1472 Jericho Church Rd ..,i..,^--,•-r_ .., ,.q.+-».v.;.+r��s+va,-y�.�aw+rs}s�rM'+('-,r'vHa�iT..,w""'.r'y�v++a^^"�'th7ti,-rw,..Jarv..-...r�°.'.w-�w�,."'^'4".-��v-.,..,.. s»�..
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF-COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
anitary,55wage ystems Y.`� Permlt Number
Name- /iif //iv /ice Date N2 70,23
Location
Subdivision Name �/`�C S Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business _- Speculation
No. Bedrooms �� No. Baths _�- No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma^.hine YES ❑ NO ❑ YS
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
A
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
Certificate of Completion 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.
,. .... ,��,: � .�. .-y,„r�a 4* ,:.+s '°:' ... 'p �'"Y.J� , C-�,...� �w:y.-`•;,r,.tia�. .! y»i-s:.>:�..--+P`.tSt ,y.,,-•`e r t
/J"/^ � 4 F., !.5 �Cft � t`? GI. f�.y >Z. :} 7 k,.`f1 '}•S.i... �A
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF 'COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
anitary,�wage ystems `1"•1 Permit Number
Name iso li i�> 7`� a,6; //��r/ // Date CM/.� NO 7023
Location —
Subdivision Name `—��f'�i`a r'' '� Lot No. Sec. or Block No.
Lot Size Housey Mobile Home Business -- Speculation
No. Bedrooms �� No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto.Dish Washer YES ❑ NO ❑ /Cy Y; - e
Auto Wash Ma^hine YES E3 NO ❑ /
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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—
}
Certificate of CompletionDate
"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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*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—ti`�- f .t, a Date
Location ar _
Subdivision Name Lot No. ____L Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation•-
No. Bedrooms —_ No. Baths _ No. in Family _
Garbage Disposal YES ❑ NO p Specifications for System:P Y 147L1U �. �.,....r_
Auto Dish Washer YES ❑ NO �-
Auto Wash Machine YES p NO -❑
Type Water Supply ` _—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
C aGv
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
�l
I
Certificate of Completion 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.
DAVIE COUNTY HEALTH DEPARTMENT Ga 4�1 `'t;Sh43
Environmental Health Section 1" I
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name -Zqu,E Date 10 - IS-
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S S
e� PS PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) a PS PS
U U U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils �- - PS PS
U U U U
4) Soil Depth (inches) S S S
Azf�t§ - PS PS
U U U U
5) Soil Drainage: Internal S S S S
�_ - PS PS
Uv U U U
External S S S
PS PS
U U U U
6) Restrictive Horizons
7) Available Space S S S S
<:� PS PS
U U U U
8) Other (Specify) S S . S S
PS PS PS PS
U U U
9) Site Classification !�'XI r
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title Date q-I0
SITE DIAGRAM
x
x�
DCHD(6-82)