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207 Ginny Lane Lot 9DAVIE COUNTY HEALTH DEPARTMENT 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 o ..., a N', \ ,X1 :, :_ Date W7a,i _ 4663 Location - Subdivision Name "� - � �. �'r Lot No. C� Sec. or Block No. Lot Size House V Mobile Home _ Business Speculation No. Bedrooms No. Baths. No. 'in'Family Garbage Disposal YES ❑ NO' Specifications for System: Auto Dish Washer YES p NO ❑ / O o o Auto Wash Machine YES NO ❑ i Type Water Supply _— *This permit Void if sewage system described below is not installed within 36 months from date of issue., I e,jfa ;,W 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 v ry Certificate of Completion c Date ' U - - V *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 as that the system will function. satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 RECEIVED riAX U 9 i931 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Reques d By 2. Address c 3. Property Owner if Different than Above Address 4. Permit To: a) Installer Alter_ Repair Home Phone 9q 9 s0.6Z Business Phone 99X sD6 Z b) Privy— Conventional Other Type— Ground Absorption c) Sub -Division 0,lt l&D,+f Sec. — Lot No. - 5. System used to serve what type facility: House Mobile Home— Business— Industry— Other_ b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions `fix V10 Bed Rooms `7 Bath Rooms Den w/Closet -"+O 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 Z urinals lavatory showers 2 dishwasher ! sinks 8. a) Type water supply: Public4/___� Private Community b) Has the water supply system been approved? Yest,-' No— garbage disposal 2 washing machine / 9. a) Property Dimensions /5,? -X 20 o A- l '7 b) Land area designated to building site 62CC T�LEFT T c) Sewage Disposal Contractor CD �l2dL -q3lr(c- T.f./< SVC 10. Do you anticipate any additions or expansions of the facility this sewage system is Intended to serve? No What type? This is to certify that the information is correct to the best of my k owledge. A ftDate wner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 91DDLL �(P� �Cc o �F V` CJI Lii,✓/J DCHD (6-82) Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size ' FACTORS AREA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position 5) 8) S S S S T§>' c PS PS PS Uv U U U !) Soil Texture (12-36 in.) Sandy, cf:S S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U U 1) Soil Structure (12-36 in.) © S S S Clayey Soils PS PS PS PS U U U U Soil Depth (inches) rc$> S S S PS PS PS PS U U U U Soil Drainage: Internal S S S PS PS PS PS U U U U� External -c:!S!7> S S PS PS PS PS . U U U U Restrictive Horizons 1) Available Space S S. S S PS PS PS U U U U 3) Other (Specify) S S S S PS PS PS PS U U U U 1) Site Classification U—UNSUITABLE PS—Provisionally Suitable Recommendations/ Comments: /�� Described by �t 4 � r Title SITE DIAGRAM 11 DCHD (6-62) AAD Date 8 - 2 r Ig3.3V ' Davie County NealK Deppartment and Name Nealtl' Myency 210 HOSPITAL STREET/ P.O. BOX 665 MOCEsvaLE. N.C. 27026 PHONE: (704) 684.5965- . October 5, 1988 Hubbard Realty Attn: Gloria 285 S. Stratford Rd. Winston-Salem, NC 27103 Re: Sewage System Installation Matthews Builders Springdale/Sec. 1 -Lot 9 Dear Realtor: The 'septic tank system that serves this residence was designed, inspected and approved by this office on October 2, 1987. With proper maintenance and use it should function properly. Sincerely, p . Charles E. Little, R.S. Environmental Health Section CL/wd