1089 Daniel Rd Davie County,NC Tax Parcel Report Wednesday, February 15, 2017
531
549
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ti��AN1 R DANIEL FAD DANJ
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WARNING: THIS IS NOT A SURVEY
� Parcel Information a:��x%
Parcel Number: L4130A0006 Township: Jerusalem
NCPIN Number: 5736725962 Municipality:
Account Number: 8306718 Census Tract: 37059-807
Listed Owner 1: SPAUGH NORMA EVERHART Voting Precinct: COOLEEMEE
Mailing Address 1: 1089 DANIEL ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: LOT 1 GOSHEN LANDS Fire Response District: JERUSALEM
Assessed Acreage: 0.84 Elementary School Zone: COOLEEMEE
Deed Date: 8/2016 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 010260412 Soil Types: PcC2,CeB2
Plat Book: 0005 Flood Zone:
Plat Page: 077 Watershed Overlay: DAVIE COUNTY
Building Value: 35840.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 15520.00 Total Market Value: 51360.00
Total Assessed Value: 51360.00
O PIS All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the
County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�OUCI� NC or arising out of the use or Inability to use the GIS data provided by this website.
CONSTRUCTION �� p0�� For'Office use OnN
AUTHORIZATION CDP File Number, 220066- 1
Davie County Health Department 101 County ID Number:5736725962
" 't 210 Hospital Street Evaluated For: HDR/WWC
�•,��,,,. P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 7 a 5 0 1
Applicant: Marvin and Norma Spaugh Property Owner: Marvin and Norma Spaugh
Address: 1089 Daniel Rd Address: 1089 Daniel Rd
City: Mocksville City: Mocksville
State/Zip: NC 27028 State/Zip: NC 27028
Phone#: Phone#:
Property Location & Site Information
Address/Road M Subdivision: Phase: Lot:
1089 Daniel Rd
::Mocksville NC 27028 Directions
Str=ucture �SINGLE... FAMILY Hwy 601 S, right on Gladstone Rd. left on Daniel Rd. on
;- ,_
left. Corner of Daniel and Hank Lesser rd
#of Bedrooms:
i
#of People:
"Water Supply: NSA
System Specifications
Minimum Trench Depth: a 4
Site Classification: Provisionally suitable Inches
Minimum Soil Cover:
Saprolite System? O Ye_s .®No 1 a Inches
Maximum Trench Depth:Design Flow: - _ 1- 12 0 p 3 6 Inches
Soil Application Rate: 0 3 Maximum Soil Cover: a 4 Inches
"System Classification/Description: "Distribution Type: GRAVITY-PARALLEL(eq.d-box)
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
"Proposed System: 25%REDUCTION 1-Piece: O Yes O No
Pump Required: O Yes O No O May Be Required
Nitrification Field 3 0 0
Sq.ft. Pump Tank: Gallons
No. Drain Lines 1 1-Piece: OYes ONo
Total Trench Length: 1 0 0 ft, GPM--vs— ft. TDH
Trench Spacing: O Inches O.C.
_
9 ®Feet O.C. Dosing Volume: Gallons
Trench Width: — 3 O Inches
Aggregate Depth:
®Feet Grease Trap: Gallons
inches Pre-Treatment: O NSF OTS-1 OTS-11
Septic Tank Installer Grade Level Required: 01011 O 111 01V
Page 1 of 3
CDP File Number 220066 - 1 County ID Number: 5736725962
❑ Open Pump System Sheet
Repair System Required:0 Yes O No O No, but has Available Space
CDesign
System
Trench Spacing: O Inches O. .
fication: — o Feet O.C.
Trench Width: Q Inches
w: — . U Feet
Aggregate Depth: I
Soil Application Rate:
u Minimum Trench Depth: inches
*System Classification/Description: Inches
Minimum Soil Cover:
Inches
Maximum Trench Depth:
*Proposed System: Inches
-- Maximum Soil Cover:
Nitrification Field Sq. Inches
ft.
