723 Pine Rdige Rd ., -._._.-__ .. -..yJ _..-'-.r„-+ut.'v.f'r•��u .:tii. -.-wL' a a.Inin+++� __Lt. W a d' :..wJ.i�..I"./.-i7'. I .. w'.4'! L..:V d.\ ♦ 4. .. -
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t y DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION f
*NOTE: Issued in Compliance with G.S. of North CarofinIa.Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC10A .1934-.1968) Permit Number
ZzName ,-�y'�•%>�., .t i' �,Lr, DateI �� t ' 74
Locationr �/
Subdivision Name Lot No. Sec. or Block No.
Lot Size i �”C House l-'-' Mobile Home Business Speculation
No. Bedrooms _Q No. Baths No. in Family _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO Ea- '
Auto Wash Machine YES ❑ NO
Type Water SuPPIY ____L_
�,`mo
*This permit Void if se:gai 6,system described below is not installed within 36 months from date of issue.
r
y l
4�
s
Improvements permit by —� 11
*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
i
CEJ
Certificate of CompletionDate 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.
RECEIVED AUG 1 11986
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
RECEIVED AUO 1 I IM Moc sville, N.C. 7028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone L(
1. Permit Requested By Business Phone
2. Address c.k,) x_ , Yl
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 Sec Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people �-
6. a) If house or mobile home, tate size of home and number of rooms.
House Dimensions 2�5 x �'ID
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 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 J D 0
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 certifythatthe information is correct to the best of my knowledge.
.� J/ p
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
kerections to propertya
God S _
/vd D� �✓d -
xaa 1"a h le
V
OCHO(6-82)
r
DAVIE COUNTY HEALTH DEPARTMENT
` Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name O fC'`Q 'a Date r V�
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S
US 1�) ID US
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) SPS
U U U
3) Soil Structure (12-36 in.) S S S
Clayey SoilsPS
U U U
4) Soil Depth (inches) S S S
PS
�—U U U
5) Soil Drainage: Internal S S S
P PS PS
U_ U U
External S S -_. S
PS PS PS PS
U U U U
6) Restrictive Horizons
7) Available Space S S PS PS
cz> eu*Z:Z�)- U
8) Other (Specify) S S S S
PS PS S PS
U U U U
9) Site Classification
U—UN UITABLE S—SUITABLE PS—Provisionally Su
Recommendations/Comments: .
Described by ,Title r"' Date � 6
SITE DIAGRAM
�-
DCHD(6-82)
�� �''
MIt� �IItttP �PMC�I� ��Eltr�i
P. O. BOX 665
arksiiiUe, �Tortli Carolina 27628
OFFICE OF THE DIRECTOR O TELEPHONE
August 28, 1986 17041 684-5985
Mr. Homer L. Lagle
Route 4, Box 225-6B
Mocksville, NC 27028
Mr. Lagle:
As per your request, .a representative from this office visited your site
on August 26, 1986, to determine the soil/site suitability for the installa—
tion of a ground absorption sewage system. Unfortunately, due to the reasons
noted -below, we must classify this site unsuitable. We sincerely regret this
classification and are more than willing to discuss this matter, further, upon
your request.
Unsuitable due to these reasons:
1. Fill material
2. Fill material is unsuitable
3. Not enough available space
Sincerely,
Robert B. liall, Jr. R. S.
Environmental Health
RBHJR
Enclosure