105 Raintree Court Lot 18{ R
' Y DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems / Permit Number
Name : �`��3 : �t /.'�.?7r-'.• ; .�r� 'Date .�',%,; r �'Jp_ t
N���
Location! i'tYnf' J —
Subdivision Name Lot No. Sec. or Block No. _
Lot Size
House
Mobile Home
_ Business _— Speculation
No. Bedrooms
No. Baths
No. in Family
-- _
Garbage Disposal
YES ❑ NO
p''
Specifications for System:
Auto Dish Washer
YES [p NO
❑
��} , , f,%-":, _,,•4'-�;�,�{'
Auto Wash Machine
. YES ❑i NO
❑
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.
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
.. �/ rcl'
r
_%/ir/}riffs'✓'./%
Certificate of Completion Date
1 '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 Department
Environmental Health Section
P. 0. Sox 665
Mockoville, NC 27028
1. Application/Permit Requested By // e-1/ 41V
Mailing Address A) 0 a 6-6100/J 191P Lt/.s AC a7/0 S
(9,/q) -
Home Phe- - S 3�Z Business Phon a__
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation 0 S/Tank Installation
5. System to Serve: X House Mobile Home 0 Business
L] Industryu Other Unknown
6�. If house, mobile home: Subdivision kAIIy7-1?4�� Secl.c� Lot; 116
No. of People 3 Dwelling Dimensions /
No. of Bedrooms 3 Basement/Plumbing
No. of Bathrooms_ Basement/No Plumbing
AWashing Machine � Dishwasher C] Garbage Disposai
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories _
No. of Showers
No. of Sinks
No. of Urinals n
No. of Water Coolers
S.
Type of water supply:
A Public
0 Private p Community
9.
Property Dimensions�/0
104:51
10. Sewage Disposal Contractor
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? Yes If No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5
years from date issued. Improvements Permits are subject
to revocation, if site plans or the intended use change.
Effective October 1, 1989.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
70
Date Signature
Directions to Property:
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF. COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date 2-6 N9 2132
Location
Subdivision Name Lot No. 1019 Sec. or Block No.
Lot Size 010 House
No. Bedrooms— No. Baths
Garbage Disposal YES VN0
0
Auto Dish Washer YES
0
Auto Wash Machine )'ES ,0
Type Water Supply
_ Mobile Home _ Business ation
No. in Family
Specifications for System:
/a oa
ar 4'
/ "
*This permit Void if sewage system described below is not installedwin/36'06 mont s rom date of issue
im
Com- �°� Al �
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: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name . , , , ; Date
Location —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 1 ' Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths — No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES❑ NO ❑
Auto Wash Machine YES E:] NO ❑
Type Water Supply ---
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
r.
f
i
i
,I
.
l
I
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: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications fo.r System:
Auto Dish Washer YES ❑ NO ;❑ s
Auto Wash Machine YES ❑ NO ❑
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
3
I
! j 1
Improvements permit by
i
*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
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME DATE ISSUED o�(o
ADDRESS PERMIT N0. % Z.
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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 f
NAME �,�,.-�f' t11.,�('/l / ��1��/ �n S�{ � DATE ISSUED
K
ADDRESS PERMIT NO. I' 2--
Explanation of charge 1 1h,4
AMOUNT DUE ^i SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
tlli� IIlitE C'EMI#� ��EZiC�J
P. O. BOX 57
arfisville, Wart4 Carolina 27028
OFFICE OF THE DIRECTOR `. - _ TELEPHONE
704! 834.5985
March 23, 1979
HBH Enterprises Re: Lot f 18
P. 0. Rnx 346 Raintree
Clemmons, NC 27012
Dear Bob,
At the request of Bob Harold a percolation test and site
evaluation was nerformed.on Lot -# 18 in the Raintree Subdivision
off 801 in Advance section of Davie County.
After refillinn each of the four holes in the back of the
lot only two of the four holes went down anyandthe remaining
holes did absolutely nothing. Auger horings in the back of the
lot revealed a condition of shallow soils ( an unsuitable
situation) anti a horinn in the front of the lot revealed a
much more suitnhlo situnt_on. The soil. at the front wns deep
with no discernable horizons and would be considered a suitable
area for nitrification lines.
Since the rear of the lot is unsuitable for a around
absorption system but the front area is at least provisionally :
suitable we will issue an improvements permit on the
condition that a numn is installed so the front area of, the
lot can be used for nitrification lines.
Call us if tte can be of any furthur assistance to you.
Yours truly,