No. Drain Lines *Distribution Type:
-Total Trench Length: ft Pump Required: O Yes O No O May Be Required
Pre-Treatment: O NSF OTS-I OTS-II
- *Site Modifications
No-grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. R e
750
*Permit Conditions
The issuance.of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. Rm�9
2000
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not
to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been
completed during the period of validity of the Construction Permit,the Information submitted in the application for a permit or Construction
Authorization is found to have been incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become
Invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance
with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? O Yes ®No
Applicant/Legal Reps. Signature- Date: /
*Issued By: 2399-Eldridge,Tiffany Date of Issue: 0 7 a 6 / a 0 1 6
Authorized State Agent: nAAAADL Malfunction Log Oyes
®Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 220066 - 1
Davie County Health Department CDP File Number:
210 Hospital Street 5736725962
• P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 0 7 / a6 / .1016
Q Inch
Drawing Drawing Type: Construction Authorization Scale: , , , , O Block
0 N/A
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Page 3 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street CDP File.Number: 220066 - 1
P.O.Box 848 5736725962
Mocksville NC 27028 County File Number:
Date: A T/.2 6. /..2 0 1.6.
Click below to import an image from an external location: Drawing Type:Construction Authorization
Page 3 of 3
P1 P2
Davie County,NC Tax Parcel Report Tuesday,December 20, 2016
531
549
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_..r_ _ _._._....._....——..
- WARNING: THIS IS NOT A SURVEY
ParcetInformation�
Parcel Number: L4130A0006 Township: Jerusalem
NCPIN Number: 5736725962 Municipality:
Account Number: 8306718 Census Tract: 37059-807
Listed Owner.1: s.- SPAUGH NORMA EVERHART Voting Precinct: COOLEEMEE
Mailing Address 1: 1089 DANIEL ROAD Planning Jurisdiction: Davie County
City: . MOCKSVILLE - Zoning Class: DAVIE COUNTY R-A
State: _ NC;'. . Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: - LOT 1 GOSHEN LANDS Fire Response District: JERUSALEM
Assessed Acreage: 0.84 Elementary School Zone: COOLEEMEE
Deed Dater - 8/2016 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 010260412 Soil Types: PcC2,CeB2
Plat Book: 0005 Flood Zone:
Plat Page: 077 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
161
l data Is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the
/-� County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or inability to use the GIS data provided by this website.
OPERATION PERMIT or fice use UnIV
Davie County Health Department *CDP File Number 220066- 1
210 Hospital Street 5736725962
P.O. Box 848 County ID Number:
'`=•�°' Mocksville NC 27028 Evaluated For. HDR/VMC
Phone:336-753.6780 Fax:336-753-1680 Township:,
Applicant: Marvin and Norma Spaugh Property owner: Marvin and Norma Spaugh
Address: 1089 Daniel Rd Address: 1089 Daniel Rd
City: Mocksville CRY: Mocksville
State/Zip: NC 27028 State/Zip: NC 27028
Phone#: Phone#:
Property Location & Site Information
Address/Road N: Subdivision: Phase: Lot:
1089 Daniel Rd
Mocksville NC 27028 Directions
Structure SINGLE FAMILY .
Hwy,601 S, right on Gladstone Rd. left on Daniel Rd.
on left. Corner of Daniel and Hank Lesser rd
#of Bedrooms:
#of People:
'Water Supply: NIA -
*I
*System Classification/Description:
P Issued by,
TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
*CA issued by: 2140-Nations,Robert
- Saprolite System? OYes ONo
Design Flow: 6 - 0 *Oistnbution Type: GRAVITY-PARALLEL(eq, Pump Required?
OYes (DNo
Soil Application Rate: 0 3 *Pre Treatment:
Drain field
rNcation Field: 1 3 0 9 Sq.f• *System Type:
rain Lines 1 Installer: Mike Mueller
Total Trench Length: 1 0 0 ft. Certification#: 1132
Trench Spacing: _ 9 Inches O.C.
