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196 Grover Rd (2) 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 .19 4-.1968) qq Permit Number Name 3 r� " /�" O �i ( Irk �k�(L�A� Date fi`�; 3386 Location GLI f.A 5'r �T ZTJ 1 v2n�.--nuc /s' D�rL T A Subdivision Name Lot No. Sec. or Block No. Lot Size L House Mobile Home _ Business Speculation No. Bedrooms No. Baths_ _ No. in Family Z= Garbage Disposal YES ❑ NO [.' Specifications for System: /a00 �— Auto Dish Washer YES NO ❑ i 4 Auto Wash Machine YES j NO ❑ ,300 X 3 X l2 $'fin Type Water Supply cry uH r, _ - 3�x �,-• iii-.cwt 6 *This permit Void if sewage system described below is not installed within 36 months from date of issue. Im rovements permit b *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 byCLlj':F +IANC I Certificate of Completion-- Date - 2 *The signing of this certificate shall indicate that the system descrified 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 �� WC��- 1�1y1 Date Address 3!0 Lot Size -� AAOCt=Soiu_�_ NC- 2-7-7o FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S y PS PS U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS S b © U U 3) Soil Structure (12-36 in.) S S ID Clayey Soils PS PU 4) Soil Depth (inches) S S S S WS PS (PS U U �T 5) Soil Drainage: Internal S S PS PS PS PS U External S S S S S S PS PS [UU U U NO T 0E , 6) Restrictive Horizons �7Piz,?z-h� 7) Available Space S S. S S PS PS PS PS U U 8) Other (Specify) S S S S PS PS PS PS U U 9) Site Classification �- U—UNSUITABLE S—SUITABLE PS Provisionally Suitabl Recommendations/Comments: Described by Title Date SITE DIAGRAM o n' M zo DCHD(6-82)