150 Whitehead Drive Lot 9 Section 2DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Namer�,;`!%o A� % _ Date /i/ / j.:iL.
Location. All
Subdivision Name 1�2-2:fat Lot No. f Sec. or Block No._
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms —No. Baths No. in Family +;r.
Garbage Disposal YES M/ NO ❑ Specifications for System:
Auto Dish Washer YES NO ;❑
Auto Wash Machine YES F_L��NO , f fr
Type Water Supply
"This permit Void if sewage system described below is not installed within 36 months from date of issue.-:
t
'0
II �7
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
Certificate of Completion'
*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.
County Health Department
ronmental Health Section
P.O. Box 848
210 Hospital Street
Courier # : 09-40-06
Mocksville, NC 27028
viv-311 Jr, VVAL13 1 r WATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
�T
C
Dw (336) - 753-1680
Name:
`V'G--11 t 5 Phone Number. 3 3 6 -C1 (�U -3 16 � (Home)
Mailing Addres:_ � , rj �T��ec� �� (Work)
4Auc.,-y\ ce e e )ocl 6
Detailed Directions To Site: Tcxy+h {SO / &&J-7k1rra -I�S_ 4r' (�i, n —5;
i111 "� ° ��O °�S S - ��" 1Z C l� 1' Gvl Ilam. l,q ^ �oL t ��CAti C V c L, -.l
Property Address: 13--G wk%tze hlw Z01 �LV—Pt C< C Lok 9 ELAin�1'19 ell
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: gi�jjl ik '-tzi / 4 Cq G2,f Type Of Facility: ,Q,SI`
Date System Installed (Month/Date/Year): Number Of Bedrooms: 3 Number Of People: Z
Is The Facility Currently Vacant? Yes 0 If Yes, For How Long?
Any Known Problems? Yes 0 If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: �'(X ('��l Grn✓ Number Of Bedrooms: Number of People Z
Requested By: �,e"_ ')� _ �.ce,.:, Date Requested: 5 =17 - 1 b
(S g attire)
For Environmental Health Office Use Only
Approve Disapproved
Com nt)s AAA 6 1 f `E7 /JyLc—�
Environmental Health Specialist�y�i��� Date:
0
*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 Check Money Order #! Amount:$Date: 6-/ 7-1
'aid By: L Received By: ZI&II,
kccount #: J(3 Invoice M
.Ft!`.i( ;N/-
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations ._
NAME DATE ISSUED
--,
ADDRESS PERMIT NO.
r S, , C, 12Zd -3
Explanation of charge
AMOUNT DU&�, . '-' SANITARIAN
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STA TEM T.
i
r.._ DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c.
Permit Number
6r�� arood Ro€al B rats Gono?c Cao %x `79
Name ' Date.;
Location 'Off 801 Advance Al 14&Ao
UM This lot wps-ya�uato10/9'78 for Ciro Gil Daviev copy; of evaluation •an fill ,
Subdivision,Name censcoc(. Leak Lot No. 9 Sec. or Biock No.
Lot Size House — Mobile Home — Business —_— Speculation
No. Bedrooms __ No. 'Baths —' — No. in Family
Garbage Disposal YES Ej NO: ® Specifications for ;System: 90.a 601, 7cnl,
Auto Dish Washer YES i] NO t3�s gpl2004XIGH
Auto Wash Machine YES ] NO 0 Mot,av Might roquiro a Pwpd .
Type Water Supply County ----
*This permit .Voidif sewage system described below is not installed within 36 months from date of issue.
p u ,
5op4ic Tank tont zz ;ct:az! f;o co3 t ct mob;
�r a,4 'efface before any a" ;;t^a
g this systems design,,!
Improvements permit by
I ,
*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 Inl`stalled by
1,'Ire
61
770
r
r Certificate of Completion ; ` 1R�u.ih - Date
f *.The signing of this .certificate° shall indicate that the system described above has been installed in compliance with .f
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 i.
DAVIT; COUNTY HEALTH DEPARTIM14T
PERCOLATION TEST RESULTS
DATE �� d
NAME `t �� % C•�?i
LOCATIOIN J
MIDINGS : / J" HOLE NO.
2
3�y-
v
/2
5
6
COMMITS n ,1
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13/x( i/,�s �'`� -Alo
LOT DIAGIWI
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DAVIE COUNTY HEALTH DEPARTMENT jj- 00�
P. 0. BOX 57
MOCKSVILLE, N. C. 27028 �-
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME I.3ty WAR Ce-a-+a1� DATE ISSUED
ADDRESS Domwood Real Estate and Con3t. Co. PERMIT NO. 2445
333 Salisbury Street
L+ock vilant W,Cw 2792@
Explanation of charge
AMOUNT DUES SANITARIAN So Mandu
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
ear orre
As discussed with you by phone on May 11, 1979, I would like to point
out one thing. Without obtaining an improvements permit from this office,
before starting construction, you are in direct violation of Laws and Rules
For Ground Absorption Sewage Disposal Systems of 3000 Gallons or Less Design
Capacity, and furthermore that if this occurs again, this office will be
forced to take the required legal steps to remedy the occurance.
Now, as to the aboved referrenced lot on Greenwood Lakes. On the
morning of May 11, 1979, Buck Hall, Sanitarian I and I visited the property.