()Inches
O.C. *EH S: 2140-Nations.Robert
Trench Width: 3 Inches
Feet Date: 1 0 / 0 4 / 2 0 1 6
Aggregate Depth: inches
Minimum Trench Depth: 3 5 Inches
Minimum Soil Cover. 2 4 Inches Appiroval Status
Maximum Trench Depth: 3 6 Inches Fal proved O Disapproved;
Maximum Soil Cover: 2 4 Inches
CDP File Number 220066 - 1 County ID Number: 5736725962
Septic Tank
Manufacturer. Lat.
Long:
STB: .
Gallons: Installer.
Date: Certification#:
*EHS:
'Filter Brand:
ST Marker. ❑ Yes ❑ NO
Date:
Reinforced Tank: ❑ Yes ElNo Approval Status
�❑ Approved O Disapproved
1 Piece Tank: ❑ Yes ❑ANO
Pump Tank
Manufacturer. Installer.
PT: Certification#:
Gallons: THS:
Date: Date: C
Riser Sealed ❑ Yes ❑ No
Riser Height: ❑ Yes ❑ No (Min.6 in.)
Approval Status
Reinforced Tank: ❑ Yes ❑ .No ❑ Approved l] Disapproved
1 Piece Tank: ❑ _Yes _ ❑ No ,
Supply Line
Pipe Size: inch diameter Installer.
Pipe Length: feet Certification#:
*Schedule: THS:
Pressure Rated ❑ Yes ❑ NO Date:
Approved fittings ❑ Yes ❑ No ApprovatStatus
''❑ Approved❑ Disapproved
Pump Requirement
Pump Type: Installer:
Dosing Volume: — Gal Certification#:
Draw Down: Inches *EHS:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ NO
Flow Adjustment Valve ❑ Yes ❑ N O
Check-valve ❑ Yes ❑ No ApprovalStatus
PVC Unions ❑ Yes ❑ No ❑ Approved❑, Disapproved
Vent Hale ❑ Yes ❑ No
Anti-siphon Hole El Yes ❑ NO
CDP wile Numbdr 220066 - 1 County ID Number: 5736725962
Electric Equipment
NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ No
Certification#:
Box Adj. Pump Tank ❑ Yes ❑ No
"Conduit Sealed ❑ Yes ❑ No •ENS:
Pump Manually Operable ❑ Yes ❑ No
"Activation Method: Date:
Approval Status
Alarm Audible El Yes ❑ NO =
❑ Approved❑ Disapproved
Alarm visible ❑ Yes ❑ NO _
2140•Nations,Robert
*Operation Permit completed by:
Authorized-State Agent Date of Issue: 1 0 / 0 5 1 2 0 1 6
Owner/Applicant Signature:
This system has been installed incompliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for
_ Sewage Treatment and Disposal,15A NCAC 18A ,1900 et. Seq.,and all conditions of the Improvement Permit and
Construction Authorization.This property is served by a TYPE 11 a sewage septic system.
Rule .1961 requires that a Type ?YPE II A septic system meet the following criteria:
Minimum System Review.ByThe local Health Department: WA
Management Entity:
OWNER
Minimum System Inspection/Maintenance Frequency ByCertified Operator: -
N/A
Reporting Frequency By Certified Operator: NIA
-Rule .1961 requires that a Type IV-and V septic systems designed fora home/business owner must maintain a valid'contract
with a public management entity.wkh a certified operator or a private certified operator for the life of the septic system.
Rule.1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements for maintenance and
operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the
system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT 220066 - 1 ,
Davie County Health Department CDP File Number.
