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989 Calahan Rd DAVIE COUNTY HEALTH DEPARTMENT t. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name '' e �/7i: s� %r'/r r"F- Date Location ,:.., ,,• r.. >r ,,:: ,,, ,.. r".t% ,: ,� �: Subdivision Name Lot No. Sec. or Block No. Lot Size !f ' '`-f< House Mobile Home _ Business Speculation No. Bedrooms �"" No. Baths Aja No. in Family % Garbage Disposal YES p NO [] Auto Dish Washer YES p NO C] Specifications for, System:ry r ✓j Auto Wash Machine YES Q NO ,0 Type Water Supply -'-,•d��'f! __ -�;-��.%,f �'�✓,�,.: '`This permit Void if sewage system described below is not installed within 36 months from date of issue. 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: -S i6e-m Installed by t�J f - i Certificate of Completion - Date " J *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 R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. h Home Phone 6 3 q 1. Permit Re uested By � �� ��/So K , Business Phone 2. Address 1f J Aw /7 3. Property Owners/if Different than Above k e^ y b oySo rr Sr. Address &yk /' Aoy III A' k s 4. Permit To: a) Install-Z"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 / IndustryOther b) Number of people T w d 6. a) If house or mobile home, state size of homp arld number of rooms. House Dimensions Bed Rooms Bath Rooms Den w/Closet f 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 tw D urinals garbage disposal lavatory & e a showers f washing machine dishwasher ? sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes— No s� 9. a) Property Dimensions— b) Land area designated to building site c) Sewage Disposal Contractor Sam m V 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 Own Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ff 0rx � ��' d? �c77�elc� S�CO►�� �oct� do r ,�h 0J4- 65 ids r P914i a r �. ll �mv cq" �oh a leas �N,�F iE c.� 2P� 'la Gs�2•a-r�� Tr./� �✓rw- c.f F� �,�- t'A'01 �cocK HOGS V_ (/K 7Z7 -art-c / Gym lC�K4' Gla SS DCHD(6-82) 17A91- L A:rT S/'rF DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name /bm-wti Date �o Address 2 �C'BE Lot Size /L r L z 7o 2 P FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S dff;:> 95P CTT�> U U U U 2) Soil Texture (12-36 in.) Sand , S S S S Loamy, Clayey, (note 2: lay) P PS co U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils S U 4) Soil Depth (inches) S S S S P © � � U, U 5) Soil Drainage: Internal S S S S PS � PS PS 45) u U External S S S S © cj�g> PS PS U U U U 6) Restrictive HorizonsSPP,�,G Spp 23i --w - Z2 Z 7) Available Space 3 PS �j"' U U U 8) Other (Specify) S S S S PS PS PS PS U U UU U 9) Site Classification U—U SUIT L S—SUITABLE PS—Provisionally Suitable Recommendations/C mments: // m�� /� - «K �O � d Described by S?rP15 �m+A"'T'° ��^'S 8 Title Date SITE DIAGRAM /. � 3 DCHD(6-82) �V n _..