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212 Overlook Drive Lot 11 Section 2DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ry *'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 �`,._ / {'�F'Fx i ',�r ,.•,Date Location g / vtrlac Subdivision Name ! ° Lot No. — II• r _ Sec. or Block No. = __ Lot Size ___ House _ Mobile Home _ _ Business _ Speculation'" No. Bedrooms _� No. Baths No. in Family_ 7 Garbage Disposal . YES E NO gam' Specifications for System: Auto Dish Washer YES NO Q Il j Auto Wash Machine YES, M . NO ' e.t >, - Type Water Supply "This permit.Void if.sewage system described below is not installed within 36 months from date of issue. ,,Contact a representative of the Davie 'County Health Department for final inspection of this system between 8:30- 0:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by �'1�f1!� / •� L`"{ Certificate of Completion —_ Date`s' #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.g,uarantee that the system Will function'- satisfactorily unction` satisfactorily for any given period of time. 1. Permit F 2. Address APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 3. Property Owner if Different than Above _ Address 4. Permit To: a) Install Alter Repair Home Phone Business Phone b) Privy Conventional Other Type Ground Absorption/ c) Sub -Division �� ��r �IneSS c.— Lot No. 5. System used to serve what type facility: House 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 t'l4 X �& - 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: commodes '2 urinal lavatory 2 showers ..2 dishwasher sinks 8. a) Type water supply: Public— Private Community garbage disposal washing machine b) Has the water supply system been approved? Yes No 9. a) Property Dimensions Z Acre' b) Land area designated to building site c) Sewage Disposal Contractor c h za,cna7r_ 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. 0 - y - /9 Date Owner Signa u OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Heafth Department Environmental Health Section P. O. Box 665 RECEIVEp SEP 19 1a Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Requested By c rn,W k0f J_",vt 4 2. Address 24-!f, 13c-XX9`7, (2th-214NVt Home Phone Ff- 5Z6 d �t'l Business Phone I GM__�2 % nO 3. Property Owner if Different than Above .S Fein ' Address 4. Permit To: a) Install Alter Repair b) Privy Conventional —A--'C-th'er Type Ground Absorption p 13 t to C) Sub -Division --� L Sec. Lot No.� 5. System used to serve what type facility: House Mobile Home ' Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms 3 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: commodes ,;I, urinals garbage disposal lavatory showers 2 washing machine dishwasher sinks 8. a) Type water supply: Publics Private Community b) Has the water supply system b/ ye ©ap roved? Y s �o 9. a) Property Dimensions oL 0 b) Land area designated to building site ea NT e,- '7n Fr o-^/ c) Sewage Disposal Contractor ? 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? 01-110 What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: r 41, 1 low y r: `/ 1 a . •r ANT Y 4a� ��` - : • ' ` i /gpeeohc` y` / y �4 t 7y� `�, • 1,.N s� ,. N o� 4 f "� l kD C y b A106 •E r C C O 12 3 7 s � J ". 5 1S' • �• �' 'A �H294�•A • e 1s�9 i e__ n. • ^ 414'^• 7) ^.,� ; N2S4^1W 16 .29 SEr V 9• Hlb . • .`s 69 S ;s•+' •� r v O d I A. `40s1 ! .I ,oa c' rc , �4 (, ry ^ j .Q _ ®ti *raw o 14 �q O oN.�^^ W ; r 1p _ i �9TC: 91 O y09t ! i C u ., 4�. 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C`6' tti 2 4 s N i �� 40 1 O f 6yb4 1, ♦r„ �\ '��� in 2 Al VIA V A ��.� �� °jV•t r, •e• ® "^� Oz N O.OwfoO OT ��”� ` '• N'� b '• 4; Cn r O., O �6� C• vh 8 ' 7 �MV. ,4• , . ;: ,•!• W;. %.• All, flv J's •3a ore 'c + to ld • p v` rto t C t 7 w Jac C. ap \�° c•9r ,� ^ E le WHITEHEAD OAtVE h i; .• o ® • / �� t •�. v O OC N It ,,if;e 96' •)•. •. t 90.t p t�It�'t •r J9 C ti♦ 6's y 10 O O 2 �o t79pp'E � LY • ` 0 INV V, Z30 \• 10 0 C. T. • cl N t 7 0' 190. ' — Uc 0• Ito 0 ts0 0' Is . 0 0' �h,♦3 •� � �� •�y�All, O t z ? 1' 3 �w 11 o { � i b+•.2 � Sy^O \� . All, O •�I 1 1 P'�33 0 � �- P . �• t� •� • t ARL • ,�o jO ' h ••. • oy,�.7 `y 4 9! , •� mss;\ 7. it Of r Am Ad 44 AM 0 OP O • O r ,y O r e V O 1� N O s E 2500 2410. 1200, 1 t t g 00 r t927lS M20*47 W 173500 O �f r o • � N.C. HIGHWAY N0. ®01 - •' j= Address e DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size�/ FArT(1RS ARFA 1 ARFA 2 AREA 3 AREA 4 Topography/ Landscape Position S JP S PS S PS U U U !) Soil Texture (12-36 in.) Sandy, S PIS7' S PS S PS Loamy, Clayey, (note 2:1 Clay) U U U 1) Soil Structure (12-36 in.) Clayey Soils S ��S" % � S PS S PS U U U Soil Depth (inches) PS S SFS S PS S PS t� U U Soil Drainage: Internal PS S PS S PS U U External S .__---� S PS S PS U U i) Restrictive Horizons Available Space S PS PS S PS S PS U U U U 1) Other (Specify) S PS S PS S PS S PS Ute' U U U 1) Site Classification U—UNSUITABLE Recommendations/Comments: Described by _ SITE DIAGRAM DCHD (6.82) S—SUITABLE PS—Provisionally Suitable Title 5w:Zd Date ,BaIiie (gOixn#g Araft4 c'Oepurtmeut aub CEO= �Ictdt4 '�Seury P. O. BOX 665 Aarkstiille �Karth (garalina 27II28 OFFICE OF THE DIRECTOR TELEPHONE October 3, 1986 (704) 634-5965 Mr. Norman Dillingham Route 4, Box 297 Advance, NC 27006 Mr. Dillingham: On September 30, 1986 this office evaluated Lot 11, Block 3, in Greenwood Lakes. The front portion of the lot is classified provision- ally suitable. A pump may need to be used in order to keep the lines from being installed at an unacceptable depth. When the house is staked off, contact this office at that time we can determine if a pump will be used. If you have any questions, feel free to call. Sincerely, katjbq4 & 9&0, 9fl. 1q. 4 Robert B. Hall, Jr. R. S. Environmental Health RBHJR:sg Enclosure Davie County NealtF De ait hent and .�lonre Nealti 9ency 210 HOSPITAL STREET / P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-5985 July 26, 1988 Potts Realty Attn: Diane Potts P. 0. Box 11 Advance, NC 27006 Re: Sewage System Installation Richard Poindexter Greenwood Lakes/Block 3, Lot 11 Overlook Drive Dear Realtor: The septic tank system that serves this residence was designed, inspected and approved by this office on July 7, 1988. This house has a county water meter. With proper maintenance and use it should function properly. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health RH/wd