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P5395 Greenwood Lakes��•-�' �•-t/`-•i"C.��'\.Yx✓'�rYv:'� v --�..,.,.y,-..,R..rv-cP-- o-•.•`;:-..,;...RN-,:o•-.._-..-n,....-o� r /LL �( r=- DAVIE COU HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION �&/�*'NOTE: Issued in Compliance with G.S..of North Carolina Chapter 130 Article 13c �J Sewage Treatment and Dis osal Rules 10 NCAC 10A .1934-.1968 Pef#ti'tit' Num r P ( ) be Name Date Z'«� ' �S',� iV2 Location -� � -S Lot No. � /�- Subdivision Name _ �%���"�`.�%�'©�.? � � �1�"S�`C' Sec. or Block No. Lot Size House ��"� Mobile.;Home — Business Speculation No. Bedrooms No. Baths 0�/ No. in Family Garbage Disposal YES ❑ NO [-' Specifications for System: ` Auto Dish Washer YES NO C]y Auto Wash Machine YES , NO ❑ ��`� Type Water SuPPIY 11 O,X ? x / *This permit Void if sewage system'described below is not installed within 36 months from date of issue. 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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by is .. - ...:.:�;�,,'i •. ... - Certificate of Completio 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. 1. Permit F 2. Address APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section cc SID P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 3. Property Owner if Different than Above Address Home Phone 9919- IS'Z94 Business Phone 4. Permit To: a) Installer Alter Repair b) Privy Conventional Other Type — Ground Absorption I c) Sub- Division �'%��4 r � Lot No. 5. System used to serve what type facility: HouseM� obile Home Business Industry Other b) Number of people D_ 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 6( X .2—L 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 urinals lavatory showers dishwasher / sinks —� 8. a) Type water supply: Publicy Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions garbage disposal washing machine 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. Date Owner SigdAture OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) zr& DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 --� \ SOIL/SITE EVALUATION Name �'����� �Q ` \ Date—3 Address Lot Size E FACTORS ARE1 A 1 ARC AREA 3 \ ARFA d 1) Topography/ Landscape Position S S t u— PS S PS U ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) APS S PS U U 3) Soil Structure (12-36 in.) CIgm Soils �� U S PS U y Soil Depth (inches) (� S PS U U i) Soil Drainage: InternalS PS% PS U U U External S P S PS U U �) Restrictive Horizons Available Space p PS PS7 —LT S PS U Other (Specify) S PS S PS S PS S PS U U U i) Site Classification kj C U—UNSUITABLE Recommendations/ Comments: Described by _ SITE DIAGRAM DCHD (6-82) S—SUITABLE PS—Provisionally Suitable '%..- _ 11—!�L - \'Ta\_ lz� Title Date Davie Courtly Nealtl De ar tment and Noire fiea �yency 210 HOSPITAL STREET / P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634.5985 March 18, 1988 Dr. John White Box 684, Bermuda Ruri Advance, NC 27006 Re: Site Evaluation Greenwood Lakes Corner of River Rd. & Lakeside Dr. Dear Dr. White: On March 17, 1988, as you requested a representative from this office visited your site and found the soil provisionally suitable for the installation 'of a ground absorption sewage system. If you have any questions, please feel free to contact this office. CL/wd Enclosure Sincerely, Charles E. Little, R.S. .Environmental Health y. v rDavie County .wealth' De artment and .dome .fiealta Ay en cy . 210 HOSPITAL STREET/ P.O. BOX 665 ` MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 April 24, 1989 Potts Realty Attn: Diane Potts P. 0. Box 11 Advance, NC 27006 M Re: Sewage System Installation Greenwood Lakes Corner of River Rd. & Lakeside Dr. Dear Realtor: The septic tank system that serves this residence was designed, inspected and approved by this office on April 19, 1989. RH/wd With proper maintenance and use' it should function properly. Sincerely, / Robert B. Hall, Jr., R.S. Environmental Health Section V