157 McDaniel Road Lot 9�. 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 C'A170 e c. E£_" �i Date _�`� -E�� 305$
Location vLZ e"L? 7-z f=
Subdivision Name 5E-41- j L Lot No. 9 Sec. or Block No.
Lot Size inti <X >i rzaj House L Mobile Home — Business Speculation
No. Bedrooms 3 No. Baths z No. in Family
Garbage Disposal YES ❑ NO p, Specifications for System: /dZzj �./J i^
Auto Dish Washer YES p- NO ❑ ,
Auto Wash Machine YESNO r-1
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Type Water Supply
*This permit Void 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 Installation Diagram:
System Installed by
Certificate of Completion • � (J-� / %A`v Date ?-L�
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 systern will function..,.
satisfactorily for any giw
ven,period of time:
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Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
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Date 5n ��
Lot Size �rea;2a2
PAr`.Tnoe APPA I ARFA 9 ARFA R ARFA d
Topography/ Landscape Position
S
S
S
PS
PS
PS
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Claye note 2:1 Clay)
PS
PS
PS
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
" >
PS
PS
PS
U
U
U
U
Soil Depth (inches)
S
S
S
S
%U
PS
PS
PS
U
U
U
Soil Drainage: Internal
S
S
S
S
PS
PS
PS
U
U
U
U
External
S
S
S
S
-�j
PS
PS
PS
U
U
U
U
i) Restrictive Horizons
NN�
') Available Space
S
S
PS
S
PS
S
PS
fC,
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
I) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments: �d
Described by Date
SITE DIAGRAM
a63
�s
L Z7 p
DCHD (6-82)