112 Cameron Court Lot C}.JI
k DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT ..AND:. CERTIFICATE OF' COMPLETION
* NOTE: Issued ih Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems q ;k>A4. G� Permit NU11Ib9r
Name 3� Date/Z1�1 N0 639
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Location�in
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Subdivision Name ,`n;r'Ce. �/i' G Lot No. Sec. or Block No.
Lot' Size / House_ Mobile Home _T Business - Speculation
No. Bedrooms—L_.No. Baths J -No :. in Family _„�
Garbage Disposal YES F] NO 2!
E - Specifications for System:
Auto Dish Washer. YES NO E]
Auto Wash. Machine YES ;NO ❑ �OOd°� 7s �'SX�y
Type Water Supply
*This permit Void it 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.
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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.
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DAME COUNTY HEALTH DEPARTMENT
IMPROVEMENTS 'PERMIT AND,, CERTIFICATE OF. COMPLETION
* VOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
u�n&ry Sewage'Systems Permit Number
Name � �'� .cam ?��r.?s I � Date �� �/ N2 -6308,
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Location��
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-'Subdivision Name �L irr ��� Lot No. _ Sec. or Block No.'
g Lot Size House Mobile Home Business Business Speculation
No. 'Bedrooms .. No. Baths No. in Family
arbage Disposal YES ❑ NO Specifications for System:
Auto Dish .Washer. YES NO ❑
Auto Wash Ma;hine YES NO ❑����� �'� ?s',��,Ya�
Type Water Supply �� ` r
T � �Ay
YP PP Y 14P ---, -� � _
*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 changes ,
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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.��c
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 lime.
DAVIE COUNTY HEALTH DEPARTMENT revs
IMPROVEMENTS PERMIT AND CERTIFICATE- OF COMPLETION
, *MOTE: Issued in Compliance ,with G:S' of North Carolina Chapter 130'Articlie13c
Sewage Treatment and,Disposal Rules (10 10A .1934-.1968) Permit Number
Name,' No 3434
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Location) lW/l��N L.Z` " .
Subdivision Name ` her-• �c ' t -- Lot No. Q, —'Sec. or Block No.
Lot" Size House 1&000"Mobile Home Business ' Speculation
No.. Bedrooms No. Baths111- No. in Family t
Garbage Disposal YES ' fl NO 2�— Specifications for System: 406d
Auto Dish Washer YES E]NO ❑ d4d 3 I
Auto Wash Machine. ` YES E] NOCl
f
Type Water. Supply - -
*This permit Void if -sewage. system described below is not installed within. 36 months from date of issue.
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!' Impr ements 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.
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Final Installation Diagram: ' � � System Installed by 1jnL_LOC
,
l
Certificate of Completion Date 'f ' 21.
#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. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
_ % Home Phone d r 2-) 6 .�
1. Permit Requested By �� S �' Go�+�c,� Business Phone t' All) -
2. Address o&Z 1,112c✓u4wc(C A r'toG
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type—
Gr u
ypeGrou d Absorption
c) Sub-Division/"J rr' Sec V�2/V Lot No. �-
5. System used to serve what type facility: House --- Mobile Home Business
IndustryOther
b) Number of people tlkk
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions j f X go
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 1
dishwasher 1 sinks
8. a) Type water supply: Public v Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 1'�C Sod'WrU��s
i
b) Land area designated to building site a�yG
c) Sewage Disposal Contractor �a.��t—, �i/�� //«U°z
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.
r
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD (6-82)
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Panic (gauntg Xenith Department
nub CEO='Venit4 '�gentg
P. O. BOX 665
ceucksbille, Wart4 Carolina 27028
OFFICE OF THE DIRECTOR
May 15, 1984
Mr. Randy Sisell
Route 3, Box 247-0
Advance, N.C. 27006
Re: Sewage Treatment 's osal
System fof Lot C in Raintree
ddition, avie County.
TELEPHONE
17041 634.5983
The on-site sewage treatment and disposal system installed
at the above mentioned location, is of such design that an Operation
Permit is required from this office. This Operation Permit is issued
instead of a Certificate of Completion. As of January,l, 1984 G.S.
[130A -337(b)] requires an Operation Permit for any system that has
the following:
Pumps and/or grease traps, any alternative
system, systems with a flow rate greater than
480 GPD, and systems serving mobile home parks.
This Operation Permit is valid as long as the sewage treatment
and disposal system is in compliance with Article 11 of G.S. Chapter
130 A, and all conditions imposed by the Operation Permit.
This letter shall serve as the aeration Permit for the
sewage treatment and disposal system at the above mentioned
location.
Date of Issuance
By (42.S.
Title z-"IiiL
y
r
f Davie County Nealth' Department
and .dome .7�ealtfi Yyency
210 HOSPITAL STREET/ P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634.5985
October 11, 1990
Mr. Jack Graves
Rt. 31 Box 357
Advance, NC 27006
Mr. Graves:
This letter is to confirm our conversation on October 9, 1990, regarding
the malfunctioning sewage disposal system that serves your residence in
Raintree Estates in Davie County.
This office has discussed three options with you as to ways to repair the
sewage system. These options are listed below:
1) Repair system on deeded easement with conventional septic tank line.
It should be noted that very little repair space is available. It is
the opinion of this office that this would be a "bandaid" solution to
the problem.
2) Repair the system by installing a sandfilter system on your lot that
discharges into a small creek on the back of your property. You would
need to obtain a permit from the Environmental Management Commission
at (919) 761-2351, North point Boulevard, Wigston -Salem, NC.
3) Repair the system by installing a "reverse" sandfilter on your lot
that would have a non -point discharge into a small creek on the back
of our property. This office can issue a permit for that system.
We will be happy to discuss these options with you again after you have
studied your options. Please feel free to call if you have questions.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd