709 NC Hwy 801 South Lot 2 Section 2DAMIE eeWNTY 'HE *U 0BwEPmi4RTNIENT''f
''� ?; IMPR0�1/EIVIIENTS PERMITr 1N�D CERTIFICATE OF �C_"
i *NOTE "Issued in Coirmpl;iance with GIS; of North Caro`lina'ChapterArticle 13c
Sewage Treatment and Disposal ,Rules (10q NCAC �10A `:1934=:.19680
rPe�ritN`umber
o N O
Name 1.�, `}J:a ,� �" Date:
Location H 67'�.'c,
Subdivision 'Name.,s
° ��
Lot Size ; 5 o f o se ` Mobile Home.- Business __ Speculation r=5
_z
No. 'Bedrooms, - No. Baths — No. m Family p
�._
Garbage ®isposal YES ❑ N0'Specificatior"s for Syste'rn:
Auto'Dish 1Nasher" YES NO ❑ / (j� C-)
Auto Wash Machine YESN0 ❑ q 60,
i
Type Water pP.y
Su l �,+"�`✓,
1
*.This permit Voi'd-'if sewage system d'e"scribed below is not installed within 36 months from. date of issue'<
r
X15-;-''
Improuem'ents permit by
T, -
*Contact a.:representati,ue of'the Davie County Health z®`epar$t"me4nt for final inspection,, of this syst'eni�bet, ew en^ 830=
., . 3 1, n
9:30A M. or 1 O:q 1<30'P'SM. on, day.; of completion Tel4ephone'-Num.b:er 704=634,;'5'985:
77
Final Installation Diagram: System In`staI ed by. I- 5 `
. r .
51
i
C etrificate '006mpletion
*The;'signing of this certlfiicate shallx nq-dib-9. that ;tfie 's'sfem desc i edw.aboue ,hash+been��insta�ll�ed n�comthe standar�dssetforth �intheabouer�egulation but sthallm N®way�b aken as'argua_ranteefhatthe sytM. iron
. sat:`< ° Yy given=.peno � • ..�. , ,� . �'� ,., ; ,. .�
isfacto�iL • for�ari, �` ``- � •
3
5 APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT �63�
Davie County Health Department ��Q Q•
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 78 8-/6 G
1. Permit Requested By 64ft W�x Business Phone
2. Address��. �• DoT 2 S�E�Oro LAILES sue D=/1.srv•y
3. Property Owner if Different than Above64f-QY F_Vw �D F-z_cz67r _
Address ��%S /'1 �►+/E$Trtr—� /O. NAS- N.0 'Z7107
4.
4. Permit To: a) Install Z Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division G'�w°vie- 3- Sec ZA a Lot No. `�"
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people 3 $i_�o acoNs
6. a) If house or mobile home, State size of Tome and number of rooms.
House Dimensions�7'x�9 FFA
Bed Rooms 3 Bath Rooms Den w/Closet ay
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 urinals garbage disposal
lavatory a showers -2 washing machine
dishwasher sinks '3
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes ✓ No
9. a) Property Dimensions Z IO2 'eN C=ANT x e200 a�to
b) Land area designated to building site/ o�Sd FT
�V.s . A) -C-
c)
-G
c) Sewage Disposal Contractor
5
5�2��✓iCc
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? A10
What type?
This is to certify that the information is correct to the best of my knowledge.
�u 3 9th 7 �
'eo�T�r2
Date wner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
6-C) Kr. B C>I -rbWR-R05
utio5R ooss e'o
H D V� c- 6 t L o T a LS J -u S�r PA;5-7-
aN —114 f- t -'F -FF-r
DCHD (6-82)
N C (t1= em wocD U4 lctS
n y erg
801 'E M4 a/777 ,4/
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CC,NTY
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OL IVIT CLLR Self ArOA G01rRi
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meq, •\ • :'' � .' ,
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4-4
�.
