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P5627 Davie Academy Rd • -.w �i, �� DAVIE COUNTY HEALTH DEPARTMENT �;""�'�'` '- IMPROVEMENTS PERMIT•AND CERTIFICATE OF COMPLETION . 3 *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 2- "l >�?� Ca?.� ?r� �, _ Date M � N2 562-7 r. Location ,(� : N v o Q, ' o c; r� �—�'e s t ) �_)- .�•:,-`,�.-;:��. ��� - ��, C`n . \` S_�.s-��.._T�. �;•c� �� R ��� �o3.y',t'� 0`?V��rs�:,zs1Jy Subdivision Name ` Lot No. Sec. or Block No. Lot Size �- � �'° House u Mobile Home _ Business Speculation No. Bedrooms .No. Baths No. in Family _ Garbage Disposal YES ❑ NO Specifications for,-System: Auto Dish Washer YES ❑ NO Auto Wash Machine YES ©' NO;0 v l� I` Type Water Supply _ *This permit Void if sewage system described below is not installed within 36 months from date of issue. ` J .t ) L c� I 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: System Installed bye-erg '1oc,�4 G ..a 10N 0 o: tiff 0 NO Certificate of Completion `- Dat "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. .y,..'�;v ...: tam. �w ;crr....w..w:-,:.::.^ _,.;..q:.. F y,..,.�2 ... . - .:- .. + L-_.... -< < - n _. .- • - n-.-.,- _ . 'r a ,, r . I'"',f r. COUNTY HEALTH DEPARTMENT t 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 T Name �.:\ � = \ ..`.. fi{1' z.to Date N� is7 y Location %��.>� ��c !a `` 1t� gr_. � .yr,r���r \CtiDP, r � S��'� � �l\1� � L.• F �.��{� - _ _ .; �y ..-a.a �.t � •� ��-� � +_ -..9 4_ \ \ \ �..: �1•..-' fig :�.. TJX Subdivision Name Lot No. Sec. or Block No. Lot Size �% L House ,'� Mobile Home — Business Speculation No. Bedrooms No. Baths — — No. in Family -' Garbage Disposal YES 4❑ NO .per Specifications for: System: - Auto Dish Washer YES ❑ NO Auto Wash Machine YES Q' NO -❑ Type Water Supply --- *This permit Void if sewage system described below is not installed within 36 months from date of issue. I ' L' 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: '' System Installed by 40 r �. , +� i 1 .- —�'.-- ice`_..) r+\ `• .ya4\ 0t %� C T Cerfifi% e of Com letion _.tem _ "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. -INFORMATION-FOR-SEPTIC SYSTEM-REPAIR PERMIT NAME A�`�A'Q -e 0.-� - PHONE NUMBER ADDRESS;_ by �,C� s�.-<,ns �, \\�SUBDIVISION NAME MA C-Is SUBDIVISION LOT # DIRECTIONS TO SITE DATE SEPTIC SYSTEM INSTALLED NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER SPECIFY PROBLEMS THAT ARE OCCURRING , Dade County NealtI De artment and dome .'�'ealtlf ayemy 210 HOSPITAL STREETI P.O.BOX 665 MOCK$VILLE.N.C. 27028 ` PHONR:(704)634.5985 February 17, 1993 Mr. Cliff Benge 204 Hollingswood Road Statesville, NC 28677 Re: Improvement Permit #5627 Mr. Benge: In reference to the above, be aware that the on—site sewage system as described in Permit #5627 was inspected by .this office on June 30, 1989. The installation was approved by this office on same date. Please advise should you have any questions. Sincerely, oe Mando, R.S. Director of Environmental Health JM/wd • Davie County Nealtfi De artment l tl Aen and dome Yeal y cy 210 HosPITAL STREET P.O.BOX 665 MOCasvILLE,N.C. 27028 PHONE:(704)634.5985 March 17, 1993 Mr. Clifton Benge 204 Hollingswood Rd. Statesville, NC 28677 Re: Repair Permit 5627 Cliff & Barbara Benge Dear Mr. Benge:. On March 16, 1993, we had a conversation about the permit for repair issued June 27, 1989. On the day in which the system was repaired the contractor called this office and asked if he could change the repair to two lines. I gave him permission to do that and it was noted on the permit. If you have any questions, please contact me at this office at 704/634- 5985. Sincerely, Charles E. Little, R.S. Environmental Health Section CL/wd ,I