1336 Davie Academy Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Y
Sanitary Sewage Systems Permit Number
Name Dat - N 0
Location
6 763
frr'/ r�j� r' :.>,ti' 4 �
11
y"
Subdivision Name Lot No. Sec. or Block No.
Lot Size—S House 1�r Mobile Home Business __ Speculation
No. Bedrooms ___, _.No. Baths .:.—F— No. in Family _
Garbage Disposal` YES,❑ NO p Specifications for System:
Auto Dish Washer YES NO ❑ ,, , �y.
Auto Wash Ma shine YES 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.
•SI
Improvements permit b
y
*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: I ys e'm nstalled by
1
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
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date ,ZZL4:Z&
Address LotSize
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position
PS _P'S PS S
U U U U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay) P C�
> U U U
3) Soil Structure (12-36 in.)
Clayey Soils 4PUP
U
4) Soil Depth (inches) _S� S_
S PS
U
5) Soil Drainage: Internal S
PS S S �,
External S � S
C�
6) Restrictive Horizons
7) Available Space �S
'–PS (VS. PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification -4u�
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by_���� �, Title � ►Z Date � y
SITE DIAGRAM
Z
DCHD(6-82)