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1707 Underpass Road Lot 1 Section 2Q `�' J DAVIE COUNTY HEALTH DEPARTMENT Pergihtee s— � Yb blame: ".' �' rt Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: ocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section Lot: j M AUTHORIZATION AUT ORIZATION FOR �," !r ,:�VASTEWATER r ' Tax Office PIN:# - - SYSTEM CONSTRUCTION, AUTHORIZATION NO: A 4 Road Name: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance'with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) / Xfes,,'' ��� ��' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE�41 # BEDROOMS # BATHS # OCCUPANTS = GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No y LOT SIZE TYPE WATER -SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE�'� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTHX.,:-, LINEAR FT. "6v,:5 _ REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 9:41.,.. **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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: 11 d All-ty AUTHORIZATION NC(��201 OPERATION PERMIT BY: � / DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR.'ANY GIVEN PERIOD OF TIME. DOM 02102 (Revised) �� d 5 X I �_ V'`'1 t'"'"_'" �`B� 1� W'�t%.l 1�s,f.•L�c. - �f;=iU.cM....M,r �.c5�s�l�l,!! G� � ��.� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME JacK PHONE NUMBER ADDRESS 1 7 0 1 U nQ,t,.,pa,,_ 9W SUBDIVISION NAME Ado • aC 27do 4 LOT # DIRECTIONS TO SITE A01- `T• 4LR �,,, U�..L,.,oure,- 10 toI( YtM� t�•. 'I�' C, IM wDtt.�- DATE SYSTEM INSTALLED 3 NAME SYSTEM INSTALLED UNDER` a L~ TYPE FACILITY KX-- NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED 3 TYPE WATER SUPPLY f:� • SPECIFY PROBLEM OCCURRING a.. DATE REQUESTED -4 INFORMATION TAKEN BY 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. 1/93 DAVIE COUNTY HEALTH DEPARTMENT • �--- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issuedin_Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Name T) —t' U1 �jtA.upys- ___ Date101 Location Permit -Number Subdivision NameLot No. _ 1 Sec. or Block No. io Lot Size ?irU House ✓ Mobile Home _ Business _— Speculation No. Bedrooms -- 42_ No. Baths _ Z No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: r vj Auto Dish Washer YES ❑ NO ❑ y0-134 3 i,y ,X.3 Yi.Z . 'tk Auto Wash Machine YES ❑ NO ❑ Type Water Supply cn^^ AjA __— *This permit Void if sewage system described below is not installed within 36 months from date of issue. l _._.%A h4 rF Improvements permit by a *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: 14141.. � Vi . ,(t' 11 1' System Installed by Certificate.of Completion Date 0 *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. 192 , f Name iT, L• C'S Address n3eT� �TftfM G-' FAr.TOP.q 1 DAVIE COUNTY HEALTH DEPARTMENT io Environmental Health Section ✓� P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date 6— J O — FJ Lot Size 7 � X 167 ARFA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position 0 S S S PS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U 1) Soil Structure (12-36 in.) S PS S PS Clayey Soils U U U Soil Depth (inches) LT <'Z)S S S PS PS PS U U U U �) Soil Drainage: Internal <� S S PS PS PS PS U U U U External SS � S PS S PS rU U U U i) Restrictive Horizons ') Available Space S PS S PS S PS S PS U U U U 3) Other (Specify) S PS PS S! PS C UU U U U I) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitabl „ ^---_ ___a ,:......- .............. �enm,.s.. %�o�2/lbs %/v11lci4+2 /✓ Um pILc C �oc�lC� A-1 TF' Described by := SITE DIAGRAM r- TitleDate �' ffl 'T A k W a D 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( -1- .36 Y-.i/�'?