163 Pool Dr (2) '..� t"v7 _ i1'-•3v�:..�:Z-'w-� ; q.. e.,. .y� `•/,.` .:y....:L�.w {j'. �•f 'tom•
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
'Sanitary Sewage Systems Permit Number
Name `'���{ \ \ Date � - 3 O " cl 2 0
_ _ � fi� N_ 6��0
Location
t
Subdivision Name Lot No. Sec. or'block No. k
Lot Size House Mobile Home Business _— Speculation -
No. Bedrooms :No'. Baths No. in Family 5 _
Garbage Disposal ; YES ❑ NO Q' Specifications for System
Auto Dish Washer YES ❑ NO
Auto Wash Ma^hine YES g�' NOh{❑
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
�-
1
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 by4 ;
Certificate of Completion - 14,y� 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.
COMPLAINT FORM
' DAVIE COUNTY HEALTH DEPARTMENT
` ENVIRONMENTAL HEALTH SECTION _
Date Received
Name of Complainant Received By
Address Telephone—
Complaint
elephone Complaint
Person Responsible for Complaint 13 �? I r•��. e v� ft i k ��/��
Address Telephone30 `� µ S� rn oc f
Directions to Complaint 6 y
Date Investigated –3 9 —Investigated By C
Complaint Justified Complaint Not Justified
Action Taken 5� \-\��c��,�y 1� 11,� t t__
NX
Date Environmental Health Staff Signature
(DCHD 1/85)
. ' Dame County ,Valtli 7yeaartment
and .dome Aealtl sy
210 HOSPITAL STREET I P.O.BOX 668 3�gg2
MOCKsvILLE.N.C, 27028
PHONE:(704)634-5985 ,
October 21 1992
Mr. Ricky Hendrix
Rt. 3, Box ,457
Mocksville, NC 27028
. Dear Mr. Hendrix:
On July 30, 1992, this office issued a repair permit for a septic problem
on your property on Pool Drive. Upon returning to the property on
September 29, 1992, this problem still exists. This problem must be fixed by
October 19, 1992.
Please contact this office at 634-5995, if you have any questions. Thank
you for your cooperation.
Sincerely,
Charles E. Little, R.S.
Environmental Health Specialist
CL/wd
Enclosures