4148 Hwy 601S DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* ote:.Issued i Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date .' - �,' 2 8 S
Location
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House �/ Mobile Home _ Business Speculation
No. Bedrooms -> No. Baths Z No. in Family
Garbage Disposal YES 0- NO ❑ Specifications for System:
Auto Dish Washer YES Ef NO ❑ _ J�
Auto Wash Machine YES El NO ❑
Type Water Supply
his permit V id if sewage system described below is not installed within 36 months from date of issue.
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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 Installati n Diagram: System Installed by
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Certificate of Completion Date - "
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*The signing f this certificate shall indicate that the system described above has been installed in compliance with
the standard 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 COUVTY HEALTH DEPARTIi UT
EPIVIRONISENTAL HEALTH SECTION
SOIL/SITE EVALUATION
VAIME lr (Zy e w . DATE 5�- 3 Z
ADDRESS ) 3/S
LOCATION Al-
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LOT SIZE.
TOPOGRA HY: t'S
SOIL TE ,.TURF:
SOIL ST UCTURE:f' /
DEPTH: 3t in
RESTRICTIVE HORIZONS: 3 � %� `�"` /ijee-
PERCO ION RATE: Presoak Mark & time Drop Time Pate Iiin. Inch
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2.
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D;.Ij 3.
0-� .-I-CLA SIFICATIOP?:
Suitable Pro sionally Suitable Unsuitable
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SANITARIAN (Y\1,,,, L
SITE DIAGF.AM
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