1500 Jericho Church Rd ` 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 �. t t I, Date 4 N-. - 4 r32
Location —
Subdivision Name Z77- 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: 1or.,
Auto Dish Washer YES ❑ NO ❑.�
Auto Wash Machine YES NO ❑
Type Water Supply 6 " },---1 __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
------------
r
f
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. Te ephone Number: 704-634-5985.
Final Installation Diagram: Syste Installed by �� —,r
$G
Certificate of Completion dz-'e 4 164'—,Date 42
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT Lot 04
Environmental Health Section 1Le' '4'
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Av'�e amu:\�la� Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position - � 1& S S
PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) Z!� PS PS
U U U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils lEf� 123�—S> PS PS-
U U U U
4) Soil Depth (inches) S S S S
�- <Z PE PS PS
U U U U
5) Soil Drainage: Internal S S S S
PS PS
U U U U
External S S S S
® PS PS
U U U U
6) Restrictive Horizons
7) Available Space S S. S S
PS PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U Up U U
9) Site Classification 101- T-f
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title '�� Date
SITE DIAGRAM
V _.
4
DCHD(6-82)
1
1eIC MATY MAP �
ED Tait•M: - r-
J►!A TO COM FLY 0
IMTION.$ EXCEPT -
VA LIATION.FOR $ - ` SS• : �� ••' .
ALi111:TX!l l_AUD_FOR
THE MiB1TTEM REPORT ON N 7.
PARii EM% - t•/ 4 -w �✓�` n"G" -:�a:�+._ as' y_ _,
A34T-THIS CERTIFICATE DOES s. - •A= t te r ' k�
TUT APER"
AJ.' l tiT� stip Vt IOti2 1 ' ,jg: `"q `e:K- =>�•�1r'=::;SYt,�: s 4• .X.R e. T p -
ALLATION OF -
t• L 4 '0,�k, fe'j+ '��,T-:•� ��� � w�-7- sf��{••4y1'=""tris" yf`;e•:•„'y`L'3'.�: 4 'F*' _
• 93 f: `' hy-��• `, �% sic`,-- �xxc ti ,�a , .
DAVE COUNTY HE
OFFICER co 0
�i� %•iJ is r. In 7. / h►�,`!y l
46,
CONTROL
CORNERstone- �• \� " \�� 1`, r i,,
.••-nf'w4i^+�- iAiirLi'�.�r'i-s^�* :u::�-r .R �'r�. O _ � S`; !• ::� �`. /� y1 ^✓_ - ='''i`
. . .- .. ..l[ +.���?' '+'s-.-Vii•>�., � �+':+:r."r:: Q. gr:rfr,•e,`,xv:2 � y - �'....f.-- .,t �. - ,;,_,•,, _ •-••, -�•
'S - ___ -- _�•. ! •t-T /� -'�„'w.'f'.�5:�.,•. -`r�r�'C!��'+•Ds1.tfy� ��•' '�1 d. .TL-'. '!`✓i..� -� �� -+_ :t � il•s-�.'�.'s
�N - - r- '� :` "r- � � "" -,` -,•� z+e.`.:iy ....:�``t-t�r2�>�p�i•: -ikts..� s,��'c�.a.•-r..•.o`4`•,a-a-' ��p.��� �,+r�e[.
t a`
EVERETTE ii. F3RrJ''Mii �.. - -'wtC'-' ,[,� h: �..� _� �,s+ -• •'i T-. `'' .c'
NOTAL AREA i
TAt DS AS • PG 661410 p Id•SUB~QIVISIC3I
y, =
No 'S7 ~- !'� /r .y0 P'p 2.605 ACRES
_ .. ''r-`y�w••,.t=.�.,�,s�,�..e•-�.�4� 4�r.. .-s-�:h; N, ._d � � `1Yr�� .,/ ' �l - , '
2.
i61, b y ,o
APPROVES. W r
fln
-- - o
.NTNG C.OARC O 1 d' -
_ JERIC.HO HEIGHTS
• lb
Pr190erk 1;' ,.Y,r•"+•.w•,'�,'i !"' ��.�C- +r y`i" •'.r .T"'. Iia.✓ r't..-'-�.i1 `i ,F-•l. A� . '�-.
�RTH <OWNER DEVELOPER: ,.
APPROVED
� ! � �• \ �J ��1�'• F? �'i{"`*�r.^e,+•.t6 .�t ��..�•..�s�•?�'rY.:�.?:' +is•,-_t••.. •,...�:• �+.%�uw:t�h''' � v.��n'�_ F�2•••i' 4`i�i'�S�v'� .
•'R FECORDMG `l �•��;a,n� �: , . ,5gy } _ .. DAViE . BUILDERS INC.
Or DAVI_ 9
SAO y' _ -
_ ,'� ' S �• - SALISBURY ST.- MOCKSVILLE; N.C-
�110CKSViL-LE`TWSR DAVIE CO. r
coNTao� q2 A3 - LEGEND --
coaNEa s e. EXISTING IRON. PIN NORTH CAROLINA
•^ OP;P:PIACEO IRON PIN
— a:_ NEW IRON PIN 50 0 50 100
r _ +.: POINT t
1.