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477 Vogler Rd PP- DAVIE COUNTY HEALTH.'DEPARTMENT' .' j - IMPROVEMENTS:1. 13ERMIT. AND CERTIFICATE OF COMPLETION �• *NOTE:' Issued in Compliance with G.S''of North Carolina Chapter 130 'Article 13c Il ' Sewage Treatment and Disposal Rules. ('10 NCAC 10A,.1934-.1968)' Permit' Number • Name �v A Date. .487� f Location �, �"'� .� v' U S' n v I{ ��..�C� 1_ '.�1 �cs^R-�"�t`..�` � i�In' '�%;;^��si•-ds �,'F' - ,1_ ' 't'l� `j r.� �,��'xT.t...r�. � lac`. LJ l: Subdivision Name ` Lot No. Sec. or Block No. ;I ,i . Lot Size, - ' House: ,� Mobile-Home _ Business Speculation No. Bedrooms.No. Baths No. in Family 4, _ v Garbage Disposals YES 0 NO w Specifications for System: II Auto Dish-Washer' . YES NO '! Auto Wash Machine YES pi NO ©, Jg �:; ��� Type Water Supply This permit Void if sewage system described 'below is not installed withiW36 month_ s from date of issue. l r"l. ► : Yoh ff it:1 I ' ' �\ Improvements permit-by = .T *Contact a representative of the Davie County HeallhDepartment for final inspection of this system between 8:30 ` 9:30 A.M. or 1;00-1:30 P.M. on day ofd complet• n. Te' phone Number: 704-634-5985. Final Installation Diagram:' ystem Installed by J- ):it S ;Certificate of Completion 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 irn NO way" 'be taken as a guarante that the system will function { satisfactorily for any given period of time !i APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone lq3'Z.la 3 1. Permit Re nested By 'SYS a �' Business Phone 2. Address I 3. Property Owner if Different than Above Address 4. Permit To: a) Installer 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 Homed Business Industry Other b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions la y- b 5— Bed Bed Rooms--Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served A// What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory a 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 1�t19 /� QCves b) Land area designated to building site c) Sewage Disposal Contractor _ 10. Do you anticip a any addition�s/ r expansions of the facility this sewage system is intended to serve? What type? is i 1 G( a_ ! [(5� This is to certify that the information is coriect to the best of my knowledge. 7a/ � Date Own Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: � r n 6n SS C o ro Y_ (mai e r) (I(Pp 9pec] b `� <- e e � I-�,e- Cd LL) h I e bS 111�a��l 2 Y r 2r. I Q ST- Sec-T) -/ q . �� � �h� renc e d ( n DCHO(6.82) M DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section, P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name t` \�� u� Date Address Lot Size I r` FACTORS AR ARE AREA 3 AREA 4 1) Topography/Landscape Position S S 4� 4b PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) ($ PS PS !. �-' U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS U U 4) Soil Depth (inches) S \ S S P PS PS U U U U 5) Soil Drainage: InternalS S p (:Pb PS PS U U U External S S < P OPS U PS U U 6) Restrictive Horizons 7) Available Space S S S PS S PS PS U U U 8) Other (Specify) S S S S PS PS PS PS U U 9) Site Classification S U—UNSUITABLE — PS—Provisionally Suitable Recommendations/Comments: Described by Title DateV SITE DIAGRAM 1 DCHD(6.82)