NOTE: WFORMATrON 34CWM IN AMA I
IS eAY.O ON ACTI•AL FIELD WAVEY
ALL Onl, IMIORVATIOM OUT3ME
A R..A"A 9IAS TAK!N FROM MANE 6`
OTHER.
AI.EA'A' IS 6OUMO109Y THE
HE.RVY LINE.
—.061
w 1517M
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---- A20•4Tw ITsavv
- N.C. N18HWAY NO. 801 8
CUBE DATA
GREENWOOD LAKE
2
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A•11�M'
.•aa:9'
HUMIN
SECTION TWO
. I000 d
. zT35"
A • 650.0'
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R • 6o0A'
7. 77.119'
A •11100'
T • 797d
tN 0 �,
�P t
DAViE COUNTY, N. C.
•0733
L • 31906'
L • 16167•
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ownsies
=411 >1821< '*
STRATFORD INVESTMENT CORPORATIO'
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Ma 6
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M.
Ma 7
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0.21711'
11 • NO O
f'► tP�
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SCALE: I" - 200' JULY 11, 1960
• 6o8.d
• 1111.5t'
R • Me
T • 1T►1d,
5 •6000
T • saw*
T •0625'
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JOHN 6 SAME CIVIL EN61M11R
• 2e6.9d •
L • 76616
L • 911.92'
L 19617'
WMCT(WSALEM. NORTH CAROL INA
069 NO- Be
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name \N3V-,. `ZDate 1 ' 1 ' % 7
Address �' j s- Lot Size
�• J- I \-'�^`'
FAr`Tr1RS
ARFAl1 / AR�� AREA 3 ARFA d
I) Topography/ Landscape Position
_
(PSS
-
PS
S
PS
S
PS
U
U
') Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
S
PS
S
PS
U
U
U
1) Soil Structure (12-36 in.)—�5
Clayey Soils
S
PS
S
PS
U
U
G) Soil Depth (inches)
S
S
do
PS
PS
U
U
U
)Soil Drainage: Internal
VSPS
S
S
PS
U
U
External�
S
S
p
PS
PS
U
U
U
i) Restrictive Horizons
)Available Space
p
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
1) Site Classification
U—UNSUITABLE
Recommendations/ Comments: �DR
Described by ,•Cy3���"�
SITE DIAGRAM
DCHD (6-82)
PS—Provisionally Suitable
Title Date
' DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
ENVIRONMENTAL HEALTH SECTION
• REPORT OF INVESTIGATION OR INSPECTION OF Soil/site Evaluation
Place visited _Praperta_of_G.91y_All iQt.t__ JUXic._CQsuLty-______-_ Date -------- Marsh..14------- 19_83_
Address _BoLk.JLZ,._Lot_12,.Czeeuwoz& T.nke_Subd.ivion ___________ Time spent One xQur___________
alom
/
D.Y. McBra er District Sanitarian • Joe Mando and Buck Hall Davie Co.. Health Dept_
Persons contacted ---------------------------------.-
(Owner, agent, tenant. manager, other)
Reason for visitRegaest-from local_Heal.th Department -_ Soil/Site Evaluation ------------------
-- ---------------------- - -
Copies to: Joel Cawthorn
Stacy Covil
Joe Mando
REPORT: The aforementioned investigation was made at the request of the Davie County
Health Department,and the following information is provided for your consideration.
1) -The lot appeared to have been cut and was severely eroded, gullied and
indicated topographic and landscape position problems. An additional
limiting factor is the.soil depth and evidence of drainage mottles.
2) The Davie County Health Department had properly classified the site as
unsuitable for a conventional ground absorption sewage disposal and
treatment system.
3) Considering the above mentioned factors relative to this site, one
could not expect a conventional ground absorption sewage disposal
and treatment system to function satisfactorily at this site.
Should you require additional information, please contact me.
DYMcB:kd
DHS Form 1489 Rev. 5/80
Environmental Health
NaAr\ES Fo&�eit
Adore y'lIS ►n1t2R:w..1..
