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1911 Underpass Road Lot 1 Section 2f DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 41 !' *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c �ewage Treatment and DisP sal Rules (10 NCAC 10A .1934-.1968) Permit Number Namef))6`1kTi°l ; ,;; �� ��./1Date S'_�/,���t" N2 i Locations Subdivision Name Lot No. % Sec. or Block No. J Lot Size '� House —_ Mobile Home _ Business Speculation No. Bedrooms ' No. Baths No. in Family '51 Garbage Disposal YES p NOp > Specifications for System: Auto Dish Washer YES NO i] ) Auto Wash Machine YES [�j NO Cp Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by . 1 Z/ *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 Diagra{n���, 21 r System Installed by V F /J h 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. V (41 APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department "• 3 Environmental Health Section ccCiG,v�D �`u P. O. Box 665 RL Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested By Potts Realty, Ing . (Richard B. PoindextlMiiness Phone 998-2100 2. Address P-0- Box 11, Advance, N- G_ 27006 3. Property Owner if Different than Above Howard Moore Address C/0 Potts Realty, Inc. P.O. Box 11, Advance, N.C. 27006 4. Permit To: a) Install_ Alter Repair b) Privy Conventional x Other Type Ground Absorption c) Sub -Division Greenwood Lks Sec. 2 Lot No. 1 Elk 1 (Corner Underpass $ Hwy 801) 5. System used to serve what type facility: House x Mobile Home Business PB 3 -Pg 58 Industry Other b) Number of people 4 6. ay If house or mobile home, state size of home and number of rooms. House Dimensions Approx 2800 sq_ ft Bed Rooms 4 Bath Rooms 3 Den w/Closet n/a b) If Business, Industry or Other, State: Number of persons served n/a What type business, etc. ___n/a Estimate amount of waste daily (24 hours) n/a 7. Number and type of water -using fixtures: commodes 3 urinals garbage disposal lavatory 3 showers 3 washing machine 1 dishwasher 1 sinks 1 8. a) Type water supply: Public x Private Community b) Has the water supply system been approved? Yes x No 9. a) Property Dimensions 380X83.4X252.55X304.05 b) Land area designated to building site center of property c) Sewage Disposal Contractor n/a 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? no What type? -- -- n/a This is to certify that the information is,corri9ct to theestmy knowledge. 12/12/88 Date Owner Signature t for Buyer OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 801 -South to Corner of Underpass Rd $ Hwy 801 (Crowder 4 -sale sign on property) DCHD (6-82) ,3N� -09 pd 000 5 `90 �'o•mm O s� N�q' tp O 3 � O 1 r 0. q�N ? yF • } %' 26 f N l 89 9'W N' crr6 6 a`c' c' \966060 w ® 0 S o�w� tiH Po (T 2� O N� O o o O N a �a 7 \*06 O �' � ti CD 0 N 8 o, 6 O ry W gyp, o n "' z 0 E O' 5184 7'E+ z N 1` N Im ' �v 119 �so.�pp ��pp, \h 3.rQ3� z a x odd` . `I`2 299.67' 160.0' 160 0' YHITEHEAD DRIVE 0 CID\ O ��, "� S 17`-'00'E 80308" • S0 � 6�S 0n (0 Ga' t O \ � lq :r ri 3 80.01 'O 19 N.C. HIGHWA' 93 848 8' N 172 00' W 1527.95' 190.0' 190.01 190.0' '0 II5.0' h� o f \� @0 4 00 0 �� O 0 OU O 0 0 f O g\� NO. 6 W N A=13`-'08' N n= 14942' n=26'28' R = 400.0' R = 1000.0' R = 65 0.0' R = 600.0' R = 340.0' 0 T = 27.35' T = 15535' S17900'E T = 79.95' 0o L = 57.33' A 112.98' 190.0' o� I 0.0 Nr) 7 190. 1 a W O - �:J O P z U 0 ® 0 ® U O U K ~ Z00 U o © v z N N N N N 7.95' - 190.0' 190.0' 190.0' 190.0, 190.0' N.C. HIGHWA' N 172 00' W 1527.95' '0 • o CURVE DATA N0 1 NO. 2 N0. 4 NO. 6 NO. 8 6 = 46929' A=13`-'08' d = 26453' n= 14942' n=26'28' R = 400.0' R = 1000.0' R = 65 0.0' R = 600.0' R = 340.0' T = 171.78' T = 27.35' T = 15535' T = 77.39' T = 79.95' L = 348.85' L = 57.33' L = 319.06' L = 161.63' L = 170.91' F Nr) 7 9 N.C. HIGHWA' Address FACTORS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION AREA 1 AREA 2 Date Lot Size AREA 3 ARFA d Topography/ Landscape Position SS PS S PS U U U U !) Soil Texture (12-36 in.) Sandy, S PS S PS Loamy, Clayey, (note 2:1 Clay) U U U U 1) Soil Structure (12-36 in.) S S S Clayey Soils &�)PS PS U U U Soil Depth (inches) S S S cf�p PS PS UIF) U U U ) Soil Drainage: Internal S S PS S PS U U U External S S p � t�S7 PS PS U -�� U U i) Restrictive Horizons Available Space S S r-p--!�) S PS S PS 4�7 11-13 U U 1) Other (Specify) S PS S PS S PS S PS U U U U - S // C, 1) Site Classification U—UNSUITABLE S—SUITABLE -PS—Provisionally Suitable Recommendations/ Comments: Described by Z/ Title Date SITE DIAGRAM v �0IS' DCHD (6-82) Davie County Nealtfr 7yen aitment . l and dome ea iiicy 210 HOSPITAL STREET I P.O. BOX 665 MOCKsvILLE, N.C. 27028 PHONE: (704) 634-5985 December 19, 1988 Potts Realty P. 0. Box 11 Advance, NC 27006 Re: Site Evaluation Greenwood Lakes Sec. 2/Block 1 -Lot 1 Dear Realtor: On December 19, 1988, as you requested a representative from this office visited the above mentioned site. The soil was found provisionally suitable for the installation of a ground absorption sewage system; however, the house must be staked off before a permit can be issued. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Envirgnmental Health Section RH/wd Enclosure