186 Lybrook Road Lot F// � �-,r..«, ��_"...—„- _ _-w MY'W"wJ77wbF'�-'. _ a.- �.cC,N'�'a• T -•,-.. _-..-,.-_ ._ ^ _..t,..
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- DAVIE• COUNTY HEALTH 09PARTMENT `b VhI�DK. jq
IMPROVEMENTS PERMIT AND CERTIFICATE, OF COMPLETION
'NOTE: issu in Compliance with G.S.-of North Carolina Chapter 130. Article 13c
Se age•Tr/eatmpnt /and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name t'.��/J� /O•`�.fl,�-
Date �Y'l' N5
i
Location 5I!`s�� /�' ���G�//f. /�/�rP % !C ./D7�x.�
Subdivision ,Name / Lot No. Sec. or Block No.
Lot, Size Housey Mobile Home _ Business Speculation
No.,Bedrooms IN6. Baths No. in Family'_
Garbage. Disposal YES' NO fl
Specifications for System:
Auto Dish Washed YES NO ❑r ,Q ,war-
' Auto Wash Machine YES _. NO fl
Type. Water SupplyO�XsXd
'This permit Void if sewage system described below is not installed within 36 mo from a e of issue.
l
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. 1
Final Installation Diagram: System installed by fir.
Certificate of Completion �� Date 73 ` 6 - Wj
'The signing ,of this certificate shall indicate that the system described abo3e. has been installed in compliance with
the standards set forth in the -above reg ation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of tim .
' APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
1. Permit F
2. Address
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
nuested 8v��._/ Business Phone
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: House Mobile Home Business
Industry Other
b) Number of people
6. aT 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 hou
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 _0� 'f
b) Land area designated to building sitq
garbage disposal
washing machine
c) Sewage Disposal Contractor — A of I _QA ./
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 correct to the best of my knowledge.
r
2110 lgva–,-,2,-
/Date
wn r Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
.• APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department IVF DEC 0•
S Environmental Health SectionECE
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Potts Realty, Inc. Home Phone 998-2100
1. Permit Requested By i Business Phone
2. Address p.0- Box 11. Advance, N C� 27006
3. Property Owner if Different than Above Rod Mills
Address P.O. Box 11, Advance, N.C. 27006
4. Permit To: a) Install x Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Rain tree AddBec.—Adds_ Lot No. E
5. System used to serve what type facility: Houses Mobile Home Business
Industry Other
b) Number of people 4
6. a} If house or mobile home, state size of home and number of rooms.
House Dimensions 2200 sq ft
Bed Rooms 4 Bath Rooms 3 Den w/Closet n/a
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hou
7. Number and type of water -using fixtures
commodes 3
lavatory _
dishwasher
3
urinals
showers 3
sinks 1
garbage disposal 1
washing machine 1
8. a) Type water supply: Public x Private Community
b) Has the water supply system been approved? Yes x No
9. a) Property Dimensions 197. 97X101. 70X196 - 06X132 - 01
b) Land area designated to building site Front/Center
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? No
What type? N/ a
This is to certify that the information is correc to the b f my knowledge.
11/29/88
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6.82)
158 Fast; 801 South; Left on SR 1660; Corner of Cameron Court
and SR 1660 (Vacant lot on left of Cameron Ct)
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'dA'0�. $ t' O 155.06 ` m HEREBY CERTIFY T44T ,
a t a76 6 ci K \ s. N. 869 is : — ' 30 36' a FINAL PLAT OF TmE 9i`�►�� <> '
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date C!
Lot Size
FAr;TnRS AREA 1 AREA 2 AREA 3 ARFA 4
Topography/ Landscape Position
S
S
PS
S
PS
U
U
U
U
'.) Soil Texture (12-36 in.) Sandy,
S
le
I P
S
PS
S
PS
Loamy, Clayey, (note 2:1 Clay)
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^---"
U
U
U
U
1) Soil Structure (12-36 in.)S
°
Clayey Soils 1
AP'
(�w
S
PS
S
PS
U
U
U
U
G) Soil Depth (inches)
S
S
S
---���
PS
PS
U
U
U
U
) Soil Drainage: Internal
S
PS
S
PS
U
U
U
U
External
S„
0 S
PS
S
PS
U
U
U
U
i) Restrictive Horizons
Available Space
S
S
S
PS
S
PS
U
U
U
U
{) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U�
U.
U
1) Site Classification
U—UNSUITABLE
Recommendations/Comments: f
C
S—SUITABLE _pJ Provisionally Suitable
Described by � Title ��� Date 2 ��
SITE DIAGRAM
DCHD (6-82)
PaWe (gountg Pettlt4 Pepaxtmeut
ttnb cNome Wealt4 �genrg
P. O. BOX 668
,lotksuille, �4orth (attrolina 27028
OFFICE OF THE DIRECTOR
December 8, 1988
Mr. Roy Potts
Potts Realty
P.O. Box 11
Advance, N.C. 27006
Re: Raintree Addition Lot F
Dear Mr. Potts:
On December 7, 1988 this office evaluated lot F in Raintree Addition.
The lot is classified provisionally suitable, however it should be noted
that there is a sewage easement located on the rear part of lot F. This
area does contain the sewage disposal system serving lot D.
Should you have any questions concerning this matter please feel
free to contact this office.
D
Sincerely,
Robert B. Hall Jr., R.S.
Environmental Health
TELEPHONE
(704) 684-5965
Y 1 �
f
Davie County NealtFr D artment
and Nome NealtI yensy
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
August 80, 1989
Potts Realty
Attn: Roy Potts
P. 0. Box 11
Advance, NC 27006
Re: Sewage System Installation
Richard Poindexter
Raintree Addition - Lot F
Dear Realtor:
The septic tank system that serves this residence was designed,
inspected and approved by this office on July 26, 1989.
With proper maintenance and use it should function properly.
Sincerely,
Charlie E. Little, R.S.
Environmental Health Section
CL/wd
Enclosure