405 Pineville 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 .1934-196 ) Permit Number
Name %� �./ ,� -r:s/�f Date _ 1, f)' n 3718
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms �---� No. Baths No. in Family
Garbage Disposal YES p NO Ej' Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES Q NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
l{�
S
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
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
Environmental Health Section
P. 0. 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 S
PS PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) !PP PS PS PS
U U U U
3) Soil Structure (12-36 in.) S S S
Clayey Solis & PS PS PS
U U U U
4) Soil Depth (inches) S S S
PS PS PS PS
U U U
5) Soil Drainage: Internal S S S S
PS PS PS
U U U
External S S S S
PS PS PS PS
U U U U
6) Restrictive Horizons
7) Available Space S. S S
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 P-�)
U—UNSUITABLE S—SUITABLE CP9�Provisionaliy Suitable
Recommendations/Comments:
Described by / . % TitleDate
SITE DIAGRAM
P
DCHD(6-82)