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226 Burton Rd
DAVIE COUNTY HEALTH DEPARTMENT ' � MPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION sued in Compliance with G.S. of North C lina Cl apter/30 Article 13c Sewage Treatment a I Disposal `( ?r. 934-.1968) Permit Number Da Namete � � � 65 Location Subdivision Name Lot No. Sec. or Block No. Lot Size 2 House Mobile Home _�� Business Speculation No. Bedrooms No. Baths e-�; No. in Family _ Garbage Disposal YES ❑ NOTSpecifications for System: Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO ❑ f� � ��`�`'` 1/ Type Water Supply `This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit bY --7 *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 !0 /40 Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with �e standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function .jisfactorily for any given period of time. { c DAVIE COUNTY HEALTH DEPARTMENT { 1 _ � IMPROVEMENTS .PERMIT AND CERTIFICATE OF COMPLETION _ *NOTE: Issued in Compliance with G.S. of North Carolina Chapterf(30 Article 13c Sewage Treatment and Disposal Ruj 'a�� j�lC��j1QA'.�i934-.1/968) Permit Number Name �` ,f, .4� 1/f es jv� Date /'�% r _ , a�J 5 t Location �,- �!` -{�l1/ � ' f r, 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 NO ❑ � v Auto Wash Machine YES NO ❑ Type Water Supply _ `1✓ /i �✓ *This permit Void if sewage system described below is not installed within 36 months from date of issue. t I` 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 J �Up i Certificate of CompletionDate—T--, "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 .,the for any given period of time. • ' C t f '• APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department 19$? Environmental Health Section P• O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested ByBusii ess Phone 2. Address Z- -14$ A G C< b D 3. Property Owner if Different than Above 7 6 021 Address - 4. Permit To: a) InstallAlter Repair b) Privy Conventional �Other Type Ground Absorption c) Sub-Division Sec. Lot No. �✓l s 5. System used to serve what type facility: House_j,ZMobile Homes /� Industry Other b) Number of people 1f" 6. a) If house or mobile home, st a size of home and number of rooms. House Dimensions � A174 �- 1,) X' +e^k c� !> �- b"` i j Bed Rooms 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 2'__ washing machine dishwasher sinks l 8. a) Type water supply: Public_ Private Community b) Has the water supply system been approved? Yes 9. a) Property Dimensions b) Land area designated to building sitero c) Sewage Disposal Contractor 10. Do you anticip to any additions or expansions of the facility this sewage system is intended to serve? What type? e•S - )�o LAS This is to certify that the information is correct to the best of m knowledge. -2— - s 0 1— Date - O n Si ure OWNER IS SOLELY RESPONSIBLE FOR C I N T LL STA AND OC LLA Allow 5 days for processing Directions to property: 13,v`1l 5-0 6' juc DCHD(6.82) yo �fc j2e� 177 , r r f AN • ;{ DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name Date Address Lot Size �� FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S PS PS PS �—� U U U 2) Soil Texture (12-36 in. Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils �8 > PS PS PS U U U 4) Soil Depth (inches) S S S S PS PS PS U U U 5) Soil Drainage: Internal S S S PS PS PS U U U External S S S PS PS 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 U U U 9) Site Classification > U—UNSUITABLE S—SUITABLE PS—Provisionallv Suitable Recommendations/Comments: Described by— Title Date SITE DIAGRAM I� 1 - S DCHD(6-82)