148 Jackson Drive Lot 5 Section 20 01�1'.IDAVIE, COUNTY HEALTH. DEPARTMENT
-AND, CERTIFI.CATE, OF: COMPLETIOW:
IMPROVEMENTS PERMIT,,
30 Article- 13
NOT, '-lssUed,-.in Cbrn0l.ia6c'e`wA G -.'S. of.'North Carblin*a Chaptb� 1 c
7 Treatment- an (10 NCACI OA Pef-mit NUM
S
ewqge '.1 9�4-1968
d
9
Date'
Name
Locati
AV,
I v- -�'a -.01-
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-4
Lot Nd
S-u-bdi_v'jsibh',N'a'm_' e" ec., or Block No.'
Mobile Home B u s in' Speculation. -
60"t S i ze' ess
-j-
Nd.,b "d
�'N'0' Be rooms ah y
GalrbaO Y E S,,��
e isp6sVr;,, - 1. � I — I I
Specifications 'for System:
W �,YES ��'Zf
--,NO 'Aq
A6to Dish asher,
A uto Wash -Machine,- E S N 0'
-poly,
Wat
Type 6r I so
m
T�is 'p'e r rn , it. Void. if':9ew6ae §vste" described below, is not installed within 36 months from date of issue
, Irz
S�A
v
R
t
improvements:.,pQrmit- by
V i 6,
6a .0 t b t 8'80"
"�Contact -a-itt._epresentativ6� of, the unty Health' Department for. final'li pectioh - of t is� sys em, e ween -
n day�rof co tiom- Telephon 0 Number: 70,4-934-59E
0
9.�O 4-. M o r 1�`,: 0 0 -1 3 0, P. M' mple' 35-.
ia Systb m 'lns�f�lled'by
�Fina[ nst6l4tioh�"D gram --
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Certificate of Completion IlDate
—77
he'signing,o It, i a c s been 'irlistalled in comphance--wIt
T f h's�bertifi6'te","shall indi ate:,thafthe-systbm described "a bb've: h'a h
the standa?ds set forth in:the above, reoylation, but shall,in,NO,way be taken as a:guarantee that the,system will fuqcti.o�rj
n �g v. ime,
;4 s at i sia"d tor i I y f 6r',`a;, y" i e r�b 6 ri6d 6ti t
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028 RECEIVED APR 2 2 1981
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Re nested By
r-Zu • Business Phone 9e4-
Au ._
2. Address 0 0 -U't e. C. a 28
3. Property Owner if Different than Above �cr
Address AoLk 01 C. Z 6
4. Permit To: a) Installer Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-DivisiojjAc'_� Sec._ Lot No. rJ
5. System used to serve what type facility: Housed Mobile Home Business
b) Number of people
Jr Industry Other
6. a) If house or mobile home. ste size of home and number of rooms.
mens
House Diio P, % Z
Bed Rooms Bath Rooms 3 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
lavatory
dishwasher V11 -
urinals
showers
sinks
4
8. a) Type water supply: Public Private Community
garbage disposal
washing machine
b) Has the water supply system been approved? Yes No -
9.
o 9. a) Property Dimensions a 3 o X a &_o x 13 a, 4 x a AAS.4 5 l �-
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.
-1-/3- e% C co w --C
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR CO PLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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Y BY E-8-8 E-8-7 E-8-6
IATES, INC-
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s-9 E-8-10
CAROL
2g, 1976
MARCH
. DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
Topography/ Landscape Position
2)
3)
4)
5)
�4)
8)
9)
S
S
PS
S
S
}--
US
Soil Texture (12-36 in.) Sandy,
Loamy,aye , (note 2:1 Clay)
PS
PS
S
PS
S
PS
,C
U
U
Soil Structure (12-36 in.)
Clayey Soils
S
PS
-c .2SJ
S
PS
S
PS
U
U
U
Soil Depth (inches)
S
PS
S
PS
p
U
U
U
U
Soil Drainage: Internal
S
S
S
PS
PS
—ps)U
External
-PS
PS
S
PS
S
PS
U
U
U
Restrictive Horizons
�--
Available Space
p
PS
S
PS
S
PS
U
U
U
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
Site Classification
U—UNSUITABLE S—SUITABLE Cf—Trovisionally Suitable
Recommendations/Comments:
Described by
SITE DIAGRAI
DCHD (8-82)
Date 0 7
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Ri
Davie County Health Department
Environmental Health Section
P. 0. Box 665 v
Mocksville, N.C. 27028 \ �'
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone %9y
1. Permit Requested By �A�✓ �" "�� �`�7Sf/ Business Phone 63 3"--c�L/d"3
2. Address l-% j Sok yo4AICE , i✓L Z7"6
3. Property Owner if Different than Above "V f�7f'iu
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorptions
c) Sub -Division 69&-rN Ltlo Q Sec. Lot No.
