244 Vogler Rd.+/rJ• s.. .4" .^"'-sw'.i'i.i. �'o�_" ..W-r:'.i.cl a:.r�..itJi''a'� 1�'.9A:.1 �.... .ve,.f-sihw. -rr...✓�w.+ry .._-._ - .. ..+.-,'..... y.^^a._.w.
DAVIE COUNTY HEALTH DEPARTMENT
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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 ca `c>�r;��� :� Date ,
r, ��)
' Location ; �; (� \ � �� ccs•.h� s m
�
Subdivision `' Lot No. Sec. or Block No.
Lot Size----��7 House ✓ Mobile Home _ Business Speculation
No. Bedrooms _ No. Baths r�' No. in Family _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES, NO
Auto Wash Machine YES g/ NO '❑
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 by % �zo
Certifica a of Completion ��--`' =�-- Date > 7%
'The signing of this certificate shall 'ndicate 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
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 1 1�
Davie County Health Department
Environmental Health Section Gw
P.0.Box 665
Mocksville,N.C.27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 919-760-3591
1.Permit Requested By Todd & Robin Reed Business Phone 919-744-2116
2. Address 2501 West Clemmonsville Roadnt 16, Winston-Salem- NC 27127
3. Property Owner if Different than Above Herman Vogler
Address Rt. 3, Box 113 Advance, NC 27006
4. Permit To:a)Install X 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_
Industry_Other—
b)Number of people 2
6. a)If house or mobile home,state size of home and number of rooms.
House Dimensions 24 x 76
Bed Rooms 3 Bath Rooms 2 Den w/ClosetI —
b)If Business,Industry or Other,State:Number of persons served NONE
What type business,etc. NONE
Estimate amount of waste daily(24 hours) 1.5 gallons
7. Number and type of water-using fixtures:
commodes 2 urinals 0 garbage disposal 0
lavatory 0 showers 2 washing machine 1
dishwasher 1 sinks 3
8. a)Type water supply:Public Private % Community
b)Has the water supply system been approved?Yes_No
9. a)Property Dimensions 1.5 acres
b)Land area designated to building site 24 x 76
c)Sewage Disposal Contractor Jones Backhoe Service
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? NO
What type? NONE
This is to certify that the information is/�correct to the best ofmy knowledge.
December 3, 1987
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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OCH0(6-82)
� DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name _�o b a bhp �o Q� Date
Address S 2GS \" Lot Size 1. 3 P
CL1 O- a570
FACTORS AREA 1 AREA0 AREA 3 AREA 4
1) Topography/Landscape Position S S
C&5 dD PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) C SP-v PS PS
U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils ISS t PS PS
U U U
4) Soil Depth (inches) S S
( PS 1 PS PS
��J....�� U U U
5) Soil Drainage: Internal S S S
PS PS
U U U
External S S S
PS PS
U U
6) Restrictive Horizons
7) Available Space S S S
PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U
9) Site Classification -�
U—UNSUITABLE ` S—SUITABLE PS Provisionally Suitable
Recommendations/Comments:
Described by Title -- Date
SITE DIAGRAM
Ss
DCHD(6-82)