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P3077 Greenwood Lakes Lot 6DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMP `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. k Name s-TAC� C-0IZ JA -1 Z�G�.. - -- Date Location Permit Number sit` 2 Subdivision Name �^�� �`"""'LAKE Lot No. �' Sec. or Block No. Lot Size House Mobile Home No. Bedrooms No. Baths _ No. in Family. Garbage Disposal YES '[f] NO ❑ Auto Dish Washer YES i NO ,Q Auto Wash Machine YES 0 NO ❑ Type Water Supply (RUNT l --- Business Fa Specifications for System 30o"X 3rX f2-„ sj -2) - Qum 6” Co Aj ca f Speculation OUO c�G ��c• •: tic it U 'This permit Void if sewage system described below is not installed within 36 months from date of issue. FRowT Improvements permit by S 'Contact a representative of the Davie County Health Department for final inspection of thi11 s system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.. 11 Final Installation Diagram: System,]nstalled by .51011 r� Certificate of Completion �� Date` *The signing of this certificate shall indicate that the system describ d 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. II DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size Z04/ x / g'K Name S•TP'ty C�M^`tFtiCz� t2— Address rzoym Z' /IDJA,4e-f Kr FAr`TnR.R ARFA 1 w AREA 2 AREA 3 AREA 4 Topography/ Landscape Position S PS PS S PS S PS U U U !) Soil Text -36 in.) Sandy, Loamy, Cla e , (note 2:1 Clay) S 5) S (50 S PS S PS U U U U I) Soil Structure (12-36 in.) S P S PS S PS Clayey Soils Qc,or-e y. (�9) U U U U Soil Depth (inches)ti (D Q S S 46 PS PS PS PS U U U U i) Soil Drainage: Internal -(Z)S S S PS PS PS U U U U External © S S PS PS PS PS U U U U i) Restrictive Horizons ') Available Space S S PS S PS U U U U S) Other (Specify) S PS S PS S PS S PS U U U U 3) Site Classification U—UNSUITABLE Recommendations/ Comments: S—SUITABLE 'CPS—Provisionally Suitable 1-1 Described by SP 's Title SAN I-rr. R cA IJ SITE DIAGRAM DCHD (6-82) Date 1 VO 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 Requested 2. Address dez 3. Property Owner if Different than Above Address Home Phone %/� g — F`fi D 0 Business Phone /7 i rz_W 4. Permit To: a) Install V Alter Repair b) Privyy Conventional Other Type Ground Absorption c) Sub -Division .AP Sec Lot No.. 5. System used to serve what type facility: House !C-� Mobile Home Business IndustryOther b) Number of people n 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 1174 X 36 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 3 urinals garbage disposal lavatory 3 showers o2 washing machine dishwasher sinks 8. a) Type water supply: Public 1-1*' Private Community b) Has the water supply system been approved? Yes � No 9. a) Property Dimensions of o `b�I X 19 8 b) Land area designated to building sit2 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. Date Owner Signatur OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: Al AV DCHD (6-82) 14