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173 Crosswind Dr Lot 6 .:.,v-A-��eva^C;"-.yimfi{rsT°:v+.'�,�,.�,*"�xs'+lAt�33aai'trt'�Ts.�-y,�;,•,z="��xa,�,yw�h,suvw .�`�M�v°u>V'3t""`a't,+ '+` `i"� .}tiivl;!�rt '�" g-� ,°' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPL/EyTION 1 *DOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a r'73 �SScN1Na Sitary Sewag System, II _ _ 9 3 Permit Number Name T A w Y .Qe Date 10 NO 7200 , Location _ �� - R �� ►S` - 1, M Subdivision Name ``\A y, S`"d N� Lot No. # Sec. or Block No. Lot Size g ' x; House ' V ` .y Mobile Home Business` « f Speculation No. Bedrooms 3 No. Baths No. iri'Family Garbage Disposal YES p NO ❑ `Specifications for System: Auto Dish Washer" YES p ,,NO, Auto Wash Ma shine YES ❑ : NO r[] 1 M.y 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., _ N o 's �s Improvements permit by 'Contact a.representative of the Davie C 1.ounty 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. .t Final Installation Diagram: System Installed by _ X 1 b V S oo� Certificate ate of C ion v Date r� *The signing of this certifiig c_W shall indicate that stem described above has been installed in compliance with the standards set forth in—the above re ut shall in NO way be taken as a guarantee that the system will function satisfactorily for any given pe o time. yS _.4';:t N .: +. ;: ,r,.� b :u; �: `�q... a, ..�.w..k '4,ti y: .:.,;,. •:.FS., .. fx�'X.'.+t''�: .r �w ,q.� "r • rea. 'ice i..,..., _::.,: !/X'U ' f DAVIE COUNTY HEALTH DEPARTMENT a �' IMPROVEMENTS PERMIT AND CERTIFI ATE QF CO.MPL TION P11-of il4OTEJssued in Com liance With Article II of G.S.Chapter 130a 73 G�oSSfw t it�ary S�ewag e�Syatem� _ r� _ 9 3 Permit Number San WW -Q pate, '— ' No 7200 - Name' _ v cz vac.-e ;; 4� U Location Al — Subdivision Name Lot No. Sec. or Block No. Lot Size House -= Mobile Home s Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal_ YES ❑ NO ❑ Sa � A pecifications for System: Auto Dish Washer YES '❑ : N 0❑ `- Auto Wash Ma;hine YES ❑ NO J � 2 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. b. ' r tf U 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 j - -1 Certificate of etion Date T 'The signing of this cert+f' ate shall indicate t t-the" system described above has been installed in compliance with the standards set forth in theabOve-regutWion, but shall.in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. 4 t - F DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME �t ` � PHONE NUMBER ADDRESS J 1 SUBDIVISION NAME C_� LOT# DIRECTIONS TO SITE DATE SYSTEM INSTALLED C6 P NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED �- TYPE WATER SUPPLY `- o N�4 SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY C - This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1193 � . . . r,.,...".-.....;n.:..-.i, .. -�.c.;e:. . -• irl,;., .... ,,:K,�.;::j;:s�w++'�, r, ...-.:..•. ...� ^:. ...o - _.ry .- r . y -. - .. ....... DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NbTE: 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 'ire Date ! e ,. :}32 Location Subdivision Name ' ' Lot No. Sec. or Block No. Lot Size "y/ House Mobile Home — Business __ Speculation No. Bedrooms - No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: , Auto Dish Washer YES ❑ NO ❑ '` �� a' `�' Auto Wash Machine YES © NO ❑ C' Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. i i 1 A r .._— '•fit\ t i 1 Improvements permit by 'Contact a representative of the Davie County,Health apartment for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of compl' tion. Telephone Number: 704-634-5985. Final Installation Diagram: Syste Installed by o. J ' 1 1 } r Certificate of Completion r �'r�i� � -' ''_ '' 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. RECEIVED J U L 1 5 iso APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT • Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. _ /� Home Phone '76 6 -�� 1D 1. Permit Requested By `?f r I �S i /� Business Phone 2. Address 3soo C d fiat t' &.t e1- cle au/ls� JVX 2'7F�1Z T' 3. Property Owner if Different than Above —Rai e-r-+ z' Address r, C C 4. Permit To: a) Installer Alter Repair b) Privy Conventional Other Type Ground Ab orption c) Sub-Division Secati:CS Lot No. 62 5. System used to serve what type facility: House I--- Mobile Home Business IndustryOther b) Number of people T 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions-7,a X S� 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 3 urinals garbage disposal lavatory showers washing machine f dishwasher sinks f/ I 8. a) Type water supply: Public Private Community— b) ommunity b) Has the water supply system been approved? Yes ✓No 9. a) Property Dimensions b) Land area designated to building site « :j(5=e-4 c)'Sewage Disposal Contractor On M_ 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? n o What type? This is to certify that the information is correct to the best of my knowledge. 1�I19 9'4' Date V Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: Pez),ol�-s- ig _e�K R o a- T O. ops e- ►� ► ,� � a� e4+ CIO C DCHD(6-e2) k APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT , 4 5� Davie County Health Department Environmental Health Section RECEIVED JUL P. O. Box 665 L i 1986 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 9q8'60.C� 1. Permit Requested By Ooeeft-T Business Phone 2. Address '31,5' Geemrtoeoo DQ(v� 1gPVWCe.j N. CA?oL4"A moos 3. Property Owner if Different than Above Ge(_,A LO -4- 6 i L 0►� S p Le Address MARCHMoHT AC2e_� 1_(57- # 4. Permit To: a) Install. Alter Repair o'^� b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: Housed Mobile Home Business Industry Other b) Number of people q 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions3000 SQ Fee T- Bed Rooms Bath RoomsDen 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 Z urinals garbage disposal lavatory Z showers Z washing machine \/e5 dishwasher yes sinks I 8. a) Type water supply: Public—Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 9 W C reS 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 correct tL st of my k owledge. � Date Owner Sig ture OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: IN �D v�yNce, Tfl�e Pe_6 Ptes C'f2ee 1� �►�►� 1. 2 /(nr[es 70 �C-1vTrzW�Jee 7"° --'-- S eT On/ �T/oN A/,e OARI<, C-0 THRU G ATe, 71,99e_ S'¢Colvv 1.kr Hi�C P�oPe2Ty if onl [e ri t15 yoo 60 uP rffe yi�C 6o _To &770N, / DCHD(6-82) f A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name Date Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S PS PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U U 3) Soil Structure (12-36 in.) S S S Clayey SoilsP PS PS PS U U U U 4) Soil Depth (inches) S S S PS PS PS U U U U 5) Soil Drainage: Internal S S S PS PS PS U U U External S S S PS PS PS PS U U U 6) Restrictive Horizons 7) Available Space S S S PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by Title �i ate SITE DIAGRAM 1 j J• DCHD(6-82)