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
IL/SITE EVALUATION
7��'
N
17W.°
L° 41,1
Date 4165?15�
U
Lot Size lalo X 2.0 e
AREA 1 AREA 2 AREA 3 AREA 4
2 3
5
9) Site Classification
)ography�.�dscape��.siti S S S
*7;> C� - PS PS PS
U
) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) PS PS
U
) Soil Structure (12-36 in.) S S S S
Clayey Soils (jp 'PS <TV PS
U U U
�) Soil Depth (inches) S S S S
PS PS PS PS
U
) Soil Drainage: Internal S` S S S
PS PS
U U (5D,U
External S S S S
PS
U U U U
�) Restrictive Horizons S' -
Available Space S S S S
cnp PS
�--� U U U
�) Other (Specify) S S S S
PS PS PS PS
U
�..�.-
U—UNSUITABLE
Recommendations/ Comments:
Described by Title —�'� Date 446
SITE DIAGRAM
S—SUITABLE PS—Provviisiona iy Suitable/
DCHD (6-82)
U—UNSUITABLE
Recommendations/ Comments:
Described by Title —�'� Date 446
SITE DIAGRAM
S—SUITABLE PS—Provviisiona iy Suitable/
DCHD (6-82)
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
/I,, tt f Home Phone / rF _ f &
1. Permit Requested By W 6IM&I J Business Phones
2. Address -4116
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter 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 C,
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 water -using fixtures: Ar & dLaQi'I/171U1 ou Wi*,,JWWV,
commodes 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
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.
23
71
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
DAVIE COUNTY HEALTH DF.PART11ENT
SITE EVALUATION CONSENT FORM
INSTRUCTIONS/PREREQUISTES
1. Complete the form below and return it to the Davie Co. Health Department.
28 -*±U119 WtV-tl ttg , L0111tt titmeaz.
3. Carefully follow the procedures as outlined in the enclosed "Information
Bulletin".
ar 3.
NOTE: ALL THE ABOVE MUST BE DONE BEFORE A SANITARIAN WILL BE ABLE
TO BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO THE(DAVIE COUNTY HEALTH DEPARTMENT,P.O. BOX 5q)
(MOCKSVILLE, N.C. 27028)
DAVIE COUNTY HEALTH DEPART14ENT
SITE EVALUATION CONSENT FOP11
LOCATION OF PROPERTY:
A&t oa &ce #a,
of hh<,,
DATE RECEIVED
(office use only)
yes no, (1.) I am the owner of the above described property.
yes no (2.) I am not the owner of the above described property, however, I
�i certify that I have consent from ,
owner's name owner to
obtain a site evaluation by the Health Department for the purpose
of determining the suitability for a ground absorption sewage
disposal system.
yes no (3.) I hereby give consent to the authorized representative of the
`X Davie County Health Department to enter upon the above described
"j property and conduct all testing procedures necessary to
determine its suitability for a ground absorption sewage
disposal system.
d-3 1783
DATE S N
(4.) I hereby authorize the Davie County Health Department to release
site evaluation results from the above: described property to the
following:
2-3 XI83
DATE q�
AT
0 Owner Only
Ej Owner's designated representative
Anyone requesting results
L't Only those listed below
paiiie CnmtLi Pealtli Pepur#men#
ttn;� ome Pealth �genq
P. O. BOX 665
�Iucksuilfe, North Carolina 271128
OFFICE OF THE DIRECTOR TELEPHONE
March 3, 1983 17041 634-5985
Gary Elliott
4660 Merryweather Road
Winston-Salem, North Carolina 27107
Mr. Elliott:
This letter is in regard to a soil/site evaluation conducted
by this office on lot #2, block 2 in Greenwood Lakes subdivision
in Davie County.
