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238 Shoffner Rd DAVIE COUNTY HEALTH DEPARTMENT �.� IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETIO *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 l?) �VN :ccr �-��W C� �; \�*\\\S –SS-Date ) �� ,1 N° !a M Location Subdivision Name \� ` Lot No. Sec. or Block No. Lot Size "' House Mobile Home —T_ Business Speculation No. Bedrooms L, ,No. Baths No,'Jn Family, ° Garbage Disposal YES 0 Nb% " ,,;; [R} Specifications for System: Auto Dish Washer,',,-,,,. YES / NO fl Auto Wash Machine YES 02/ NO fl Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. T 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 Ml � 13� %33 Certificate of Completion 'MQ^ Date *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. U • Y7 APPLICATIO F05 SITE EVALUATION/IMPROVEMENTS PERMIT 198 avie County Health Department JA0 �/G Environmental Health Section P P. O. Box 665 21� �� Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 63 V'5_9�Ll 1. Permit Requested By Cwt,; 11) avvN 6- L.owder,Ni i �� � JR- Business Phone 2. Address 1J. C• a'7o 3. Property Owner if Different than Above 6t, ok,& +- a e Address r'`y v z�.. (2-d- 4. Permit To: a) Install v Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division ystem used to serve what type facility: Hou ✓M i Hom tit usiness Industry b) Number of people `� 6.�a) If house or mobile home, state size of home and number of rooms. N\\�� House Dimensions -TO Bed Rooms y Bath Rooms r-)- 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 V sinks �p Type water supply: Public Private V)A Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 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. Date Owne Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: �br--CAd 91 c�ea. U � �.. DCHD(6-82) ©I t+ heJ J 1 � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 1� SOIL/SITE EVALUATION Name "«l'J �' ./J7��/� Date (5 Address MP Lot Size n FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S CE7) cff) PS PS'L U U �--� 2) Soil Texture (12-36 in.) Sandy, S Loamy, Clayey, (note 2:1 Clay) is) --E� U U 3) Soil Structure (12-36 in.) ® S Clayey Soils �6 S PS U U U 4) Soil Depth (inches) PS U U U 5) Soil Drainage: Internal S S .-S 4w- � PS External S T PS PS U U 6) Restrictive Horizons _ 7) Available Space ® QS PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U 9) Site Classification - - A0 - S U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: �� � ` b Described by �/� �� �� Title Date SITE DIAGRAM a DCHD(6.82) (gountg pealt4 cOepartment ttn� cmome pettltlt '�Senrg P. O. 'BOX 665 ,locksbille, �KvH4 Carolina 27028 OFFICE OF THE DIRECTOR TELEPHONE 1704) 634.5985 July 11, 1986 Mr. William G. Lowdermilk, Jr. 225 Gwyn Street Mocksville, NC 27028 Mr. Lowdermilk: As per your request a representative from this office visited your site on July 10, 1986 in order to determine the soil/site suitability for the installation of a ground absorption sewage system. At that time the lot was classified provisionally suitable; however before a septic tank system can be issued the house location must be staked off and that specific area evaluated. If you have any questions feel free to call. Sincerely, Ad s c Robert B. Hall, Jr. R. S. Environmental Health,