121 McDaniel Road Lot 4DAVIE COUNTY HEALTH DEPARTMENT
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
S,ew�ge•Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name t/���/ liz�� - Date 4004
Location -.
Name Lot No. _
--7
Lot Size House Mobile Home _ Business
No. Bedrooms No. Baths r:2— No. in Family
Garba a Dis osal YES NO
Speculation
g p ❑ ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑f2^0xr/vg' ,
Auto Wash Machine YES ❑ NO -E)� �`L�C./
Type Water Supply
*This permit Void if sewage system described 4e1ow is rtotnstalled within 36 months from date of issue.
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.
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 � r%�, r ��v Date4004
Location
Subdivision Nan
or Block No.
Lot Size i�� House Mobile Home _ Business
No. Bedrooms _ No. Baths c�2— No. in Family L
Garbage Disposal YES ❑ . NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO p���
Auto Wash Machine YES ❑ NO ❑ �(
Type Water Supply
*This permit Void if sewage system described low is not installed within 36 months from
Improvements permit by
Speculation
*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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:(Issued in Compliance wi6G.*S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ('oh SkcL4� Date s-- 7-9 - kr 3933
Location
Subdivision Name 'Se div o P; , I A Lot No. 4 Sec. or Block No.
Lot Size
House Mobile Home
No. Bedrooms 3 No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑
Auto Dish Washer YES ❑ NO 0
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
Business Speculation
Specifications for System: i atm /9'= `--
b--6,Y
--
D-'3,Y - 7- VZ; X 3'i- 1 8'' k
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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:
r
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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION i
*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 Cnk\ Slxc Cd n- Date 3933
Location
Subdivision Name _S .dr, r, i,Q Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms_ No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System: i azJo `tom. P^ e -
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO •❑ D -Zi - Z VZ) X s'fi
Type Water Supply C —
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 compliarice 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 �/Jl�:✓%//�/'e � A6ire-5 -- Date
Address /�/O �3�Y Lot Size
FACTORS
AREA 1 AREA 9 AREA 3 AREA 4
1) Topography/ Landscape Position
3)
d)
5)
�)
8)
9)
S
S
S
S
PS
PS
PS
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)S'�
PS
PS
PS
�
U
U
U
Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
PS
PS
PS
U
U
U
Soil Depth (inches)%
S
S
S
PS
PS
PS
PS
U
U
U
U
Soil Drainage: Internal
S
S
S
S
pS
PS
PS
PS
U
U
U
External
S
S
S
S
PS
PS
PS
U
U
U
Restrictive Horizons
�Z6�e
Available Space
SS
S
PS
S
PS
S
PS
U
U
U
U
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Site Classification
-5
U—UNSUITABLE
Recommendations/ Comments:
S—SUITABLE PS—Provisionally Suitable
Described by1� Title ��� Date Zzld�-"
SITE DIAGRAM
DCHD (6-82)