The URL can be used to link to this page

169 Rag Rd . , : . I ,.. : . � HEALTH DEPARTMENT RELEASE ; ��c��f�fi� �� f�n�� '� ��'��-„, . . - �� 3� a.�. ... . *CDg Bi1e;Numbe�� s r� ��3: � �� F 1 ; Davie County Health Department ;� ,,� �,, • ,�� '� Environmental Health Section ,"'��County 2D�N�mber �3,�,�� .�� ' 210 Hospital Street � ��Q, �� ,�3,�� • ` Mocksville, NC 27028 �y Eva2uateii�Fo�r �� ' �w�$,. NO„_�f?tVWVG.��.,,� , ,.�„�'� �.,, „. � � Phone:336-753-6780 Fax:336-753-1680 "" Permit Valid Until: 05/14/2019 Applicant: Bob Crotts Property Owner: Bob Crotts Address: 169 Rag Road p.d�ess; 169 Rag Road City: Mocksville City: Mocksville State/Zip: NC / 27028 State/Zip: NC / 27028 Phone #: (336) 998-8777 Phone #: (336) 998-8777 Provertv Location & Site Information Address: Rag Road Subdivision: Phase: Lot: Road#: Mocksville NC 27028 Township: *Structure: SINGLE FAMILY # of Bedrooms: 2 # of People: 1 Directions:Hwy 601 South, Turn Left on Deadmon Road, Go almost to Hwy 801. Rag Road on Left. Flagged between MH and House. *Water Supply: N/A Type of business: Basement: � Yes �X No Total sq. Footage: No. Of Employees: *Proposed Improvement: Replace Mobile Home *Release Conditions: Maintain 5 foot setback to any portion of the septic system **Site Plan/Drawing attached.** Total Time:(HH:I�Ti) OHand Drawing OImport Drawing Hours Minutes Activity Code: : . HEALTH DEPARTMENT RELEASE � y ��r �f�,�.P rr��'3��,,�,� � �� .. }wry}y y� �}�7��/y,..,. �' 3 h. s-n3�� 41JC CI��B i�WILLJb�3 3v��I Y��,y 3�� +��..� � � � 1 ; Davie County Health Department ` �� ' a�� 'y�,g��"'"�"� ,� _ �� „ ' �. £� i -�- Environmental Health Section �o��Y��;��%�'�� ; '. � �' 3Q� 3 �a� rt "" 210 Hos ital Street "`� � �� 33� { �� b ,, � . , , '' fYs 4�913 S , q , � Mocksville, NC 27028 � ��valua�efl"�Far��` , �s� �' Phone:336-753-6780 Fax:336-753-1680 ��"��"` � " `��" �� Permit Valid Until: 05/14/2019 This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? �Yes �No Applicant/Legal Reps. Signature: *Date: *Issued By: Nations, Robert *Date of Issue: 05/14/2014 Authorized State Agent: **Site Plan/Drawing attached.** Total Tima:(HH:t�Ai) OHand Drawing OImport Drawing Hours Minutes Activity Code: , • Davie County Health Department ��is I�' : Environmental Health Section fi ..g� . . �,,;: . �j�]E� P.O. Box 848 . �;�'� � .y ` ,�`� '�'C � 210 Hospital Street � � �' �tl 1`t�' � � I Courier# : 09-40-06 S ; .,... �e.ca Mocksville, NC 27028 ,� Phone:(336)-753-6780 - Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: �� `j ,�r-o��S Phone Number �7O �� 7�7 7 . (Home) Mailing Address: �v � (Work) G t1� � Z 7D 2�? Email Address: //ll.�'c�r'o-�-�S �l��dt�.�, n A�' Detailed Directions To Site: (o�/ S• 7 rs .�P4��o n �d — 3 3��(i�� a ��a 9 /�� ( /.e�� 35 _,�e�v.ee,n �' �Yio ��/e �om� Ah � �`,`a�r�cic GI ouse. Property Address: g � /��7� F�pq g e �G Please Fill In The Followin Information About The EXISTING Facili Name System Installed Under: C1C. 0!Z S Type Of Facility: � �� "�%w`•, Date System Installed(Month/Date/Yeaz): l"l �(� s Number Of Bedrooms:_�Number Of People:_c� Is The Facility Currently Vacant? es No If Yes,For How Long7 U I��f7r�X � 1/I".S. Any Known Problems? Yes No If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility:s� /y�h,/.� M� ��I�� Number Of Bedrooms:�_Number of People � Pool Size: Garage Size: Other: _ Requested By Date Requested: S-6-/� Signature) For Environmental Health Office Use Only Approve Dis pproved � � Comments: �� SP J �j � � � � C �5�� Environmental Health Specialist Date: *The signing of this form by the Environmental Health 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 Ch k Money Order # Amount:$ Date: ' Paid By: ��jr�s� Received By C� Account#: ��(� Invoice#: � , . . , . DAVIE COUNTY HEALTH DEPARTMENT _. _ _ _ ��' ' " � (Septic Tank) Improvements Permit and Certificate of Completion ," (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C) OWNER OR CONTRACTOR _"�~�k��,,,,�,�i C> ��,e`: `�o r Y. DATE ..:'�I-7'S PERMIT LOCATION C7�� `l�.