Mr. Dan Reilly of this office evaluated the property 10/9/78 for Mr. Gil
Davis and the site being classified as suitable, with the following provisions:
The sewage system if in 'the front yard would be kept as.high as possible,and.
thus stay away from the lower front yard. As a result of further evaluation
on 5/11/79 please note the following:
1. Area proposed.from 10/9/78 evaluation is now unsuitalbe due to
topograpy in regard to .plumbing stub out.
2. The. only available space left where this office can issue a
permit, is the rear yard. This would require a change in
plumbing and possibly a pump.
Please find enclosed a bill.for the improvments permit on lot #9
Block.8, Greenwood Lakcs. Upon receipt of payment we will forward the permit
to you.
>`—„`
C"Zt17iE �QTili��? �EiII�Ij
�E�2iz�ttTETi�
.
.
2iTT� �itTttE � PcT����
�1�CTiC�J
P. O. BOX 57
�linchsbille, �iitrtll (ILnrnlinu z7Q28
OFFICE OF THE DIRECTOR
May 14, 1979
-
TELEPHONE
"
704/ 634.5985
Mr. Danny Correll
% Boxwood Real Estate
and Construction Co., Inc.
333 Salisbury Street
Mocksville, N.C.
27028
Re: Improvements
Permit -Greenwood Lakes Lot
#9 -Block 8
D Air C 11
ear orre
As discussed with you by phone on May 11, 1979, I would like to point
out one thing. Without obtaining an improvements permit from this office,
before starting construction, you are in direct violation of Laws and Rules
For Ground Absorption Sewage Disposal Systems of 3000 Gallons or Less Design
Capacity, and furthermore that if this occurs again, this office will be
forced to take the required legal steps to remedy the occurance.
Now, as to the aboved referrenced lot on Greenwood Lakes. On the
morning of May 11, 1979, Buck Hall, Sanitarian I and I visited the property.
Mr. Dan Reilly of this office evaluated the property 10/9/78 for Mr. Gil
Davis and the site being classified as suitable, with the following provisions:
The sewage system if in 'the front yard would be kept as.high as possible,and.
thus stay away from the lower front yard. As a result of further evaluation
on 5/11/79 please note the following:
1. Area proposed.from 10/9/78 evaluation is now unsuitalbe due to
topograpy in regard to .plumbing stub out.
2. The. only available space left where this office can issue a
permit, is the rear yard. This would require a change in
plumbing and possibly a pump.
Please find enclosed a bill.for the improvments permit on lot #9
Block.8, Greenwood Lakcs. Upon receipt of payment we will forward the permit
to you.
..�__. .. Y... �...... y..as.. -et.y {� 8,Y'."�' �a . .. .,:. M -.w _.. .u.. 'wi' 4a:a' i -.."�r'6-f+c . �,.y. "Ye. �. 'Ac �. a_ L.:. Ya V •h -e a�-� ..y .� 1 .• - ;. :\P"� � 1 i' Y r 1
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 Permit Number
Name F.\\ �, j Z Date 2 NO 7022
Location
y Lot No. Sec. or Block No. �~
Subdivision Name �`�'
Lot Size House Mobile Home _T Business _— Speculation `
No. Bedrooms 3 No. ,Baths 2 No. in Family—
Garbage Disposal YES [D/ NO ❑ z.
Specifications for System:
Auto Dish Washer,"' YES UE' , NO ❑ f o 0 0
Auto Wash Ma .hine YES 'NO'[']
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 si e-pf s-arttte-tr UffdedM
iA\4hN4
"Al
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 `-
I
. .4"
41
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 COUNTY HEALTH DEPARTMENT
.IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in -Compliance With Article 11 of G.S. Chapter 130a
` Sanitary Sewage Systems Permit Number
Name I
- V A� a �� ti` u, ' - Date ~` - ^7 NO 7022
._
c.b L..
Location )
52
Subdivision Name Ca '�"'" \` `�' Lot No. ` Sec. or Block No.
Lot Size ��'� �'`" House " Mobile Home —T Business -- Speculation
No. Bedrooms .No. Baths No. in Family —
Garbage Disposal YES ❑/ NO ❑ Specifications, for System:
Auto Dish Washer YES [ NO ❑
Auto Wash Ma^hine YES C] NO ❑' r�{.��;
t,
Type Water Supply -_—
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
_-' p_ ' p R�the inferided-use cf�angi -
This permit is subject to revocation if site tans, or
I 14F
ts.•
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 %)_1 /'I -
P5 P
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 WO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
' DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) /J
NAME ,�//LG/�S/'�G��� PHONE NUMBER
ADDRESS -9 SUBDIVISION NAME
LOT #
e ,
DIRECTIONS TO SITE =�(J" �(G �S - ff11 "f �2 e 14. d71 --
DATE SYSTEM INSTALLED / NAME SYSTEM INSTALLED UNDER ��Xwo n,D dnqz, �SVz
TYPE FACILITY tSr NUMBER BEDROOMS .Y NUMBER PEOPLE SERVED
TYPE WATER SUPPLY e_Q SPECIFY PROBLEM OCCURRING zL7-
DATE REQUESTED 19 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knoe, and that I understand 1 am responsible for all charges incurred from this application.
/7,,SIGNATURE OF OWNER OR AUTHORIZED AGEN
Rev. 1193