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P3784 Hwy 601SDAVIE 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 tom•.:,rG.1 - Date ► -kS 6; 3734 Location t- , t ` -7 I, _ 1 i 4 t. 1–, Subdivision Name Lot No. I Sec. or Block No. Lot Size 1 )! y z ` House t-- Mobile Home _ Business Speculation No. Bedrooms Z... No. Baths �I� No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: ► oo0 5. 0. Auto Dish Washer YES p 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. F Improvements permit by,, r, S, *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 -T. �jhQq-� lovq J 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 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 P.- O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION ime ���— S A►ti►.,..,i z>r1(- 2�'�F w,�� Date qtr 4– V 3 �- Z ,--- s a'X Z Zc3 idress �"' �' Lot Size PAr`.Tr1R.q AREA 1 AREA 9 ARFA A AREA d Topography/ Landscape Position Z'T� <M) S S PS PS � PS U U U Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) <1!t� -,E,N PS PS U U j U U Soil Structure (12-36 in.) S S S S Clayey Soils <EFM::> r<M) PS PS U U U U SoiVDepth (inches) S S S S `fes <1 -> 'rcm> PS PS U U e, U U Soil Drainage: Internal S S S PS PS U U � U U External S S PS PS PS PS U U U U Restrictive Horizons Available Space S S PS PS PS U U U 1 Other (Specify) S S S S PS PS PS PS U U Ull U Site Classification PS 61y U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable recommendations/Comments: )escribed by a • Yha" Title '--�`t'� Date rZ' /7�'Y ;ITE DIAGRAM _ I rc-,% ct. z ratio P" �""`_ ,.�•-- Qf `rX v y �J j I 1 � )CHO (6.82) APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section' P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone '�% VC/ ' 3 Pd 1. Permit Reque ted By i 5,4 Business Phone 074' 2. Address Z( /Yt O c ip 3. Property Owner if Different than Above a" /4 % Sa rn 7e -'v If c/ A of ,) 0-40 ,( Address V ij I o r- A 5q#. 14- JI 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 IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. i d rg Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals garbage disposal lavatory f showers washing machine dishwasher sinks 8. a) Type water supply: Public I/ Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 3 S0 V Q Q D 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? N o What type? This is to certify that the information is correct to the best of my knowledge. / .) — / 1 -- r t`_ - i w ,-(., - 4 not r r" v, - t> Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 4-4 44z �- DCHD (6.82) IV, OFFICE OF THE DIRECTOR ,Bttiiie (gountV-Xettlth Department Unb (Monte xettlth '�gentg P. O. BOX 665 fflocksbille, North Qlarolina 27028 December 18, 1984 Mr. Jesse Boyce, Zoning Officer Davie County Courthouse Mocksville, N.C. 27028 Re: Dwight Sammons Property Highway 601 South Mr. Boyce: The above mentioned property was evaluated by this office on December 17, 1984. The purpose of this evaluation was to determine the soil/site suitability for the installation of a ground absorption sewage treatment and disposal system. Please note that the results of said evaluation were very favorable, thus this office can forses no problem with issuing the required improvements permit to install a sewage treatment and disposal system for the proposed project. Feel free to contact my office should we be of further assistance to you concerning this matter. 'ncerely, as Mando, R.S. Env. Health Coordinator Davie County Health Department TELEPHONE 17041 634.5985