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985 Riverbend Drive Lot 51-` •' 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 ,s Permit Number Name _ Date J N_ 7 18 .91 h�i Location Subdivision Name Lot No. / Sec. or Block No. Lot Size _ �_ House Mobile Home _T Business _— Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES NO ❑ Specifications.;for System: Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES NO ❑ j "' J.- n,/ �� % cif .'J i '1 Y^ Type Water Supply _ ___ 10" r *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: E Fv 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. .. 6 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PFJ'T2 V RDavie County Health Department 1155 `_� Environmental Health Section �6 P. O. Box 665 1 Mocksville, NC 27028 + bd 1. Application/Permit Requested By Mailing Address P.O. Box 597 Advance, N.C. 27006 Home Phone 919-998-5446 Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation EX Septic Tank Installation 4. System to Serve: f7 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Bermuda Run Country Club Section 5 Lot # 5 1 ❑ Basement/Plumbing No. of People 2 ❑ Basement/No Plumbing No. of Bedrooms 3 Or 4 1I Washing Machine No. of Bathrooms 2 z FLI Dishwasher Dwelling Dimensions? Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private ❑ Community 8. Property Dimensions See A t t c h e d Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes L21 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. Directions to Property: Enter Bermuda Run through front entrance off Hwy. 158. Inform guard you are there to inspect lot owned by Beattie and Hazel Armstrong and buyers are Thomas C. and Myra M. Hutchins. Turn right on Riverbend Drive. Lot is second vacant lot on right. 235 Riberben Drive. This is to certify that the information provided is correct to incurred from this application. J5=/-7- ?- DATE best of my knowledge, and I understand I am responsible for all charges 4-1 NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ® 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by &&Z dJ&n� to conduct all testing procedures as necessary to determine said site's 4itability for a ground absorption sewage treatment and disposal system. -/ - 93 DATE SIQfJATURE DCHD (12.90) • APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P O. Box 665 RECEIVED JUN 2 p 1W Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone - 1. Permit Requested By Business Phone 2. Address 3. Property Owner if Different than Above Address 4. Permit To: a) Install_-,LAlter 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 Industry Other b) Number of people Zym 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 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 waterr--using fixtures: L/ commodes tl urinals +� garbage disposal lavatory showers `� washing machine dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes�No 9. a) Property Dimensions G9A��` �/ 3S- x 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. QLZ� 2-o". Z ete�4U2 IV Date Owner Signat re OV OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-62) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Address 4 r Date Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position 9) S CF S S � S PS U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S PS S S S PS U U U 1) Soil Structure (12-36 in.) Clayey Soils S ® S dS S t;� S PS U U U Soil Depth (inches) S (::75U S SS S PS U Soil Drainage: Internal PS S © U S � iT S PS U External S— �p' � S PS U U U 1) Restrictive Horizons ') Available Space S 0 � � S PS U U U U 1) Other (Specify) S PS S PS S PS S PS U U Ute. U Site Classification /- -4 �•� ^ �f - U—UNSUITABLE S—SUITABLE I PS—Provisionaliv Suitable _ Recommendations/ Comments: -c- 710,71 — �L t—ter n / Al Ile Described "'by� x/( Title �'Date VA& SITE DIAGRAM OPS / 3s DCHD (6.82) FIM P avie ( ountg Pealth P epartment nnb POme Realth �Seneg P. O. BOX 665 �orks%ille, North (garolina 27028 OFFICE OF THE DIRECTOR July 15, 1986 Ms. Carole D. Johnson Crowder Realty 3528 Vest Mill Road , Winston Salem, NC 27103 Ms. Johnson: At your request, lots 51 and 52 in Bermuda Run were evaluated to determine the suitablility of installing septic tank systems on each lot. Lot 51 is classified provisionally suitable on the back side; however, a pump will need to be used in order to utilize the avail- able space in the rear yard and to prevent the septic tank lines from being installed at an unacceptable depth. Lot 52 is also classified provisionally suitable on the back side; however, a pump will need to be used in order to utilize the available space in the rear yard and to prevent the septic tank lines from being at an unacceptable depth. Also due to the lack of provi- sionally suitable soil in the rear yard any dwelling on said lot must be limited to three bedrooms. Before any permits can be issued the prospective buyers must fill out the appropriate application and stake the house off on said lot. If you have any questions, feel free to call. Sincerely, 6�13.aCa e2 , (�ir. R. f Robert B. Hall, Jr. R. S. Environmental Health Enclosures TELEPHONE 17041 634-5985 OFFICE OF THE DIRECTOR Hazel Armstrong BOX 762 Bermuda Run Advance, NC 27006 Dear Ms. Armstrong: paiiie ( ountg Health Department anb Home Health '�genrg P. O. BOX 665 Aorhol3ille, North Carolina 27028 March 31, 1987 At your request, lots 51 and 52 in Bermuda Run were evaluated to determine the suitability of installing septic tank systems on each lot. Lot 51 is classified provisionally suitable on the back side; however, a pump will need to be used in order to utilize the available space in the rear yard and to prevent the septic tank lines from being installed at an unacceptable depth. TELEPHONE 17041 634.5985 Lot 52 is also classified provisionally suitable on the back side; however, a pump will need to be used in order to utilize the available space in the rear yard and to prevent the septic tank lines from being at an unacceptable depth. Also, due to the lack of provisionally suitable soil in the rear yard any dwelling on said lot must be limited to three bedrooms. Before any permits can be issued the prospective buyers must fill out the appropriate application and stake the house off on said lot. If you have any questions, feel free to call. Sincerely, Charlie Little, R. S. Environmental Health CL/wd Dai ie County Nealtl r7yen artment and Nome Nealtfi 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634.5985 June 5, 1989 Hazel Armstrong Box 762 Bermuda Run Advance, NC 27006 Re: Site Evaluation Bermuda Run - Lot 51 March 1987 Dear Ms. Armstrong: At your request in March 1987, lot 51 in Bermuda Run was evaluated to determine the suitability of installing a septic tank system. Lot 51 is classified provisionally suitable on the back side; however, a pump will need to be used in order to utilize the available space in the rear yard and to prevent the septic tank •lines from being installed at an unacceptable depth. Before a permit can be issued the prospective buyer must fill out the appropriate application and stake the house off on said lot. If you have any questions, feel free to call. Sincerely, Charles E. Little, R.S. Envirqnmental Health Section CL/wd cc: Myra Hutchins 5-4-93 0,