Loading...
1245 Underpass Rd � -� HEALTH DEPARTMENT RELEASE Forot�ceuseoniv> 'CDP File Number �959Q1 -1 y Davie County Health Department K d ���o � ,�. � 210 Hospital Street County 1D NuMber. � P.O. Box 848 HDR/WWC '�, „��� Evaluated For: °���"' Mocksville NC 27028 Phone: 336-753-6780 Fax:336-753-1680 PERMIT VAlID � g / 1 3 / a 0 a 0 U NTI�: Applicant: S#eve and Kathy Allen Property Owner: Steve and Kathy Allen Address: �29 Stiliwater Drive Address: 129 Stiliw2�ter Drive ���Y. Adaance ���Y: Advance State2ip: NC 27006 State2ip: NC 27006 Phone#: (336) 909-0569 iPhone#: (336)909-0561 Property Locatfon 8 Site Information Address1z45 Underpass Road Subdivision: ` � �` Phase: Lot Road# Advance NC 27006 SINGLE FAMILY Township: `StruCture: Direcdons #of Bedrooms: 4 !#ot People: 2 Hwy 158 east right on Hwy 801,left on Underpass Road about 3 miles on right in curve. *Water Suppty: �A Type ot Business: easement: Q Yes Q No Total sq. Footage: No.Of Empioyees: 'Proposed Improvament: ReconnectionlG arage/Shop 'R�eteas�Condittons ; Maintain 5 foot setback from any portian of the septic system � This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site wiq continue to function for any period of time. ApplicantlLegal Reps.Signature Required? 4Yes �No ApplicantlLegal Reps.Signature: 'Date: � � "Issued By: 214a-Nations,Robert 'Date of Issue: � . $ � 1 3 / a 0 1 5 Authorized State Agent: * ite Plan/Drawing :attached.** �` ` OHand Drawing C>Impott Drawing NEALTN DEPARTMENT RELEASE �`- 19��'�01 - 1 .�su�a Davie County Health Departmenf CDP File Number: �� ��� �, 210 Hospital Street � . �� ' P.a.BoX sas County File Number: � Mocksville N� �7028 Date: 0 8 � 1 3 / a 0 1 5 � ���rs'u4fna�� � \. � .... .� . ,a�� „��NM rw• �(1Ch Scale: O ck = ,ft. Drawing Type: Health Department Release � ON/A . __ !._--- -- - �_ ----- ._--- -� .�. _. I.. ��.� .:----- l. ...- � ---- 4 ..�__. _ .. � ._- - --� ___._.� .. .. l ..�.--- . --- i ..._ _-- i ' ' � I t 1 ' i t�� _._ ___ . , � � l � .......... . ............ ... . ._ . ..__�. . . . . .t._. ...._.... . .... . , .., �n' f � � � �. ' I . � 1___._I i �'�.0 � � ,t �'' �_ � _�...... .. . :.._ .__ �__ , �..,_____._�_-_____�_,._. .___ . _ _.._..�_ r_ ��y�„� . I � . . _ � _�.____� � __ � j � � . �:.� �_�_� � , ; , `�`' ! I _�;�_ .�_� 4 }.__w.� _. ; . _�.. � �_�.�..� __�.__.�. ______. __._�___ ��_,�._____.�_____ �.._� � i � � ' � !� � � � , : I � . _ _ _. ___� _ _ . _..__ _ ,.___ � _ _ _ -- - _ _.. _ --- - _,._ ,___._ .. _. _ _ � .. : ; , , ; � ; i , ; I � � � , � , , � , , � __ . _. . .. _.__ ___� _ _.. .__ a . - .— ---__.,_._ __. _ . _. ___,____: _ _ _ m __ _�.. � E . .: _: _ _.. __._ _!_ _a � ; � � ; � : ; � ' _� , : , , , ; _ __ ; .,. . : :_ _._._.., �. __._ ,_ . , _ .. _.._ _. _...,.. .. _ ' _ ___ _ , � ' � . : i .. . __, . . _ .. � : : ;. _f ; ; � � �- , � , � � � 1--� � I � ! � l E � � " _ _ }..�_---r —A_ * —r : . ` ..� �.�,... . T �. ..r'_-.--__; — .�....� � T� � � 4 I � ' � I � �_ � ; � � I : I� I � ': /�'I • ; , � . ! _ -- -._.. _ . _...........� __ ._ _ ._.._ �._... ._........_ .� ._..---� � _.._ ... ___ �-..... __I _� ___� ,_ .,�_. _ ,...__ ; � ,_ _. , ; � } .__. � � � � � � ( � � �� ' � � < < ' _.. ___ _- � . �. .__ � � _ . __ __.. . _,.._ �_,..... _ . . . _ .,. + "_._. ..__ _ _.�...._.__� . .+ -._ ...i _ . � ..,_ ( � I 1._ � 1 ' I � ' � I � ! # ����. ._ F .