234 Grannamon Dr ,I
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;-A DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF. COMPLETION
*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 .WICHARD GUANNlIMAN Date "'/ b V Z 5 �
Location 601 LEFT oN _L�U -1n F s 6o .�' ? w a-F s fuss (,J/1 civF.K /W
i 6611 FN S006, 7-- L F c1F c U/�,
Lo-T
Subdivision Name Lot No. Sec. or Block No.
Lot Size �G House Mobile Home _ Business Speculation
No. Bedrooms Z No. Baths No. in Family 2.-
Garbage Disposal . YES ❑ NO Specifications for System: 14)04) G,4ie0" TAu,,c
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
4�
5
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: Syst m stalled by VKWN WD i�Gf�`�'aJkrr-P�r-t
to 2/1 Fes-
�-•- Date,? . '
Certificate of Completion —�� /
*The signing of this certificate shall indicate that the system describe 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.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name
—S—It/4,4a a P 4XAjV1V41knA1j Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position Q S S
PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) 9PS PS
U U U
3) Soil Structure (12-36 in.) S S
Clayey Soils P NPS PS
`( U U U
4) Soil Depth (inches) S _ S
p �� PS PS
j U U U
5) Soil Drainage: Internal S S
PS PS
j T U U
External S S
PS PS
U U
6) Restrictive Horizons
7) Available Space S 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—Provisionally Suitable
Recommendations/Comments:
Described b Title Date
SITE DIAGRAM
DCHD(6-82)
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
1. Permit Requested By Cj 114 6, 6/aWlllal1c(Al Business Phone Co
2. Address , 70 r?v C Chi
3. Property Ow er if Different than Above &II-10AI l-e� Cra�•�a�-ra.�
Address 76. �'o)e `/'�o f7cC_k y / C
4. Permit To: a) Install Alter Repair
b) Privy Conventional V 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 9-
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions /1/-,dy 7C"
Bed Rooms_2 Bath Rooms 9- Den w/Closet ir/otiG
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 2= -541111,1`1 urinals 0 garbage disposal
lavatory showers �-=.5�``"�"` `Tct�9s washing machine
dishwasher O sinks — 3 `63,74 -I ft,/a ,
8. a) Type water supply: Public Private '� mmunity
b) Has the water supply system been approved? Yes rCoNo
9. a) Property Dimensions 0-- C/cIles
b) Land area designated to building site Z41/'Z` r'2
c) Sewage Disposal Contractor Sc/-4
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? y d
What type?
This is to certify that the information is correct to the best of my knowledge.
Or
Date Owner Signature
OWNER IS $Q.LELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
-- r Allow 5 days for processing
Directions to property:
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DCHD(6-82)