/ 1. Permit Requested By JS Business Phone����i-3�a5��1�7/ 2. Address 333 ,F� s3,yne -- 3. Property Owner if Different than Above -SAM C - Address 4. Permit To: a) Install_,CAlter 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 IndustryOther b) Number of people &19= 6. a) If house or mobile home, state size of home and number of rooms. House DimensionsAM: Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served A�47 What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes lavatory dishwasher urinal showers sinks 8. a) Type water supply: Public k"" Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions ,ZDO �( /6 7 garbage disposal washing machine 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 to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: (�Ae &M, I/y L/gu /1 V.. DCHD(6-82) P aVie (gauntg Pealt4 P epartment nub Pnme Penit4 Ageurg P. O. BOX 665 .Iurkoville, �qnrth Carolina 27028 OFFICE OF THE DIRECTOR June 17, 1983 H. L. Cress 3633 Ethan Court Charlottep NC 28211 Dear Mr. Cress: As requested, a representative of this office visited the lot located in Greenwood Lakes subdividion, at the corner of Underpass Road and Oakwood Driveq to determine if this location is suitable for an onsite, ground absorptions sewage treatment system. This site is now classified provisionally suitable for a septic tank system. Final approval will be dependent on the proposed house location. Enclosed please find the bill for the site evaluation. TELEPHONE 17041 634.5885 If you have any questions, or we may be of further service, please feel free to contact this office. Sincerely, Ed Spe It R. S. as ` 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 i .Wr6, Date __7,_3P '� Location Subdivision Name i - Lot No. --�. Sec. or Block No. �o Lot Size 2�aI Z4.2 House _ ✓ Mobile Home ___— Business Speculation — No. Bedrooms '2) — _ No. Baths — -2– — No. in Family _ Garbage Disposal YES ❑ NO ❑ A^r Specifications for System: , yy�f j�.a.� Auto Dish Washer YES ❑ NO ❑ 10 643 ov 9 Auto Wash Machine YES ❑ NO ❑ Type Water Supply —C 0�_^ 43q ----___— *This permit Void if sewage system described below is not installed within 36 months from date of issue. %04 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: vi W Pt) 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. y,� Cam DAVIE COUNTY HEALTH DEPARTMENT ,� ! Environmental Health Section ,�!• R 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name IA Q t IA3 Date 7- Address �' �' 13 9�► Lot Size -7o►z F, FOr.TnR.q ARFA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position S S S S �� PS PS U U U U !) Soil Texture (12-36 in.) Sandy, S SS S Loamy, Clayey, (note 2:1 Clay) PS PS U U U 1) Soil Structure (12-36 in.) Clayey Soils S SS PS S PS U U U Soil Depth (inches) S S S PS U S PS U U )Soil Drainage: Internal - PS PS U U U U External S SSS U PS U S PS U i) Restrictive Horizons ') Available Space S PS S PS U U U U 3) Other (Specify) S PS S PS S PS S PS U U U U I) Site Classification U—UNSUITABLE S—SUITABLE PS—provisionally Suitably Recommendations/Comments: '� �� S�-" 3s e" „J, Described by — Title Date Date 7 SITE DIAGRAM DCHD (6-82) / a —r G I 1. Permit F 2. Address APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. C_ .9- 70/ 3. Property Owner if Different than Above Address Home Phone Business Phone���- 9/G/ 4. Permit To: a) Install ✓ Alter Repairr b) Privy Conventional Other Type Ground Absorption c) Sub -Division Secy Lot No. J 5. System used to serve what type facility: House ✓ Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions i'Z- -70 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 urinals showers dishwasher sinks 8. a) Type water supply: Public Private Corgmunity b) Has the water supply system been approved? Yes No 9. a) Property Dimensions b) Land area designated to building site garbage disposal washing machine 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 to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: jer,/�'C� --�-E- TV Z� Dr¢,ea,i4 '01tw0 i_: ©aJ �jLrw�V_'� DCHD (6-82) 6 / W fZP//46-f eol-1 "14 �� / 7 92 . PaVie (gaun#g Pealth Pepar#men# nub Pome wealth Asenru1 P. O. BOX 665 �iElatksi�ille, �urtfl (attrulintt 27II28 OFFICE OF THE DIRECTOR TELEPHONE November 19, 1985 (704) 634.5985 Unique Builders P. 0, Box 1399 Clemmons, N. C. 27012 Gentlemen: On November 189 1985 this office inspected and approved the septic tank system that services the house built by your company in Greenwood Lakes, section 6, lot 1. The system was properly in— stalled; however, it cannot be expected to function properly if the surface water from the front yard is allowed to stand over the system. This office recommends the front yard be graded as to remove all surface water. If you have any questions feel free to call. RBH/sg Sincerely, )��Y �Z( Robert B. Hall, Jr. R. S.