111 Raintree Court Lot 19ffjo
.� DAVIE COUNTY HEALTH DEPARTMENT
_i 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 ; Date R 4977
Location -
r
- � •
.�,
Subdivision Name .� /%P� Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms'
No.'Paths . No. in Family
Garbage Disposal YES NO :F.4110*7 Specification for System:/
„• fD
Auto Dish Washer YES NO ❑ _ /,Y F.
Auto Wash Machine YES NO fl
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 representativeof 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:' F System Installed by
. ........
Certificate of Completion C Date"Aaq
n
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.
If
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requested By
2. Address ln7 J-7 411V ?�F�
3. Property Owner if Different than Above
Address
Home Phone—
Business Phone
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division AZ 411V%-17FZ7- Sec. Lot No.
5. System used to serve what type facility: Housed Mobile Home Business
Industry Other
b) Number of people
6. a) If house or mobile home, state sizegf home and number of rooms.
House Dimensions
Bed Rooms ` Bath Rooms—Z /7- 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_
lavatory showers
2
garbage disposal
washing machine
dishwasher sinks
8. a) Type water supply: Public'— Private Community
b) Has the water supply system been approved? Yes A No
i
9. a) Property Dimensions //D / Z :F6
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is
Date
OWNER IS SOLELY RESPONSIBLE FOR CO
Allow 5 day
Directions to property:
DCHD (6.82)
to the best of my knowledge.
Owner Signature
ANCE WITH ALL STATE AND LOCAL LAWS
processing
1
t
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS r'ERMIT
Davie County Health DepartmentL'���
Environmental Health Section
R O. Box 665 &4)'0,?
Mocksville, N.C. 27028 2 �9p9
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requested By -bp"J' ° T''`T Business Phone
2. Address . :? a- z f t►9o► Ste Gkp.-!�)
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Z Alter Repair
b) Privy Conventional ✓ Other Type
Ground Absorption
c) Sub -Division 12n7.,%4rt4- 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 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
lavatory
dishwasher
urinals
showers
sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor
garbage disposal
washing machine
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is cor totebest of my knowled e.
5- Z— a
Date Owner Signatu e
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6.82)
� DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
GAr Tr)PQ AREA i APPA 9 ARFA R ARFA A
Topography/ Landscape PositionS
PS
S
PS
U
S
PS
U
!) Soil Texture (12-36 in.) Sandy,,
Loamy, Clayey, (note 2:1 Clay)
(P�/
'�
S
PS
U
S
PS
U
1) Soil Structure (12-36 in.)
Clayey Soils47
S
PS
S
PS
S
PS
U
U
Soil Depth (inches)
S
S
PS
S
PS
U
U
U
)Soil Drainage: Internal
S
S
S
PS
U
S
PS
U
External
pg
PS
S
PS
U
S
PS
U
1) Restrictive Horizons
Available Space
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
Described by
SITE DIAGRAM
DCHD (6.82)
S—SUITABLE PS—Provisionally Suitable
Title
Date
E
C tIitlf �111nitt�lFFllthP�ItITtIttCltt
ttll�1 �4ome �ivalth �grngi
P. O. BOX 665
c,ocksbiUe, IsH4 Carolina 27028
OFFICE OF THE DIRECTOR
May 22, 1986
Mr. David Rice
P.O. Box 11901
Bethabara Station
Winston Salem, NC 27106
Mr. Rice:
TELEPHONE
17041 6345985
On May 16, 1986 this office evaluated lot 9119 in Raintree to determine
its suitability for the installation of a septic tank system. The soil on
the front side is provisionally suitable. However, there is very little
space available for septic system installation. The entire front portion
of the lot will need to be used as the back is unsuitable due to topography.
The proposed home would need to set back 60' to 70' to insure adequate space
for the proposed installation. It should be noted that a pump may need to
be used to prevent the lines from being too deep in the ground.
This office suggest that we meet with the prospective home owner
to insure that no problems arise regarding space limitations.
If you have any questions, feel free to call.
Sincerely,
a. ate, 00A. Rj.
Robert B. Hall, Jr. R. S.
Environmental Health
RBH:sg
Enclosure