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323 Kennen Krest Rd Lot 8 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 and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name :J' . ,— r s: s r �i,v/J ✓i Date Location /< z.�_ 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 p Specifications for System: Auto Dish Washer YES [ NO ❑ Auto Wash Machine YES NO Type Water Supply "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: 704-6 4-5985. Final Installation Diagram: System In t Ile by (� f ✓ ! %j f ^/, 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 P 0. Box 665 RECEIVED AtN' 2 b 1987 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Reques d By a w.a$ vta�s�t�Sy�n,� Business Phone 2. Address S 3. Property Owner if Different than Above SG V�A t Address 4. Permit To: a) Install `� Alter Repair b) Privy Conventional ✓ Other Type Ground Absorption t%D&Y c) Sub-Division KeK „ as�` Sec. Lot� �� LotNo. « I 5. System used to serve what type facility: House✓ Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions I h 30e Bed Rooms Bath Rooms_1 y Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) X 7. Number and type of water-using fixtures: commodes %L- urinalsgarbage disposal I lavatory Z __ showers I washing machine dishwasher sinks 8. a) Type water supply: Public Private Community ,t b) Has the water supply system been approved? Yes ✓ No (__611 7 W a r;A. 9. a) Property Dimensions 213 'x 1413 , 90 k :Q d x 3C. I . 33 ' b) Land area designated to building site c) Sewage Disposal Contractor lunL ref cA gs-g-ft. 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? h.— What type? This is to certify that the information is correct to the best of my knowledge. I -7a- T7 :9" A, , (S A — Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 3R Vil0 '�'wstK R;�kt oh �',�aJ� ,Aar VR�vt• /ory % lt DCHD(6-82) OP APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT `!�-� i Davie County Health Department �Y' Environmental Health Section \ L P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. f Home Phone `1 !!Ze 0 Z' 1. Permit Requested By C6 i S Business Phone SL-me—_ 2. Address Z- 3. Property Owner if Different than Above Address 4. Permit To: a) Install-2f—'Alter Repair b) Privy Conventional Other Type Ground Absorption L-oT� I I NAP �_5 g C) Sub-Division � 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 Bed Rooms Bath Rooms 2— Den w/Closet 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 urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes-sZNo 9. a) Property DimensionsZ-I� 9 o K 7 >c, 361- 3 ? 0 ik re S b) Land area designated to building site A(( c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? N 0 What type? This is to certify that the information is correct to the best of my knowledge. D to Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 17 DCHD(6-82) 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION /ter Name e Date Address' Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S PS PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) (PSy PS PS PS U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils ® PS PS PS U U U U 4) Soil Depth (inches) S S S PS PS PS U U U U 5) Soil Drainage: Internal S S S S PS PS PS U U U External S S S PS PS PS U U U - 6) Restrictive Horizons 7) Available Space S S S PS PS PS U U U U 8) Other (Specify) S S S S PS PS . PS PS U U U . U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by Title �� Date SITE DIAGRAM DCHD(6-82) _ STATEMENT DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION 210 HOSPITAL STREET P. O. BOX 665 MOCKSVILLE, NORTH CAROLINA 27028 (704) 634-5985 DATE 1/9/87 Harry Christopher DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT. Site Eval. 25.00 BALANCE DUE — �2I�1IE (�It1I2t�� EIII�� E�J?Sx�ritElt� Unb PornE X9MI#4 �genrg P. O. BOX 665 c4luchsbille, Nart4 (garolina 27028 OFFICE OF THE DIRECTOR - TELEPHONE January 9, 1987 4041 634-5985 Mr. Harry Christopher 4200 Lake-Cliff Drive Clemmons, NC 27012 Mr. Christopher: On January 8, 1987 this office evaluated lot 8 in Kennon Crest in Farmington. On that date the lot was classified provisionally suitable on that date. Please contact this office when your house is located. At that time, a improvements permit can be issued. Sincerely, • Robert B. Hall, Jr. R. S. Environmental Health RBHJR:sg Enclosure ' • Davie County NealtF �7yen arlment do and me .�lealt!t �Y 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE:(704)634-5985 July 11, 1988 George Martin Attorney-At-Law P. 0. Drawer 1068 Mocksville, NC 27028 Re: Sewage System Installation Thomas Smith Kennan Crest-Lot 8 Dear Mr. Martin: The septic tank system that serves this residence was designed, inspected and approved by this office on July 7, 1988. With proper maintenance and use it should function properly. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health RH/wd