348 Country Lane Lot 1,.�cr, �,.1e1`xaie•.R��;i"':i�2�2.�m_vxn�:-iin*.:� '^4''� v ,. ... �:�' W.'a�it°.. ,...�y� ,;..::y w - ,. ,.
p�. t/X OL
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* NOTE: Issued in Compliance With Article I I of G.S. Chter 130a
Sanitary Sewage Systems �%11�;� l Permit Number
Name �l Date N27455
Location l�B�✓�/��.�i��/r_' Ate//i�/'�ra / S— 8 ��'b�
Subdivision Name Lot No. Sec. or Block No.
Lot Size —_ House Mobile Home _ Business _— Industry
No. Bedrooms --.No. Baths _ No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO E3Auto Wash Ma^hine YES /ANO ❑ yt%'
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 site plans or the intended use change.
L
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
5-)OW'd
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
s sfactorily for any'given period of time.
-'i
O� DAVIE COUNTY HEALTH DEPARTMENT
M CERTIFICATE OF COMPLETION
IMPROVEMENER
TS P IT AND
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems �%%i,/� Permit Number
Name C,lle't./ �1ifL�ti�� Date N-7455
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Industry
No. Bedrooms .No. Baths _ No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO ❑I f
Auto Wash Ma^hine YES NO ❑
Type Water Supply a
*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 site plans or the intended use change.
E
r
Improvements permit bye!
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion .%r' Date`9-`�
*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 G.S: of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name 54 Date =i:; -�� � ? �G75
Location /°
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 ❑
Specifications for System: €1 L� + 2—
Auto Dish Washer YES E] NO ❑ � 0 �� "o
Auto Wash Machine YES [.-]NO ❑ Y
r
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
Z3,4t
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 DI lo-Al-ep
r�Ui
Certificate of Completion- 7� 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.
y� _. �.:.- �:�.>..-...W xifk, -+'I.. h•,-�'.4x J.. -. ��'. .J....�•^u'.. � ...'J�:+1 ^. aN •. ,..,,i— �_.. -. _ �I.. �, k .�. ..; _
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, c 1,, Date_ 3 15,15
Location I :"y i, s 4 _
on
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 ❑
Specifications for System: r`;l i +
Auto Dish Washer YES ❑ NO ❑ � �� kir •
Auto Wash Machine YES ❑ NO ❑ `, 'Tj
f <<h
Type Water Supply _
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
L; iej
,r
I�1-------------------------
J
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:
1,
System Installed by D_Itt-a'e v r a£
r ,/
�cn,
q
Certificate of Completion /r. ( fes✓ Date I
"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.
9/23/ ,016
Appraisal Card
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Owner: BEAVER aTPIE31 NICNAEL •erwl: X4.100.40-001
30 C�Oulplf� Lry
httpJ/maps.daviecountync.gov//ITSNettAppraisaiCard.aspx?parcel=H410OA0001 , 1/1
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AUTHORIZATION NO: '15-70 19AVIE OUNTY HEALTH DEPARTMENT t d
' . - ! Environmental Health Section - - PROPERTY INFORMATION '
Permittee's P.O. Box 848
Name: EGt_i e -p-' Mocksville, NC 27028 Subdivision Name: 1.11'1 1'h/Y.17NC� -�IDI�
Phone # 336-751-8760
Directions to property: Section: Lot:
AUTHORIZATION FOR
WASTEWATER
rot.l r�fir � � tl �,..!� • "'�'"; U �' ! tr.. Tax Office PIN:# - -
T L SYSTEM CONSTRUCTION .� �t
Road Name: ��/a Zip: A 6
**NOTE** This Authoriiation for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ENv ONMENTAL HEALTH SPECIALIST DATE ISSUED
DAVIE OUNTY HEALTH DEPARTMENT
TMPRO� EMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's
Name:#" Subdivision Name: CattYt`
Directions to property: Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN•# - -
Road Name �d� Zip:*
**NOTE** This Improvement,Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
M compliance with Article 1 T of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENV ONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESID
ENTIAL SPECIFICATION: BUILDING TYPE i*A t MA—# BEDROOMS' 'I # BATHS # OCCUPANTS_ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE ' # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE---:—REPAIR SITE fool
SYSTEM SPECIFICATIONS: TANK SIZE ----GAL.. PUMP TANK GAL. TRENCH WIDTH '�4+t, ROCK DEPTH I rt LINEAR FT.
OTHER � O �[ 1 � f1'\rir e . � �1 fl� ISO' 'AL1 "A[:
�M�C k oVi Q o Q �.. v. r\ t u 11
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**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,THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
DCHD 03/96 (Revised)
77 _
� +•
. '
�."< 4 HEALTH OUNTY
H DEPARTMENT �o
IMPR EMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee'
Name ' f_� 4? ;3 ea�/e .(2.- + Subdivision Name: CD a Yi 'rl .r
Directions to property: 3' r Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# - -
E Zi '
/`J Road Name: d p.c`� 00
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
ver PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE N W, .- # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE 6000
It R !
