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330 Kennen Krest Rd Lot 2 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION .�s�/J�i•"rte,...-. *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 b' i� rR,rE �'i,a_.F , �,i ! r i-1.� Date 1 -7 -9 ? l r ; Location Subdivision Name \n r L�� t"c . Lot No. _ _ Sec. or Block No. Lot SizeK ►'« '"!(L House Mobile Home — Business Speculation No. Bedrooms No. Baths ��% No. in Family _ Garbage Disposal YES ❑ NO p-• Specifications for System:-5r,; Auto Dish Washer YES p--NO ❑ qs ,j•,i �, ,•,�.cl,�„r r� . �. r� i 3 jf Auto Wash Machine YES [3-- NO ❑ 1. 7,1,,.: b ,f Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. /.3 , 9- 7-13 L r 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. r Final Installation Diagram: System Installed by Certificate of Completion =F"� ! � ' Date's - /`� *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. i DAVIE COUNTY HEALTH DEPARTMENT PERCOLATION TEST RESULTS DATE NAME 04W !�Gr✓�� LOCATION FINDINGS: HOLE NO. COMENTS 1. 2. i 3. 4. ll� 5. 6. By: c LOT DIAGPM 1 ' tti�ie (lronn#g �e�1#1� �P}rttr#men# unb Fume Pezdt4 �genrg P. O. BOX 665 Aorkstiille, North ( arolinn 27028 OFFICE OF THE DIRECTOR - - TELEPHONE October 27p 1983 (704) 634-5985 Mr. Dave Walsh Northwest Builders&Dev. Rt. 9, Box 120 A Winston—Salemt N.C. Re: Bob Price Sewage System Mr, Walsh: Please find enclosed the revised permit concerning the above mentioned , system. At the request of Mr. Jim Hartman, sewage disposal contractor, this office visited the site on October 269 1983 for the purpose of making a determination concerning whether a.pump would need to be installed in the front yard system. After the visit it was determined that a pump would be required in order to keep the system as shallow as is required due to the soil conditions. Please take note that the first permit issued (#3373) is now void. Should you have any questions regarding this matter please feel free to contact this office. Sincerely, Joe Mando, R.S.t Env. Health Coordinator Davie Co. Health Department 4 .. .. .: .....,. .r.�.^... r,. ':i,.y 4 r+..y. ',-.I n•.:-}M. r r- -..,..,m- .:.. y:.. ham': f.ii:,.y 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 Date—A– 74 ,'' 7 3573 Location Subdivision Name ('�iir� l ��� �,•• ,,, Lot No. Sec. or Block No. Lot Size q A Y 1 ,r 3,j i House ✓ Mobile Home — Business -- Speculation No. Bedrooms No. Baths –2 ' ?- No. in Family Garbage Disposal YES ❑ NO Specifications for System: SVs4e. V, l_ /300 Auto Dish Washer YES p-- NO ❑ _43,,r 330 Auto Wash Machine YES p- NO -❑ T,/,t Ve. st L Ss�o ra/• i.�•,E- -cs'f _//v,✓3:✓ice ii Type Water Supply *This permit Void if sewage� ll systemdescribedbelow is not installed (within 36 months from date of issue. VN tNer0 �J PU'. tyLAJ P Il���I 1 �\ �1Lt �0 QUUr UL Pu,– fnp,: i v1d.. MCA VC Siu,c. ��2.0 IY\c ,S Cnu�. r�.,�l _ (I.o� r /y%'.j lC or `ice .51��]Ll ZS/I' �46* S� a l•ItMsr:~ 3'y..r a�rsy 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. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Isjued 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 LE 7a. 17 i r + , I, �' 1 Date Location f Subdivision Name (nt Lot No. a Sec. or Block No. Lot Size ;,+ 'k � ,+ ��� House ✓ Mobile Home _ Business __ Speculation No. Bedrooms 3 No. Baths 2 ' No. in Family__ Garbage Disposal YES p NO 2- Specifications for System: Auto Dish Washer YES L�l- NO _Zv Auto Wash Machine YES ©- NO ,E] Type Water Supply (}c♦�rr,i *This permit Void if sewage system described below is not installed within 36 months from date of issue. 14 U� h'.`it + .�.fl 4 ,4 rr.o 4 •,,. M'.d t.(I c it 7 d. ,Q-"--------------- r,+ S'io 41 tus t Improvements permit by . 11�r, .h•, - c� *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. DAVIE COUNTY HEALTH DEPARTMENT SITE EVALUATION CONSENT FORM INSTRUCTIONS/PREREQUISTES 1. Complete the form below and return it to the Davie Co. Health Department. 