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P3997 Feed Mill Rdi - . 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 i P Name --==t-' ) �� j1.,..� Date �"' 3997 Location�fi'%�, ✓ , r� �: ji 1�,�,ti / f ;�:' — ,f� i - -- m1u, 9 Subdivision Name Lot No. Sec. or Block No. Lot Size r'<l House �� Mobile Home — Business Speculation No. Bedrooms �r No. Baths No. in Family Garbage Disposal YES NOp-- Specifications for System: Auto Dish Washer YES NO Auto Wash Machine YES [T] NO -p Type Water Supply _ *This permit Void if sewage system described below is not installed within 36 months from date of issue. . Al *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 Certificate of Completion [; �J U A116 *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 P. 0. Box 665 . Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone �2I4?--'5 33 1. Permit Requested ByfflJ Business Phone!9- 2. Address 1VC--SG ©� 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter RepairOth b) Privy Conventional t er Type Ground Absorption c) Sub -Division Sec Lot No. 5. System used to serve what type facility: House Mobile Business IndustryOther b) Number of people— ej 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions ,/520 -64 )E1 Bed Rooms_.3 Bath RoomsDen 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: n commodes 2 urinals f '2 lavatory A showers CL dishwasher sinks / 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes �o 9. a) Property Dimensions L b) Land area designated to building site c) Sewage Disposal Contractor garbage disposal washing machine ! 10. Do you anticipate any additions or expansi ns 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.. —T Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: /f 45,70 a7 7 �,��� 6W W1,S117- � pL�� QA) r DCHD (6-82) Address GA r.Tn R C e DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION / Date��G Lot Size AREAS AREA 4 AREA i ARFA 7 Topography/ Landscape Position S S S �-S PS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 1) Soil Structure (12-36 in.) S S S Clayey Soils PS PS PS U U U U Soil Depth (inches) S S S S PS PS PS U U U �) Soil Drainage: Internal S S S S PS PS PS U U U External S S S S `gam PS PS PS may/ U U U U 1) Restrictive Horizons ')'Available Space S- S S PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U Site Classification !;—[ y I U—UNSUITABLE Recommendations/ Comments: Described by SITE DIAGRAM 4 DCHD (6-82) S—SUITABLE PS—Provisionally Suitable Title