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171 Riddle Circle Lot 2Y Lf f Cr. it ' DAVIE 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 antdd ,IDisposal Rules (10 NCAC 10A .1934-•1968) Permit Number Name *CM1CIw_ lit I�iY6,0—k DS"�r� � p_ Date f�6!� i :.:'y Location % 5� —�� T5-2C�.� ncL Ktt S 1 o bpr-cj )` -, r4:G( Subdivision Name 171 fu'feLle l,irt. 1. Slf�fr3 Lot No. x- Sec or Block No Lot Size I House t/ Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family — Garbage Disposal - Auto Dish Washer YES ❑ NO YES ;N0 Specifications for 'System: p 1 `I� Auto Wash Machine YES qr NO •❑ Co J 30, O Type Water Supply b tt NTS►' _ *This permit Void if sewage system described below is not installed within 36 months from date of issue Improvements permit by C`Q' *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 Certificate of Completion Date �14, '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 Ll o Y 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 \�cDate �-�`� t� L�' 4-023 V � , Location i.S`6 \:.,�\� ,.a \�a ``P(�no,rh,�\ Subdivision Name j7� t RrrICC�Q. l ,(.t"e.� Yt` ('3 Lot No. 2- Sec. or Block No: ' Lot Size u ' 1 House Mobile Home _ Business __ Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ,❑ NO Specifications for System: Auto Dish Washer, YES Q'. NO `lam Auto Wash Machine YES Cy Nor❑ 30 0 X l a t "' Y3u Type Water Supply C` n tA. tom:: 1' __— Q. *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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.( 1..� A., L 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. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 51/9-983–o3" 1. Permit Requested By —Business Phone 2. Address I34'rPcPj[j4& R(06,0 -C, avoai 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter— Repair b)Privy— Conventional Other Type— Ground Absorption c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: Housed Mobile Home— Business_ Industry— Other— b) Number of people___:3 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions A 4yLxys' Bed Rooms -3 Bath Rooms a Den w/Closets 0 b) If Business, Industry or Other, State: Number of persons served — What type business, etc. Estimate amount of waste daily (24 1 7. Number and type of water -using fixtures: commodes urinals © garbage disposal lavatory 3 showers -? T4A%FS&WtM CornhIM074l washing machine / dishwasher 1 sinks 1 8. a) Type water supply: Public ( Private Community b) Has the water supply system been approved? Yes X No - 9. a) Property Dimensions 124,1't' K 2(..84 b) Land area designated to building site c) Sewage Disposal Contractor Tot" 41eN 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? 011 What type? This is to certify that the information is correct to the best of my knowledge. (%19157 I1 C_La•Pt?e o,71t Date 0 —Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: Loo -Aa SpRirJsoALE DCHD (6-e2) , 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 n SOIL/SITE EVALUATION Name L+. I LADate Address Lot Size F d E , CAPTnoC ARFA 1 ARFA 9 AREA 3 I ARFA d Topography/ Landscape PositionS S S S PS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, S S S , Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U U q Soil Structure (12-36 in.) © S S S . Clayey Soils PS PS PS PS U U U U Soil Depth (inches) ci!> S S S PS PS PS PS U U U U Soil Drainage: Internal CIE> S S S PS PS PS PS U U U U External �$-> S S S PS PS PS PS U U U U i) Restrictive Horizons Available Space SS PS S PS S PS U U U U I) Other (Specify) S PS S PS S PS S PS U U U U I) Site Classification U—UNSUITABLE -S—SU ABLE PS—Provisionally Suitable Recommendations/ Comments: Described by 4•rAo-16 Title Date SITE DIAGRAM I. (or .µl .. W JA 2S. 8G. 70 Lor* 2 L9AA° s q f L9.0 9' DCHD (6-82) Davie County AealtFr Department and Nome . fealt§ 9yem y 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634.5985 March 16, 1988 Hubbard Realty Attn: John Petitto 285 S. Stratford Rd. Winston-Salem, NC 27103 Re: Sewage System Installation Jack A. Phelps, III Springdale Dev./Lot 2 Dear Realtor: The septic tank system that serves this residence was designed, inspected and approved by this office on April 14, 1987. According to your agent, this house has not been occupied to date. With proper maintenance and use the system should function properly. Sin erely, n n Jo ando, R.S. �• S. Dir for of'Environmental Health JM/wd