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179 Partridge Ln (2) .:..;;-r .':•,.--a ,,+�:.a_-• -i._..,.... ... :':�- .+ y.;:vs 'd. j(i..p:.3, -i. ..-. .e.- S . 4 . . .a. --- 1 •- *� I\DAVIE ~COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '.NOTE Issued-in-Compliance with G.S. of North Carolina Chapter 130 Article 13c � Sewaige Treatment and Disposal Rules (10 ' NCAC 10A .1934-.1,968) Permit 'Number Date 3Name JA Location �^„�� �✓ y _ l r e'.� - fir', , s :� .� / 1� . All Subdivision Name Lot No. Sec. or Block No. Lot Size rj< House I Mobile Home � Business Speculation No. Bedrooms No. Baths_ No. in Family _ Garbage Disposal YES Q NO p-" Specifications for System: Auto Dish Washer YESNO p 1 ///• ' ' 'rC� Auto Wash Machine YES NO ❑ ff��ii'' Type Water Supply ZZ *This permit Void if sewage system described below is not installed within 36 months from date of issue. 14( F { F 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 A i Certificate of Completion E?� J � 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. ` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department 5 Environmental Health Section cr ��ux 1 P. 0. Box 665 Mocksville, N.C. 27028 r CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone4 03 Permit Reque%e4 By TZ Business Phone 2. Address 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional - Other Type Ground Absorption c) Sub-Division Se� Lot No. 5. System used to serve what type facility: House Mobile Home Business Industry Other J b) Number of people 6. a}If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms 3 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 urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Coo unity b) Has the water supply system been approved? Yeses No 9. a) Property Dimensions 6 CLCJL.Q-,=, A— b) Land area designated to building site c) Sewage Disposal Contractor _ILA- 10. Do you anticipate any additions or expansions of the fac (ty this sewage system is intendeil o serve? What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signatur OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STAT AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6.82) ' DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) ye no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: _ Owner only — Owners designated representative Anyone requesting results — Only those listed below DATE SIGNATURE DCHD(11/84) +' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section.. P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name LZ Date Address Lot Size r FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S ? 11 U 2) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) P a U 3) Soil Structure (12-36 in.) S S p� Clayey Soils & (�P9 U ''T�j 4) Soil Depth (inches) S S C PSS PS U 5) Soil Drainage: Internal S S � S� S) U U External S S 6P PS -PS U U U U 6) Restrictive Horizons / S J 7) Available Space �S S S PS P5 PS U U U U 8) Other (Specify) S S S S PS PS PS PS U{ U U . U 9) Site Classification U� L U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Z6 Described byTitle �3'1�`� Date to SITE DIAGRAM X-2- k� DCHD(6-82) D BY: Daniel L. Timberlake, Attorney. ( ame) (street and Numbe ) (city) (State) (zip) e tax bills to: E—(Name) (Street and Number) (city) (State•) (Zip) OF NORTH CAROLINA , t�Al Y OF NXWV DAV IE. `J QUITCLAIM..DEED Men by These presents, That ' DORIS N'. TUCKER and husband. THURMAN TUCKER ' I%County, N.C. in consideration of- 0 f _of RICK STANLEY ereby released;and forever quitclaimed,unto RICK STANLEY heirs and assigns forever,all such right,title and interest,as they may - have•in or to all-.that-parcel of land lying Davie North Carolina- (Township) ounty (state) ,described as follows: . . ATTACHED "EXHIBIT A" INCORPORATED FULLY HEREIN BY REFERENCE. -(NO .TITLE SEARCH REQUESTED OR•PERFORMED)--- ntor, Doris N. Tucker; has an outstanding• Judr orsyth County, NC.' whicch has... n'transcribel to- Davie County. Judgment Cred• released and Quitclaims it interest! in and to' t' he Real Estate by inst• zorded next, releasing• it lien • to' the Grantee herein. • � .� rte._ ;''