated to building site I Y*Agfts c) Sewage Disposal Contractor •Baa'TAM t V ' CETT S 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: -s.4 MIl3 T 1�v'T�2C�o�� OF MILLING 12,D, Z�S ori' Lei (cctAitw, nzoM S C� DCHD(6-62) DAVIE COUNTY HEALTH DEPARTMENT ti ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, R O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED c�0 —Doc; (office use only) �n yes ®o 1. I am the owner of the above described property. oe no 2. 1 am not the owner of the above described property, however, I certify that have consent from ZO�t���ogS , owner to obtain a wner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described propertyand conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. X0 DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: —Owner only —,LOwners designated representative ✓_Anyone requesting results Only those listed below DATE SIGNATURE DCHD(11/84) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name /a 111L12 Date / 9 Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S CFSD PS PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) <Lsl---� PS PS PS U U U U 3) Soil Structure (12-36 in.) p S S S S Clayey Soils �/ �fi�y PS PS PS I" • U U U 4) Soil Depth (inches) ( S S S S PS PS PS PS U U U 5) Soil Drainage: Internal S S S S 0 PS PS PS U U U U External S S S PS PS PS U U U 6) Restrictive Horizons CV J/ // 7) Available Space `PS 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 / S ' U—UNSUITABLE, ,1 S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: e % � Described by—z�_����/ Title _ Date SITE DIAGRAM I r, t t N UCHD(6-82) e y Davie County .fealtli De artment and .dome XealtFi Aen 210 HOSPITAL STREET/P.O.BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5965 April 19, 1989' . i Allen Builders Route I. Advance, NC 27006 x Re: Septic Tank System Dear Mr. Allen: On April 11, 1989, this office did the final inspection for the septic tank system that serves the Kent Dunn residence on Milling Road. On that date it was determined that the power line serving the house had dissected the backyard,- making it impossible to install the total 500 linear feet. Approximately 450 feet of line was installed at various gravel depths. In order for this system to function properl� all surface water should be diverted away from the system. If you have any questions, feel free to call. Sincerely, Robert 8. Hall, Jr., R.S. Environmental Health -Section RH/wd cc: Kent Dunn