210 Hospital Street 5736725962
P.O.Box 848
County File Number:
Mocksville NC 27028 Date:
Olnch
Drawing Drawing Type: OperationyP-ermit Scale: . OBlock
ON/A
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CONSTRUCTION For Office Use ON
sAUTHORIZATION *CDP File Number 2200,66-1
Davie Count Health Department 5736725962
Y P County ID Number:
210 Hospital Street Evaluated For: HDR/MC
•�9 4,,,- P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 7 l a 5 a 0 a 1
Applicant: Marvin and Norma Spaugh Property Owner. Marvin and Norma Spaugh
Address: 1089 Daniel Rd Address: 1089 Daniel Rd
City: Mocksville City: Mocksville
State/Zip: NC 27028 State/Zip: NC 27028
Phone#: Phone#:
Property Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
1089 Daniel Rd
Mocksville NC 27028 Directions
Hwy 601 S, right on Gladstone Rd. left on Daniel Rd. on
Structure: SINGLE FAMILY left. Corner of Daniel and Hank Lesser rd
#of Bedrooms:
#of People:
*Water Supply: NSA
System Specifications
Minimum Trench Depth: a 4
rDesign
ssification: Provisionary suitable Inches
Minimum Soil Cover:
System? O Yes No 1 a Inches
low: 1 a Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 3 Maximum Soil Cover: a 4
Inches
*System Classification/Description: *Distribution Type: GRAVITY-PARALLEL(eq.d-box)
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
*Proposed System: 25%REDUCTION 1-Piece: O Yes O No
Pump Required: O Yes O No O May Be Required
Nitrification Field 3 0 0 Sq.ft. Pump Tank: Gallons
No. Drain Lines 1 1-Piece: OYes ONo
Total Trench Length: 1 0 0 ft GPM—vs— ft. TDH
Trench Spacing: 9 ®O Inches O.C. —
Feet O.C. Dosing Volume: Gallons
—
Trench Width: — 3 O Inches
®
AFeet Grease Trap: Gallons
inches Pre-Treatment: O NSF OTS-1 OTS-II
Aggregate Depth:
Septic Tank Installer Grade Level Required: O 1 0 1 0111 01V
Page 1 of 3
CDP File Number 220066 - 1 County ID Number: 5736725962
s '
❑ Open Pump System Sheet
Repair System Required:0 Yes ONO ONO, but has Available Space
rDesignFlow:
System
Trench Spacing: ()Inches O. .
fication: — V Feet O.C. _
Trench Width: O Inches
_ — 8Feet
Soil Application Rate: Aggregate Depth: inches I
*System Classification/Description: Minimum Trench Depth: Inches
Minimum Soil Cover:
Inches
Maximum Trench Depth:
*Proposed System: Inches
Nitrification Field Sq.
Maximum Soil Cover:
Inches
ft.
No. Drain Lines *Distribution Type:
Total Trench Length: ft - Pump Required: O Yes O No O May Be Required
Pre-Treatment: O NSF OTS-I OTS-II
- *Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rm.s
750
*Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. Rmai ng
2000
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not
to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been
completed during the period of validity of the Construction Permit,the Information submitted in the application for a permit or Construction
Authorization is found to have been incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become
Invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance
with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature Date:
*Issued By: 2399-Eldridge,Tiffany Date of Issue: 0 7 a 6 a 0 1 6
Authorized State Agent: Malfunction Log OYeS ='
0 Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 220066 - 1
+ Davie County Health Department CDP File Number:
210 Hospital Street 5736725962
P.O.Box 848 County File Number:
Mocksville . NC 27028 Date: 07 / a6 / a 0 1 6
0 Inch
Drawing Drawing Type: Construction Authorization Scale: , O Block
0 N/A
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Page 3 of 3
P1 P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department '
210 Hospital street CDP File Number: 220066 - 1
P.O.Box 848 5736725962
Mocksville NC 27028 County File Number:
Date: .0.7./.2 6. x..1 0 1.6.