��r«��+.,,.�+. ��,��.,��lt. '^ N� 5 / � �*'-a f --C' s?r�.�t r S.R. N0. SUBDIVISION NAME LOT N0. SECTION OR BLOCK N0. HOUSE ❑ MOBILE HOME $USINESS ❑ House Trailer Il4-Sq-.--.F,�,� N0. BEDROOMS �, N0. B�ATHROOMS Two Bedroom House 0 Ga • 600 Sq. F,�.,-�`�' GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. �Sq. Ft. AUTO. DISHWASHER YES ❑ NO Q Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD �Qp sq. ft. DEPTH OF STONE IN LINES s ��'�,�,,d�r, 07 � � N �a t�C WATER SUPPLY: Individual � Public ❑ IMPROVEMENTS PERMIT BY �;4.�,, C1^��,ti..��},� INSTALLED BY � � /� / W / -_- CERTIFICATE OF COMPLETION BY � Date--�""� -•7 S� (8/16/73) *Construction must com with all other applicable State and local regulations LOT AREA . . f.J .S. c,}e+�Y�.a?..- .� nr. t;11,. � . .. �MG�fi . . � �� . . � - . U.�� i�� . .. . � � . . . . � $� �. � �� . j �6 ��C4�� y . . -1 - � �L Vv r �OO � � � r� �. t, - _ ;,r ,� . . . . .� � . . . . . � . � . � ,�1�.��- . .. . . . � . . . .. � , �' . . � , DAVIE COUNTY HEALTH DEPARTMENT y��y w..� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued.in Compliance with G.S. of North Carolina Chapter 130—Article 13c. _ ,-,,- � ,.s , �, Permit Number Name '- � t� `" rr�— - — Date � "�=��`�!�'-� � : �;�!�� ...-_ .., / � t ' f;- /� f'' ,.ff � �) rr..-,.. �,,,.. �,,,_„_. ` Location ? f�` `� r� �'-/ ,' ,_� > f, '� � .�. r'i' r'' M' ;; — '!, . , �! , ,� i,Y /2� �L(if% �'',='�i/ f' -" �"'� r /rJ i' � . Subdivision Name Lot No. Sec. or Block No. Lot Size ''�'�� House 1--�'"� Mobile Home — Business Speculation No. Bedrooms � No. Baths � No. in Family � �T Garbage Disposal YES p NO p�'"� � � , Specifications for System: F/�y�� Auto Dish Washer YES p NO ❑ �y� � � Auto Wash Machine YES ��O p �`� �� ,, �i �� :� � �� j /� Type Water Supply r,�-'�-!� _— �%`� � �/ � `This permit Void if sewage system described below is not installed within 36 months from date of issue. - _w._.,..,�-..�_.__....�_....__...�,�.._.___� ._..___._____ �__..`.._.._.._.., �.r._.._..ti �,--� ..._._._..�.__...___ ��'.":Ka "' .- -....., f `�--_-. ti.-___.�__..._...__,_„ _�� `--.._,.,,, ,,,� �...,`-.. -- ��` .�. .--�- � ,,.�,'�r/�./ � //`Y/ :I J` //.i" 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 ��`?�- ' `�,�� ` � `�''�'`�C.C' .� _ _. . ..._ _ _ \. . . ..` � � ., ' �:��1��/Yr��1,�'f'r� J� '��I �)v 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. . ' DaVIE COUiJTY HEALTFi DEPARTA�NT P�FiCOLF�TION TEST RESULTS DATE � � NA.rIE � � � LOCATIO�d — ! fc/ i%i / ` � � � s � �� `�� FItdD2:dG5: HOLE t10. CONII�9EIJTS �/ 1 �/G/r/ y �% �� ,�2�-�D'� '" . �- �� / .� � . -" 2 �'��rv ��,"� /� f� ��`� �S�'Y`/�tcG��.�'y 3 �.�,�� ,��,,/ �/, 'i'� ,�� T��.N�, . d l � �� / l/. '�'.5� ��'�� ,�-� � ; � � i .i ) J �� 2 ,,�-`!�"�� `� t. � d ,� / '(,�fi /� `�� / � A�: � / ��` � � IAT�G� � , � �j � ( � � {_ .. � - . �� °• - DAUIE COUNTY HEALTH DEPARTt�tENT �; C'•�w . P. 0. BOX 57 p �/�r ��IOCK5VILLE, N. C . 2702� 7/ (704) 634`5985 � ��' _ ' . Stater�ent for Septic Tank Improvement Permits � : and/or Site Evaluations NAP�'E DATE ISSUED=��«�,r � , �A'DDRESS _ PERt�iIT N0. _��J . _ � � - . � • ` Explanation of charge - . . ai�p«.. . 4 . . . . .,' . - AMOUNT D[IE �� SANITARIATd"' � r � , - ` I - PLEA�E REP�IIT THE ABOV`E;�AhIOUNT .ON RECEI�PT 'OF THIS STaTEr�iENT. ` _ �,t . _ . � _ .__ .... .� � � _ . � "�� `_ . . a�si. .. . .._.. . . � ,a, ..... ._ � .- . A q ,V