355 Hwy 801N t_y DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c fE
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name .��% 'i / V��,4�%�� Date 72/,?
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date ��
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position — S S S
PS " �� PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) P PS PS
U U U
3) Soil Structure (12-36 in.) �S --� S S
Clayey Soils _ �� PS PS
U U U U
4) Soil Depth (inches) S S
PS PS
U U
5) Soil Drainage: Internal S S S
PS 5 PS PS
U U
External S
D pS PS
U U U U
6) Restrictive Horizons
7) Available Space S. S S
PS PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification /• _
U—UNSUITABLE S—SUITABLE PS—Provision
Recommendations/Comments:
Described by Title —� -�'� Date
SITE DIAGRAM
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DCHD(6-82)