On February 28, 1983 the above mentioned lot was evaluated
to determine the suitability of installing ground absorption
sewage disposal and treatment system. Please note the findings
below:
Topsoil: All topsoil on lot has been removed or washed
away.
Subsoil: Red clay soil ranging in depth from 611 to 28".
Soil shows signs of poor internal drainage.
Drainage mottles are pervasive at 2011-2411.
Saprolite is encountered at 24-30".
Topography: The majority of the lot is severely eroded,
thus making installation of a septic tank system
very difficult, if not impossible.
Based on the above mentioned conditions this office classi-
fied the lot unsuitable for the installation of a ground absorption
sewage disposal and treatment system. At a later date we will
have a representative from our regional office evaluate the lot.
We will forward his findings to you.
If you have any questions, feel free to call.
Sincerely,
Robert B. Hall, Jr.
jh Sanitarian
CC: James Foster
4715 Merryweather Rd
Winston-Salem, N.C.
DEPARTMENT OF HUMAN RESOURCES
DIVISION OF HEALTH SERVICES
ENVIRONMENTAL HEALTH SECTION
REPORT OF INVESTIGATION OR INSPECTION OF Soil/Site Evaluation
Place visited ________ Date -------- Marah14------- 19_83_
Address _---------- Time spent One Hgur___________ `
1
D.Y McBra er District Sanitarian• Joe Mando and Buck Hall Davie Co.. Health De t.
Om-----------x--1---------------------...t--------------------i------------Healt----E--
Persona contacted- ---------------------------------------------------
(Owner, agent, tenant, manager, other)
Reason for visit __ Request_from _local_Health Dtment --Soil/Site Evaluation
-------eBar-------------=----------------------------
Copies to: Joel Cawthorn
Stacy Covil
Joe Mando
SRT: The aforementioned investigation was made at the request of the Davie County
Health Department,and the following information is provided for your consideration.
1) -The lot appeared to have been cut and was severely eroded, gullied and
indicated topographic and landscape position problems. An additional
limiting factor is the.soil depth and evidence of drainage mottles.
2) The Davie County Health Department had properly classified the site as
unsuitable for a conventional ground absorption sewage disposal and
treatment system.
3) Considering the above mentioned factors relative to this site, one
could not expect a conventional ground absorption sewage disposal
and treatment system to function satisfactorily at this site.
Should you. require additional information, please contact me.
DYMcB:kd
DHS Form 1489 Rev. 5/80
Environmental Health
Davie County Nealtli De artment
and ..glome XealK err
210 HOSPITAL STREET / P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
September 10, 1987
Mr. Gary Wayne Elliott
4675 Merriweather Rd.
Winston-Salem, NC 27107
Re: Site Evaluation
Greenwood Lakes/Lot 2
Dear Mr. Elliott,
On September 4, 1987, as you requested a representative from this
office visited your site and found the soil provisionally suitable for the
installation of a ground absorption sewage system.
The system would have to be oversized because of the soil conditions.
A three bedroom house would need four hundred feet of line instead of the
usual three hundred feet.
If you have any questions, please feel free to contact this office.
Sincerely,
NJJ�%4r
.
Charles E. Little, R.S.
Environmental Health
Enclosure
CL/wd
STATEMENT.'
" f ' 11DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. O. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 4/26/89
F Gary Wayne Elliot
4675 Merriweather R6ad
Winston-Salem, N.C. 27107
L J
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
hermit fir` 5534 Greenwood Lakes Sec.2
Lot 2 1 $ 15.00
Paid 4/26/89
Ch. # 4302
Rec.# 13509
BALANCE DUE —
STATEMENT
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. 0. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 9-10-37
Car; Wayne Elliot
+675 llarriwoatllcr ??d.
r; >Lori-S41ora ,C 27107
Site Eval./Greenwood La,es-Lot 2/Soc.2- 35.00
L I
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
Site Eval./Creenwood Lakt::s-Lot Z(Sec .)
U35.00
oaf
BALANCE DUE —
;35.00