Click below to import an image from an external location: Drawing Type: Construction Authorization
-�- a
27
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Page 3of3
P1 P2
Davie County Health Department
4i6f Environmental Health Section
` P.O.Box 848
.5„ 210 Hospital Street
O U Courier# : 09-40-06 1
Mocksville,NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: Avivix) /V`F d l& � J Phone NumberSk Ve AL (Home)
Mailing Address: ID91 Nivid :?76 `5-k&& (Work)
Le/ e- At 2-70-9'
-9'
Detailed Directions To Site: 60 IrJ) No-elt`10acg / Kal &y &Ajd'
_ Property Address: 4.41
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: U' d. . Type Of Facility:
T
Date System Installed(Month/Date/Year): = 3 Number Of Bedrooms Number
Is The Facility Currently Vacant? Yes If Yes,For How Long? �GYri lI �t�ws ��2
Any Known Problems? Yes No If Yes,Explain:
Please Fill In The Following Information A bout The NEW Facility:
Type Of Facility: c.SJy fYl/f � X Number Of Bedrooms: Number of People
Pool Size: Gara a Size: Other:.
Requested By: Date Requested: �o^ 2 />
�. q 9 6M
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
__
Environmental Health Specialist Date: Cal
*The signing of this fonn by the Environm ntal ealth Staff is in no way intended,nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash hec Money Order # Amount:$ 0.00 Date: 29
Paid By: Received By:
Account#: Invoice#: UU6Y7,
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Davie County, NC Tax Parcel Report Wednesday, June 29, 201 f
549
���''�-•� � 117 ` �+� r 128 f
j I
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109 /
1069 _ti j/ ..� �'
1115
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L.. r `h
WARNING: THIS IS NOT A SURVEY
g Parcel Information
Parcel Number: L4130A0006 Township: Jerusalem
NCPIN Number: 5736725962 Municipality:
Account Number: 69627000 Census Tract: 37059-807
Listed Owner 1: SPAUGH MARVIN EUGENE Voting Precinct: COOLEEMEE
Mailing Address 1: 1089 DANIEL ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: LOT 1 GOSHEN LANDS Fire Response District: JERUSALEM
Assessed Acreage: 0.84 Elementary School Zone: COOLEEMEE
Deed Date: 8/1983 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 001200293 Soil Types: PcC2,CeB2
Plat Book: 0005 Flood Zone:
Plat Page: 077 Watershed Overlay: DAVIE COUNTY
Building Value: 10150.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 15520.00 Total Market Value: 25670.00
Total Assessed Value: 25670.00
4 t;�tE All data Is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�O fl Y1� NC or arising out of the use or inability to use the GIS data provided by this website.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems q Permit Number
Name
IT. 0. S,PAtj /j 0. 7 /4� y/-f Date �� � ��/`� N2 72A J
Location Ivo - /71 ?4 el,./JV411i 12d 7. c% �
/ lell D,4n% - m.
�N�1Gt. FJlgrl:el/
Subdivision Name Lot No. Sec. or Block No. '
Lot Size House Mobile Home Business Speculation
No. Bedrooms No. Baths l No. in Family _
Garbage Disposal YES p NO Q" Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Ma shine YES ❑ NO ['r
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. Ila
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
�rlr �Ol Pi-r
b 1
s
- GC
Certificate,of Completion Date
'The signing of this certificate shall indicate1hat 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.
(a fit,.. f 's. r ' it..:. - �' ,i .>' - . - . °♦ i -, � _-a, ;a:..-;H• .-, � 'y. ,
DAVIE:.COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION,
*.NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
.. -a Hary SeW tie sstems• �" y - � Permitpu 4 ter
Name-r------ ,� Le�,+° Date NO
,. .
7 1,;4. '/eft 1'2oP - 7 /r/-,�
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 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 Ma shine YES ❑ANO :n y
Type Water.Supply / n;h ` # �• t
*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 9se change.
r
' h
F
i
I `
Ila
r 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.:
• -- f�* �r/;!I / ter�f,,_r
Final Installation Diagram: System Installed by
a �
,S
,/
Certificate of Completion 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. _ _