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 16 ROCK DEPTH (g LINEAR FT.
S r ;
OTHER n a( 1 (y"� r r l 1 A s� i'a 0 � (r\ � � �C t_ 1 � � � �. i ;"1.I �� kA4
V 0- 6k,1 Z
REQUIRED SITE MODIFICATIONS/CONDITIONS: -
IMPROVEMENT PERMIT LAYOUT
V
Ell
r ,
4 ,
Co L
"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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: 5' ,5-aMA�
+
ADS
A Vzu, Q
L
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t, ,C WO
t�"•�ot4\ �'
eV7 v G J•(
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(CUl cFG)
L) AS�a-c 91 oc r
�C..tt_ of G4QACo'S
k
AUTHORIZATION NO. 15 1 0 OPERATION PERMIT B 1- DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T -I SYSTEM DESCRIBED, ABO E HAS BEEN INSTALLED INC PLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 03/96 (Revised)
I
�i
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
rC4 Ila 11, 1"l -S
'.t
PHONE NUMBER %r/. %5733
ADDRESS _3 q g Cou y,_r,,,t Ug rc_ SUBDIVISION NAME Cou vao, Lr.,
r" Y-1 t- 2? o zY LOT # 1
DIRECTIONS TO SITE i OL2'►^�-
DATE SYSTEM INSTALLED la - NAME SYSTEM INSTALLED UNDER��we
TYPE FACILITY VALID- NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY n `-1. SPECIFY PROBLEM OCCURRING N 4e-eQ 40
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, n that I understand responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGEN
Rev. 1193 0
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
% /�y� Arerma Numoer
Name Date , T 2:2 1� 2322
Location r�
Subdivision Name tom'y '"� of No. Sec. or Block No.
Lot Size ` House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES p NO Specification f2.r, Sy tem:
Auto Dish Washer YES � NO
Auto Wash Machine YE NO p
Type Water Supply
T
YP pp Y
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
rc �
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
is
Certificate of Completion Date
"The signing of this certificate shall indicate that the system described above has een 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
s IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in. Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
Subdivision Name 1' `'Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES p NO `l. Specifications for System:
Auto Dish Washer YES p NO Q =
Auto Wash Machine YES 0 NO ,0
Type Water Supply _
*This permit Void if sewage system described below isnot installed within 36 months from date of issue.
i r
i
I
c
r
f
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
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.
t
a
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
'
X - rho .- ag
Name t/. !'s, - Dater�
Location
Subdivision Name %' f. / �% �” .f =' or, -Lot No. Sec. or Block No.
Lot Size House Mobile Home
_ Business
Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO E]
Specifications for. System:
Auto Dish Washer YES p NO ❑
C ` :�; ; ; . •.: -
✓'� ` �-'
Auto Wash Machine YES p NO -❑
Type Water Supply
i'
*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
f f ,
1 �r
c -
r 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.
DAVIE COUii'I'Y HEALTH DEPARMIENT
PERCOLATION TEST RESULTS
DATE /O - /7- 7 9
NX,X Country Lane Estates Section II
LOCATION Off Country Lane Country Lane:: Estates Section II Lot # 1
10
Lot Size: 0.767 Acre
FINDINGS:
t�rK iebT rHti Ung
uh usua Iw�-1 '�d. a••s
Z6.1 - s hvw r tbe,,�C,
SII r�cw.
HOLE 140.
1 '1
a - 6 n..v. lam
2 �1 � Ino rl: k -� t a 0 YI, t. hj._
4
C0.,v MTS
5 Q UtACL1Q ra�L : 160 w. �l.c h 1�t C MS%si
_?et`"
✓'(�o � � KQ l) 6
So.l Eual. t��ldl'14 By:
Na tl �54�
LOT DIAG.7W
bio ./9 -
• DAVLE COUNTY HEALTH DEPARTMENT
a..
' (Septic Tank) Improvements Permit and Certificate of Completion (2,
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR 's� �'l;; ,' '4•'�:� 4+•� ✓,� i ►`�,f,,r DATER.,. , �{ PERMIT
4�
LOCATION 342
S.R. NO.
SUBDIVISION NAME ,, ,'�J $1 l ✓ w . ..i L. rt LOT. NO. SECTION OR BLOCK NO.
BUSINESS Cl
NO.'BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
,AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLE
(8/16/73) *C
LOT AREA
By_
.House Trailer
800
Gal.
400
Sq.
Ft.
:Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
,..Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
Date L
w