__ _. ___ __ I_ � r - :- - ._ ► _� _. _�_ __ t � __ � _ ___ ,. � , ; � � � _ _ , �_ . _ . ._ _ �._ ���. � I � � I � � i � � i � ; . ; , . . ____ r_____._.__� �_W : _.� . �. _ _�.W.� �____� _ _ _ � i , !_ �� _ � � .� ; � I ,!�.. � �{ �' , _ _.I��._.__ � p I � �. .. _.___.___ . ..._ - - ,_____ . � . . .._ ., . _ . ; _.. ____._ ..__ i �,�. __.._ �..�_ � _.. ( i � I ; ; l �`... 7.,, , � � - I bi I I + i I ` ( � ` �._ _.._-----_�.__.... ! ..._. � _..._ __...�.�._ ..._._.�h,-��W_.� �_. � ...�_.� __ ...._.._--�---__ �____ ---_. ___r___ .___.._. r � _---_. ___.._� ____. _�. , .�..� .. � ._.� _..�; �_. . .. . .,.. �...� ��. ._I. . . .� � . ._�..1_.� ..._� : . . . � .. . _ .. .._ . ; �.�J.-� 4 ........_ �i._....._..�............. .......I. ...........i .....� ......... »....__��....�...�; .».,. �..�.�...........� ... , ..._,..i._ _ _'._ ��,�' .......�................. _. .__.......� __.._. � , fi � � � �� ��� � � � � � I � �� � � � ; �__.... ._1...�..__,_ . �� --__.l .__..�_�._._i .._i. ._.i_.._..�._ __ .____._.. . _ ___-- � .�_ �_. _ �._.._ . c�t-�' � � i � ; '� ; � . i � i i__ �i � , 1 ( � F r . � i � � ._�. '_.... �_.....�.�_----_._ ____'_.� I t I _...__�_ __r_._.'_ _._.I � I ' __��.__I__.__t . ._. _ _ . __ , � i � ; , � � � .�_Ms. _..��.�. .. � .. ._ �h _. � � ... � ..��_ � � ..._..� . , .__.m �._..... �� �_� �_. .__ . � � ��,�_� .. �. .. � � . . s , .._.. � � � , ( � �� aj � �� � . � � � ... � � { f ; .._� ,. �__« ..._�__�� _ .«.,� e�.�_..�,_ .__� ... __.� _ . u._ .... _ —_�._., .� � � � ��' � _ — ... _ ._�___..._�.� � d, _ _ �� � � � - �._----�- : ___... ._....__ _.....� �_----. �_.. ---�_. . � _,_.._. ._� _ � � I f � , , � � . : - -----. --- . , � --_.. 1_ , t t i : � ; � � � F � �._�__._1_..__� .� � __._I— --�_____ I � _. � !� l_ . � IA ........, ...._ .. i .__......... -... ....._.... . . - __.» .. _ � � � �� � f � i � ' � i � I I I ( _ .�u .. ..—! _��.,. . .�_..�.._. .......... . ��.m.. i �... . _.._. ma_ . .. ��. . .. �e.� . . E . , .. �, _�� � � . , � � � , i , , � i , , I �� ` � I � � � ;�.n._ :,x...�.��.....�.....� � .�.�.��..,.., � �!......���........ .......e.. � . .., .. ...,a ....... ...... �� . _....an� ..... " �. .. � � � I I I i ° � I i i ' !.. ! �.�.i., _._._. .!. _: .__.. _1 .___..._� . �� r. ._..... ! ___.w�______�__. .1.__._._. � _._���._�''` � ..... _ . .. 1 __ ...,_ � _�_ � �.. I � � �.._�___� � � � � � � . � � I .�._�mm..��. !__; . � 1 . ` ' � !-�.- ;,,.ca'�.,t.�/� --�-; �- ._ _.�.�_�,._._ � � �__..� � ! � . , � I 7 � � T_ _ .: _� ___. � �: . . .. ,,.._.� .� � � ._ _._�_ __ � _ _! . , i �. �__... .......... ... e !_.ww,.... , _. � � � i � � Page 2 of 2 �� ..,. �w� . ,, • f . 1 Davie County Health Department ��;$f� Environmental Health Section � _ , . . , P.o. �oX g�g , �1 ' �, A�� 210 Hospital Street `ti'j� I �O� �� , '� c�- -'( ourier# : 09-40-06 -, D�`' ocksvillc, NC 27028 �,ava� � Plione:(336)-753-6780 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling econnechon ` Name: � `�� � �%� Phone Number o��J�' 6�"��� (Home) Mailing Address: .�ZQ s � G-��� (Work) �V�,l�.�Q � ��j a�� Email Address: 4-u-���"�l�`�l.�Q� •Cr3Yvl Detailed Directions To Site:� W Ql/l �IT�PtT�—S-`I � �W1Q,1rc�" �xxy.e-"��� ��'��,� fLlqll�� uh-1� 1�5 -[�o � rJ V l�.C cu�-�-�rw.s�-1� [(o� l�S-�Ol �� -�n vc' 1�$�-me�- `o��n.