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154 Ginny Lane Lot 18DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in'Compliance with G.S. of North Carolina Chapter 130 Article 13c Name Location Sewage TreatmeAt and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number . Subdivision Name S Lot No. ,n" 4157 Lot Size ,/ ��i r" House L/ Mobile Home — Business Speculation No. Bedrooms �_ No. Baths 2_ No. in Family Garbage Disposal. YES ❑ NO Ca' Specifications for System" Auto Dish Washer YES NO E] c�%• r Auto Wash Machine. YES �j NO Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue 'b Improvements permit byi�i`/ *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 r 'vD Certificate of Completion > �_ Date Ila, *The signing of this certificate shall indicate that the system described above has been installed in compliance with: thestandards 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 CAJ 6c,, Date Address Lot: –2 -_S -r FACTr1RR - ARFA 1 - ARFA 2 AREA 3 ARFA d Topography/ Landscape Position 2) d) 5) �) 4) C�5 S S S PS PS PS PS U U U U Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) S PS PS PS U U U U i) Soil Structure (12-36 in.) © S S. S Clayey Soils PS PS PS PS U U U U Soil Depth (inches) © S S S PS PS PS PS U U U U Soil Drainage: Internal S S S PS PS PS PS U U U U External S S S PS PS PS PS U U U U Restrictive Horizons Available Space S S S S PS PS PS U U U i) Other (Specify) S S S S PS PS PS PS U U U U Site Classification U—UNSUITABLE CS—SUITABLE% PS—Provisionally Suitable Recommendations/ Comments: Described by 777 an e S' Title Date SITE DIAGRAM 0 b DCHD (6-62) 06