925 NC Hwy 801 South Lot 2 Section 2�.. .1 DAVIE COUNTY HEALTH DEPARTMENT
` IMPROVEMENTS PERMIT AN® 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 ii I -t''. Date .A - Z. +� 9
Location
�d1i'j1%~��{?. li l' %iU„!1���.r�[�" ,/�/� °¢•'�ls�%�X17� r����',t+.���d;.��. �n ,�'�G•
`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;. bdt'shall.in.NO way be taken as, a'guarantee that the system will function,*
satisfactorily forany given period of time.
'
Subdivision Name r
T ___ =•.t < �_,'d
:
Lot No.. 4 - f Sec. or Block.No.
Lot Size —_> �_---
House
— ;--
Mobile Home _ _— Business _ Speculation
No. Bedroom's 0161--
No. Baths
__ l�
No. in Family _
Garbage Disposal
YES .fir NO
❑
Specifications for System: ; t
Auto Dish Washer
YES ❑ NO
0
S' YIz" AacK
Auto Wash Machine
YES 0 NO
F-]
Type Water Supply —
f'sr ,,, i,.,`
— ----
�aYe Sua(.- Cw-4ruei L ,pEs C�.1'1 t,
`This permit Void if sewage system described
below is not installed within 36 months from date of issue.
Chw.•�e�4
�� �b�R:
`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;. bdt'shall.in.NO way be taken as, a'guarantee that the system will function,*
satisfactorily forany given period of time.
4*
a 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.
1. Permit F
2. Address
3. Property Owner if Different than Above
Address
dov%t6
4. Permit To: a) Install1_� Alter Repair
b) Privy Conventional Other Type
Ground Absorption
r'!
Home Phoneqq K -y (A
Business Phone
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: Housed Mobile Home Business
Industry Other
b) Number of people `]
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
rr�� VOLed Rooms Bath Rooms — V Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hou
7. Number and type of water -using fixtures
commodes
lavatory
dishwasher
urinal
showers Al
sinks
garbage disposal 1
washing machine 1
8. a) Type water supply: Publics Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 3 a c r e- s – 5`I;4't k4) 1-7o'&!!!69) 4 3 i' (B+IX) �lSb.•-r ( ,; d� � �
b) Land area designated to building site to y v1
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.
(D �q - M /
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
J1� 0 V.11art_
1�9� � , 6 _P 1
e.ts� � -tom
&I
cam, --��, ��►�.,L.. ��.;�-�-�. �..�.d.� �o l . �,�.�
ko_C LtEra� A
DCHD (6-82)
Y
F , , •- yj� �`
n/
DAVIE COUNTY HEALTH DEPARTMENT 47Environmental Health Section /a�`� V
R O. Box 665 ll *tnWe"d La -A"
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
--a (, 1 Date
Name jl l
Addressy"t-� go Lot Size
PAnTnPC AREA i AREA 9 ARFA 3 ARFA A
Topography/ Landscape Position
S
S
S
S
l f!!�>
2
-0n-_>
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
r—e5!t>
r-ERSD
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
��
PS
U
U
U
U
) Soil Depth (inches)
may''
S
(�
S
efm>
S
PS
U
U
U
U
)Soil Drainage: Internal
�
�
PS
U
U
U
U
External
S
C �U
S
(151
S
PS
U
U
U
I) Restrictive Horizons
-
Available Space
S. (—(EW
S
S
PS
U
U
U
U
f) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
►) Site ClassificationS�
U—UNSUITABLE S—SUITABLE CPS—Provisionally Suitable
Recommendations/ Comments: 4—o7—# / 4. 2 .der d Bl t Led,
Described by
SITE
Title &11• q4j;d &-M jc,�. Date q"11, "tS
gG 1
DCHD (6-82)
pavie (gnnntg Pealth Department
anb game pealth c Senrg
P. O. BOX 665
gorksuffle, North (garolina 27028
OFFICE OF THE DIRECTOR
Betty Potts
Betty Potts Realty, Inc.
Route #3, Box 237-A
Advance, N.C. 27006
Mrs. Potts:
TELEPHONE
17041 634-5985
April 22, 1985
RE:- Lot #2, Block 4, Greenwood Lakes
Davie County
As per your request the aforementioned lot was evaluated by
this office on April 16, 1985. 'It is the understanding of this
office that Lot #1, Block 4 has been combined with lot #2, Block 4
to create one large lot. Firstoff, let me say that Lot #1, Block 4
is totally unsuitable. The results of evaluation concerning Lot #2
are as follows:
Topography/Landscape Position is classified provisionally suitable.
Soil Texture and Soil Structure is classified provisionally suitable.
Soil Drainage: Internal and External is classified probisionally
suitable.
The overall classification of Lot #2, Block 4 is provisionally
suitable.
Before this office can issue the necessary permits, the prospective
home owner will need to mark the proposed location of said home. Once
this is done notify this office so we can complete our work at the site.
Please advise should my office be of further assistance con-
cerning this matter.
jh
Sincerely,
*yvk"
Joe Mando, R.S.
Env. Health Coordinator