154 Kerr LnA 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
30 -
Name C�� "A 75, RK Date N2 524.2
Location
QW 15�4�
Subdivision Name Lot No. Sec. or Block No
Lot Size � R\ House Mobile Home Business — Speculation
No. Bedrooms — cl No. Baths No. in Family D–
GarbageDisposal YES .0 NO C] Specifications for System:
Auto Dish Washer YES. [:) NO C] b 1,
Auto Wash Machine YES V NO C] Q�
""-Type Water Supply \x
.This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit byl::��`�°
*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
J001
Certificate of.Completion 1 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.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Departmentd ,�H Z %
Environmental Health Section �,V
P. 0. Box 665
Mocksville, N.C. 27028 (`
r
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 9 9 8- 2 Z 3 O
1. Permit Requested By e0aefr E- o W( -Lf- Business Phone '7 6 S - 2 3 2
2. Address f_ ^a x II v✓t ce Z%o (5
3. Property Owner if Different than Above -1-1Z fi V ) S Yy(L IC
Address r 1_ (.1 Ad y 8,,Xe . N- C c,
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 B
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 1 q X 11
& (e
Bed Rooms Bath Rooms 2 Den w/Closet
b) If Business, Industry or Other, State: Number of persons
..
What type business, etc. - -
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes 2 urinals
lavatory
dishwasher
2
showers
sinks
garbage disposal
washing machine
8. a) Type water supply: Public Private ✓ Communi y
b) Has the water supply system been approved? Yes -1o
9. a) Property Dimensions A%- yG O� „ IS -S15- S //S W-130
b) Land area designated to building site /20 Z -O ,*
c) Sewage Disposal Contractorj�r LL1$
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. �° °A,? -
Jvn/e- 2 S, 1,792T
Date Owner Sidnalure
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
� 01 f X) '� -T' �'`� Lei i
Go PF ��I n�.e-^�� �y 12 M , l e 5 710
},I I U) Tvi� (L�6W-rof
PAjed -T u ILLS , �'� �-� &105�A I' k �► 5 w� y r' e
r �
51v . kLN-f�,��k�' Ng � oi\P f� r2 5 r -�-v �t,� 41 q kj- oJ
N e <*T 1,o e - o A D) f 0 LLb vJ 70'0 FT f ����e�- i y d- A N ID
Sloe. o �- PA0q
DCHD (6-82)
`► DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
Q SOIL/SITE EVALUATION
Name i` ° �� o �� Date 6 3 G
Address r,'A Lot Size I --)-�
c
FACTOPR ARRA 1 1 ARF? 2\ AREA 3 AREA d
1) Topography/ Landscape Position
PS
PS
U
S
PS
U
S
PS
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
PS
S
U
S
PS
U
S
PS
U
3) Soil Structure (12-36 in.)
Clayey Soils
PS
U
S
PS
U
S
PS
U
1) Soil Depth (inches)
U
U
S
PS
U
S
PS
U
i) Soil Drainage: Internal
pg
� PSS
S
PS
U
S
PS
U
External
U
PS
U
S
PS
U
S
PS
U
�) Restrictive Horizons
-----,
—�_
Available Space
U
PS
S
PS
U
S
PS
U
�) Other (Specify)
S
PS
S
PS
S
PS
U
S
PS
U
i) Site Classification
U—UNSUITABLE S—SUIS i_ -Ps —Prov isionally Suitable
Recommendations/ Comm ents:
Described by
SITE DIAGRAM
DCHD (6-82)
Title Date
Davie County Health Department
andHome -Come Health Agency
Environmenta[Health Section
P.O. Box 848 / 210 HosaRN. STREET
COURIER #09-40-06
MOCKsvILLE, N.C. 27028
PHONE: (704) 634-8760
September 16, 1996
Robert Hottel, Jr.
154 Kerr Ln.
Advance, NC 27006
Re: Sewage System Check
154 Kerr Lane/Advance
Dear Mr. Kerr:
As requested, a representative from this office visited the aforementioned
site on September 14, 1996. At the time of the visit, there was no visible
indication of any effluent from the sewage system on the surface of the ground.
Please be aware that the above statement is in no way intended, nor should
be taken as a guarantee (extended or limited) that the sewage system will
function properly for any given period of time.
Please advise should this office be of further assistance.
Sincerely,
Charles E. Little, R.S.
_. Environmental Health Section
CL/wd
Enclosure(s)