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2477 Hwy 801S5:4. .. .s .,�,�.a t i+•2:. ttr < .'S� ... ..1',`. `.T. .i„ a]t i. . .. ,r +'Y•r t .i j.:4 lva C/yS±.�''M t- . DAVIE COUNTY HEALTH DEPARTMENT s fi IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETIONpt S `NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treat)nt and Disposal Rules (10 NCAC 10A .1934-.1968) Permit- Number Name:1'rr' �' Date —L/ 2 l ? 9 Location T Subdivision Name Lot No. Sec. or Block No. Lot Size ��" -� ' HouseMobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family__ Garbage Disposal YES ,F] NO Er Specifications for S m: Auto Dish Washer YES NOs- Auto Wash Machine YES NO p Type Water Supply ' �/^ .moi r `This permit Void if sewage system es ­crib -e'a'se w is not installed within 36 months from date of issue. Improvements permit b l *Contact a representative of the Davie County He A Department for final inspection of this system between, 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of comp) tfon. Tellpthone Number: 704-634-5985. Final Installation Diagram: ystetalled by' j Certificate of Completion �� rG' 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. 1. Permit 2. Address 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. 3. Property Owner if Different th n Above Address 2 6&10a. ✓� GC/ 4. Permit To: a) Install A tl er Repair b) Privy Conventional Other Type Ground Absorption c) Sub -Division SeLot No. 5. System used to serve what type facility: House I Mobile Home Business IndustryOther b) Number of people 'y 6. a) If house or mobile home, state size of home andnumber of rooms. House Dimensions Ix ?a /&l C �5✓iS rn� Bed Rooms— Bath Rooms_ 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 A urinals garbage disposal lavatory a showers a► washing machine dishwasher I sinks 8. a) Type water supply: Public Private Community ✓ (...c oU�-�-�� b) Has the water supply system been approved? Yes �No 9. a) Property Dimensions (9,s©" A 375' 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. /_ n_�- Date Own r Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: vy-\ - 1- _ 1,I Q , y -o oy'\ P Com' P16. DCHD (6-82) or\ 0CN\E)&_j e1z'q 5706 • O . ` ;a � r tie t r _ d/� ' a44 O • v z 693 1460 415 77.5Mc ,16 2 r 223.1(7 $62 30 8 8n - 77ri A c 8.98 A c. Os I iCI, � O �`;IIRIA 310.20 f• 4 .42227. 50 1200 p ly— � 550 II 1 33Ac. OD 3no i17..77Ac. ) �A G+.� 200 1 j0 I)– 404.58 N y6 -, 22 eg m o p t5� L,r �i m Q� .8 N 20d 5M ., 16 S. R. 16 18 150 1 8.4 3A c, W I 10,55 34 224 d 16674 92 y35 61 18.53Ac 25.2Ac o �•. T 1 p 495 4o 215 ID 34 0.4' toin Po 2 A c v) to a 3� 1(3 Acs � �, 325 U) 21 w 1 7 0.0 ~ 792 If). 4AC N 2 65-(7 2 3.73 291. 20 -- 9 I 6A C. `30.51f� 16.51 Ac s`o - 25 26 c�P-7 r295Ac a2.9k. 2.88AF Ak ,,� 1 2 3 - 241.313 12�',.p2 265 2 75 6 00 265.89 F I(.56A c.) 49 A31 -51 _.." S•R' 1 6 35 co n0 22789 of d' `� gll g0 O ' o, 00 30.01 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name—���%i��� Date /11� Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 ARFA A 1) Topography/ Landscape Position S� 'S/ S (is S PS S PS U U U U 2) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) PS PS S PS S PS U U 3) Soil Structure (12-36 in.) Clayey Soils g S PS S PS U U 1) Soil Depth (inches) S (t PS S PS S PS U U i) Soil Drainage: Internal S ppS� PS S PS U S PS U External P S PS S PS U U U P) Restrictive Horizons Available Space ©` PS S 'PS S PS S PS U U U U I) Other (Specify) S PS' S PS S PS S PS UU U U U 1) Site Classification 1, S le. U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: Described by Title Date SITE DIAGRAM --------------- DCHD (682)