2. . Along with the form, remit the amount due as shown on enclosed statement. 3. Carefully follow the procedures as outlined in the enclosed "Information Bulletin". 4. Notify Health Department upon completion of item number 3. NOTE: ALL THE ABOVE MUST BE DONE BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO THE(DAVIE COUNTY HEALTH DEPARTMENT,P.O. BOX 57) (MOCKSVILLE, N.C. 27028) DAVIE COUNTY HEALTH DEPARTMENT SITE EVALUATION CONSENT FORM LOCATION OF PROPERTY: DATE RECEIVED to-r-117 0414c"'Y/ 9Rl J�/4RN11�r� �/j�V•c. (office use only) 1Nlw � yes no (1.) I am the owner of the above described property. yes no (2.) I am not the owner of the above described proarty, however, I j:1 certify that I have consent from ROW,- 9. PAKF ,owner to owner's name obtain a site evaluation by the health Department for the purpose of determining the suitability for a ground absorption sewage disposal system. yes no (3.) I hereby give consent to the authorized representative of the ! Davie County Health Department to enter upon the above described L property and conduct all testing procedures necessary to determine its suitability for a ground absorption sewage disposal system. Cl DATE _ SIGNATURE (4.) I hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: Owner Only Owner's designated representative 2 Anyone requesting results DATE (2 Only those listed below f SIGNATURE r DAVIE COUNTY HEALTH,DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C) OWNER' OR CONTRACTOR W:ru cJ:*_4, .-rA. DATE �4 917g PERMIT LOCATION . ". ,m-r N° 1902 S.R. N 0. SUBDIVISION NAMELOT NO. SECTION OR BLOCK NO. HOUSE «""_ MOBILE HOME E3 BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS .� NO. BATHROOMS _ Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO 99" " Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES 2-- NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES 0- :NO ❑. Tn45� ��l�C. St.�aG St�ST• �c,. waS�.•1Mric�. SITE SUITABLE YES ❑ NO ❑ .• ---� -� --�► .,,�. --... SIZE OF TANK gal. /002x ./. NITRIFICATIONFIELD sq. ft. �� �� .. �.► 4-- 7$`r3 DEPTH OF STONE IN LINES WATER SUPPLY: Individual ❑ Public m4�� IMPROVEMENTS PERMIT BY • ► r,Irv� O INSTALLED BY CERTIFICATE OF COMPLETION By. Date (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA /•QTS �t�t .x• ~~ i ... l �� � tf it � :, l+C ✓ - DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 HOCKSVILLE, N. C. ' 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME " .W uc, �A, DATE ISSUED OAI�/70' ADDRESS t`�-�:S" PERMIT NO. Explanation of charge AMOUNT DUE /„5SANITARIAN PLEASE REFIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT. 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. tr Home Phone 1. Permit Requested By /�Q t�Q,Pw-� Business Phone 1-00 77 2. Address 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. 11 5. System used to serve what type facility: Housed Mobile Home Business Industry Other b) Number of people 2- 6. a) If house or mobile home, state size of home and number of rooms. '3 House Dimensions & X 2.y A-'w° 6W2y'Q AR00- Bed Rooms Bath Rooms �' �- Den w/Close b) If Business, Industry or Other, State: N ber of persons served N� What type business, etc. N Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes 3 urinals O garbage disposal lavatory * showers 0` washing machine dishwasher I sinks Z 8. a) Type water supply: Public—Private Community b) Has the water supply system been approved? Yes X No 9. a) Property Dimensions 2 d 0 f X *0� MAMY b) Land area designated to building site �x 3y, c✓�z+lx ti./ '61�R c) Sewage Disposal Contractor �� `MOV AI ' -6i )V•, 10. Do you anticipate an,y additions or expansions of the facility this sewage system is intended to serve? AID What type? AIM This is to certify that the information is correct to the best of my knowledge. el .74 Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: I�}1Rptl 7dr ��1'TF 1vw 8 s/f� o N T ti • DCHD(6-82)