232 Overlook Drive Lot 10 Section 2s : DAVIE .COUNTY HEALTH DEPARTMENT
.IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with.G.S. of North .Carolina Chapter 1.30 Article 13c
Sewage Treatment and Disposal Rules ('10 NCAC 10A .1934-,1968) Permit Number
Name ..� �ti �4 a •- t ., e, _ Date
au�l
Location
232 lot ed
Subdivision Name Js 1'4' UA I #Ifjfit�u� � Lot No. Sec. or Block No
Lot Size 2j .Z — House --- Mobile Home __ Business —_ -Speculation
No. Bedrooms s—_ No.,Baths No. in Family Z '
Garbage Disposal YES
NO .Q -�. pit$ ��''
Auto Dish Washer •YES' ti .1 ct�, k„ Specifications for System.: ionra
Auto Wash Machine YES F,]' NO ,0 f ' ° "�. •j
-Type Water E -.. >.. max.,
,Supply �•.a r b qA t
---
*This permit Void. if, sewage- system described below is not instal ed within 36 months from date of issue.
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14 1
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Improvements permit by.`_
*Contact a ,'representative of the Davie County Health Department for final inspection of this system between 8`30- .
9:30 A.M. i!or 1:00-1:30 R.M..on day, of completion. Telephone Number: 704-634-5985. .
Final Installation Diagram: System Installed by ► +
m y
,
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described•above has been installed in compliance with.
the standa'rds.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. ;
Address
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
/'-/Z/ s
Lot Size
Com
GArTr1RC ARFA 1 ARTA 2 AREA 3 AREA 4
Topography/ Landscape Position
S
PS
S
lf!%>
A)
S
I(ffD
1:55
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
PS
S
S
S
I) Soil Structure (12-36 in.)
Clayey Soils
S
®
S
i
S
S
1) Soil Depth (inches)
S
PS
S.>
.��
C�
ll—P
U
U
)Soil Drainage: Internal
PS
P
SCS''
O -r,>
U
U
U
External
S
PS
(::Ap. 5
U
i) Restrictive Horizons
�� V40,
Ifl0
') Available Space
S
PS
S.
PS
S
S
rzT�S)
3) Other (Specify)
S
PS
S
PS
S
PS
U
U
U
U
i) Site Classification
U—UNSUITABLE S—SUITABLE PS --frr-o—visionaliy Suitable
Recommendations/ Comments: W,kl b' - �0 '� - "°� `�
Y
Y�-,� Title , Q'it frit^c�
Described by Date
SITE DIAGRAM
DCHD (6-82)
44
4V
ell
J�3
41
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. !,
Home Phon�,p
1. Permit Requested By To�,\ yofk!tj Business Phone 911 2ff -SqQ3
2. Address p0 - A nK ;,., - � /%j - C . �iU /D,
3. Property Owner if Different than Above N
Address 14q yo ne_ bayr'S viol
4. Permit To: a) Install ✓Alter Repair
b) Privy Conventional Y Other Type
Ground Absorption
c) Sub- Division 6�reiiwkeri UPS Sec._— Lot No. 0
5. System used to serve what type facility: House r Mobile Home Business
e IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 3 6' X g
Bed Rooms 3 Bath Rooms Den w/Close
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 showers 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 ).2d / X ap's //11�
b) Land area designated to building site ' 2000 S P4 ?r
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.
`g
Date Ow er Signatur
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
/ V C. 4o
Zai lU
S'CL /•2," _ -5 -
s
I
PaVit (9ou ttV AEalt ptpartment
Unb CEO= c8aith Agenru1
P. O. BOX 665
�ucksbille, �artlj tllttrulinx z7IIz8
OFFICE OF THE DIRECTOR
November 219 1985
Mr. John Yarbrough
P.O. Box 1352
Clemmons, N. C. 27012
Mr. Yarbrough:
_ - TELEPHONE
(7041 634-5985
Re: Lot #10, Greenwood Lakes
Davie County
The sewage disposal system serving the new dwelling on the
above mentioned property was installed on October 24, 1985. The
system was inspected by a representative from this office on the
same date and was approved.
Please advise should my office be of further assistance to
you concerning this matter.
Sincerely,
oe Mando, R. S.
irector,,EnvironmentalOHealth
JM/sg