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990 Yadkin Valley Rd Lot 1 DAVIE COUNTY HEALTH DEPARTMENT I - 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 (1,0 NCAC 10A .1934-,1968) / 'Permit Number'` • . :Name r .,` :�%�t�. r�'%f�-'cr` Date /©� �. 4 ,�'�• Qp /� o. . ..Location Subdivision Name Qi Lot No. Sec. or Block No. Lot Size House'; y� Mobile Home _ Business _— Speculation No. Bedrooms' —'No. Baths A� - Noi in Family = Garbage Disposal YES E NO Specifications for System: Auto Dish Washer j YES NO � Auto Wash Machine YES NO 0 ', / Type Water Supply . 00',Ci l { ' "This permit Void if'sewage system described below is not installed within 36. months from date of issue. : yt 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 , 1 Certificate of Completioni Date 'The.signing of this certificate shall l'indicate that the system'.described above has been installed in compliance with the standards set forth m;the aboveregulation; but shall in NO way be taken as a guarantee that the system.wiII'function . y satisfactorily for any given period of times� 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-.1968) Permit Number Name - ` l ;'%'/_ Date ��` /-�� t �. e Location _ Subdivision Name ' r(i -i�✓r Lot No. / Sec. or Block No. Lot Size House Mobile Home _ Business __ Speculation No. Bedrooms — No. Baths No. in Family Garbage Disposal YES ❑ NO 17r Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Machine YES T NO ❑ ' / c+ ,-. ,:� '/ c 1` Type Water Supply ___ *This permit Void if sewage system described below is not installed within 36 months from date of issue. f 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 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 r%d/l�jf/f�� Date A��-5�� Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position�� ., S S �P$J PS PS 2) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) PS P PS PS U U U 3) Soil Structure (12-36 in.) S S Clayey Soils PS PS PS dtip U U 4) Soil Depth (inches) � S S p P,SJ PS PS U U U U 5) Soil Drainage: Internal S S PS PS PS U U U ExternalS S PS (iP5% PS PS U U 6) Restrictive Horizons 7) Available Space � S S PS PS 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—Provisionaliy�uiiatale Recommendations/Comments: Described by— Title Date �d SITE DIAGRAM � 1 I'2 DCHD(6-82)