5. System used to serve what type facility: House Mobile Home— Business
dl
/ Industry Other
b) Number of people 7`
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions *7 LT
AV
Bed Rooms Bath Rooms -7- Z- Den w/Closet_
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 ho
7. Number and type of water -using fixtures:
commodes -3 urinals
lavatory showers Z
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 / • 4C2Ls
garbage disposal
washing machine
c) Sewage Disposal Contractor "'� LON /Ksr1— / -fC - /�c~A-1C i IT s-irniic�
10. Do you anticipate any additions or expansions of the facility this sewage ystem is intended to se e? _X__k—
What type? H*4 F RAZ# /n/ , _A5__6_7nE tJT (LE f'Q SS f 13 L -L
This is to certify that the information
'�
iisscorrect to th st of my knowI d
/� 0. -
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
o�N�2 aF l,/n�0�7Z�itSS re-o'e' moi✓ -0 �J
Directions to property:
DCHD (6-82)
/^/ C kQ _J=A/ w e-c.D LJq-k &---I
t g
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section,
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION l
Name Date
Address V- 'E' Lot Size
A
c
FAr.Tr1RC ARFA-1- ARTA �-\ ARFA 3 AREA A
1) Topography/ Landscape Position
S
S
S
PS
PS
PS
U
U
U
U
'.) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
(::&
PS
PS
PS
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
>
S
<:N;
S
PS
S
PS
U
U
U
U
G) Soil Depth (inches)
S
S
PS
PS
PS
U
U
U
�) Soil Drainage: Internal
pS
PS`
S
PS
S
PS
U
U
U
External
p
S
PS
S
PS
U
U
U
Restrictive Horizons
�---
Available Space
pg
is
S
PS
S
PS
U
U
U
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
i) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by ` ��--� Title L Date
SITE DIAGRAM
UCHD (6.82)
` 7
DAVIE COUNTY HEALTH DEPARTMENT lin�•�as
Environmental Health Section �rtt r
P. O. Box 665
Mocksville, N.C. 27028 D�
SOIL/SITE EVALUATION
Name Zc'N, `Z>ot#S -eeIAN Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA d
1) Topography/ Landscape Position
�7
S
S
S
PS
<:T!D
PS
PS
U
U
U
U
'.) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
®
CPQ'
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
CMS>
�cP�
PS
PS
U
U
U
U
�) Soil Depth (inches)
S
S
S
S
-'Cnm>
PS
PS
U
U
U
U
Soil Drainage: Internal
S
S
S
S
<fn:>
PS
PS
U
U
U
U
External
S
S
S
S
ef�j
PS
PS
U
U
U
U
1) Restrictive Horizons
Available Space
S
S.
S
S
U
PS
U
PS
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
S—SUITABLE (�' PS—Provisionally Suitable
c�.,,�a9a �' MW �n���a b t - gs'�
Described by �- Title .�... • � Date
SITE DIAGRAM
DCHD (6-82) I V1 d4 J q5)
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. (
l Home Phone `(Z�V(—w 14'
1. Permit Requer y
V J Business PhoneQ'0 i 1 IC,
2. Address
3. Property
Address
if Different than Above
FA
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 obile Home Business
Industry Other
b) Number of people lz��
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms— Bath RoomslDen 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 19 urinals garbage disposal
lavatory a 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 /, I A&.9—
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 st of my knowledge.
�- � � - �� � •sem) V�
Date I Owner Signat reC/Ws�
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
!�n _ 1
in
�.
DCHD (6-82)
OFFICE OF THE DIRECTOR
pavie (gnuntg Pealth Department
artb pnme xetdt4 '�genry
P..O. BOX 665
gocksbille, �Zurth (Qttrulintt 27628
June 12, 1985
Mrs. Betty Potts
Route #3, Box 237-A
Advance, North Carolina 27006
RE: Greenwood Lakes; Lot $5, B1. #7
Soil/Site Evaluation
Mrs. Potts:
The aforementioned site was evaluated by, this office
on June 11, 1985. As a result of said evaluation this
property is classified as provisionally suitable for the
installation of a ground absorption sewage treatment and
disposal system.
Before a permit is issued by this office, the pros-
pective homeowner must inform this office as to the
location of the proposed house. There is one area on
the lower portion of the site which we will need to stay
away from with the sewage system.
Please advise should this office be of further
assistance concerning this matter.
jh
TELEPHONE
17041 634.5985
Sincerely,
ryk"
Joe Mando, R.S.
Env. Health Coordinator -