�}v �� � -�a��e.x.�k l�"D ur �G�u� 1v►�lA.r�-c�er►w�dL�� � lew 2i.' (�7 Property Address: ��'� U►.1'`C�CX'p a.SS Q�, Q�..1/Q,Y�C.�� Il.)G Z7. Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under:J�e � �� Type Of Facility: ���1:� �a-�`W ��• Date System Installed(Month/Date/Year): � �z Number Of Bedrooms: � Number Of People: a Is The Facility Currently Vacant��No If Yes,For How Long? JQ �� ���W,1 Any Known Problems? Yes ��If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility:��.lJ� ��l��Na.t u� �1n.�'t . Number Of Bedrooms: �� Number of People�_ Pool Size: � ClJ Gara�e Size: ��v`�1L��yOther: Requested By: Date Requested: � • �"�5 (Sign e For Environmental Health Office Use Only Approved isapproved Co �_ � ��/ �e'r : � �' r�- - r S s� Environmental Health Specialist Date: �l � *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: Paid By: Received By: Account#: Invoice#: . ^ ��I _ • ' � ��} )WV l� ti •�^�-� �/ /� �� � �./v 1�� , /� I ' � BUILDER TO SHOW THE FOLLOWING ITEMS ON SITE SKETCH BELOW FROM THE HOMESITE INSPECTI Y.Front Set Back 7.Septic Location 'I�.Well Pressure Tank 'f'�Gas Line Stub 25.Shoot Existing Grade Elevations 2. Rear Set Back 18.Sewer Tap 1�4!Nearest Transformer 20. Natural Drain 26.Approximate distance top of 3. Right Set Back 9.5ewer/Septic Exit 15!Electric Meter Base 21.Sump Crocks foundation will be above existing 4.Left Set Back �.Well Location 1§r Breaker Panel 22�Foundation Door grade at high comer: �� -'S.�nveway/Sidewalks 1�Water Tap N' Temp Power Pole 23.�dentify Bench Mark �k'/. Existing Structures �.Water Entry �Propane Tank 24:Identify High Corner � 3�, 3��, „ 3� ,� 3�'� 9 ! � ; I'I � �ry �� _ 0 . ' � ,Z ���� ���r � � �� � �� � �r� Revised 411I15 WHITE—OFFICE YELLOW—BUILDER PINK—HOMEOWNER Page 3 of 4 � �` 1 � . � . � . . .. . .33�. � ' . . . � .I . � . . � . .�-�.`t'�,^:': �li � I � .i�;2 �� � . .. . _�_ . . � � .�y� . . .. . Y . . . . ✓•.+�. . . . �•', �fJ,,, . . � i r � �f's� . r � � f�+'� './' �'"�-�-.�..'1..��-��' Yy.r+' � i . '�.�'.: rrr . Lpy r�s�,� ��^{14+. •_.�+�-�'���_,..J�"-^"'� `✓�,�`\ .fr ',� . � � , y ,. .jy' . 5 r"� �� . ♦ _,.. � i – � " `r.�\ty _ -- �.u..w — ��:� `� 1� .,_` � �ti t 4ti ��' : �� ,�` � i � ')�.'�.� ti i �;� ��;:: 'ti .,���,. ��;��� � � x ��:�;, � �,r 1 y �w � 5 w, •.6.`3�_?� �,i�a��'�� � • � r r�v` i�;r 1 � :. ��� ��'iw ,,: 1 . �� � �..��. .:,ci"' i � ; �n,�: 'L;'!i'• 1 � ��{,� � . ., ,V::4,� I . . ++ � ��4���' . 1 � ..� �,~\� ��.����tiN1p� � � . . `.� �.`y . . �� r 1 1 \` �r � f ♦ � \ � L.''_rlr5�� � . . 1� r� 2;':r`�'�4- . . �_- r �A',�Y r ��:f�q�S�n� �� . � -��.. (y•�� y� .�°� •�„ '/'�4 �:+,:F�'i;{:f' �� 'l�4:. �.� ...rt�sµ�: 1 y��-�. } ���r.t-�t:•. P�'I � ,',P,ru:;��. ,,,,,_!��,L L'+t ::i�'��`4�#�i � � L�:.T'1 ; i �; ��'E, � •�. � . . . ���t� . • ��r .+�✓y �� �'+�4 ti�=. � � Printed:Aug 04, 2015 A11 data is provided as 15 withaut wattanty or guarantee of any kind eiiher expressed or implied inctuding but not timiied to the impii¢d warrantfes of inerchantability or flYness for a particular use. Ail users of Davie County's G1S website shaif hold harmtess the County of Davie, North�arolina,iis agents,consultants,contractors or employees from any and all claims or causes of actlon due to or a�lsing out of the use or ina6ltity to use the GIS data provfded by this website.