131 McDaniel Road Lot 6DAVIE COUNTY HEALTH .DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 136
Sewage Treatment and Disposal Rules (10_ NCAC 16A .1934-.1968) Permit Number
Name (r, \,,,;, i \d, s Date °� 'f -ks �� 3994
Location
Subdivision Name
Lot No. Seca or Block No.
Lot Size
House
Mobile Home _ Business Speculation.-
peculation.
No.
No. Bedrooms
No.
Baths
(z
No. in Family
Garbage Disposal
YES
❑ NO
0,
Specifications for System:. 1000 qo . F`^
Auto Dish Washer
YES
p- NO
❑
- K y •. ��
Auto Wash Machine
YES
Ej NO
❑
Type. Water Supply
--
*This permit Void if sewage system described below is not installed within 36 months from date of issue
*Contact a representative of the Davie C
9:30.A.M. or 1:00-1:30 P.M. on day of
Final Installation Diagram:
Improvements permit by
Department for final inspection of this system between 8:30 -
Telephone Number: 704-634-5985.
i
Certificate of Completion
"The signing of this certificate shall indicate that the system describe above has been installed in :compliance with
the standards set forth in the above regulation, but shall in NO way betaken as a'guarantee that the system will function
satisfactorily for any given period of time.
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size Za22(1212r-
10
FAr:Tr)RR Int AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/ Landscape Position `t��is6;N
S
PS
S
PS
S
PS
S
PS
Z�P�e6
�/
d °
U
U
U
?) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, note 2:1 Clay)
ct>
PS
PS
PS
U
U
U
U
I) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
��S --
�
PS
PS
PS
U
U
U
U
Soil Depth (inches)
ep-��
S
S
S
IT
PS
PS
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
U
U
U
External
S
S
S
PS
PS
PS
U
U
U
i) Restrictive Horizons
Available Space
S
S
PS
S
PS
Is
PS
qP
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title �h� Date
SITE DIAGRAM
RM
DCHD (e-82