P3397 Angell Rd- DAVIE COUNTY . HEALTH DEPARTMENT
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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 1 O .1934-.19 8)
Permit Number
Name �,�i` Y, , %����,"�•,;•" Date
3391
Location
r /
Subdivision Name Lot No. Sec. or Block
No.
Lot Size /r( House �` Mobile Home _ Business
Speculation
No. Bedrooms _L,7,_ No. Baths Z No. in Family
Garbage Disposal YES ❑ NO [.)-'
Specifications for System:
Auto Dish Washer YES T NO ❑
Auto Wash Machine YES NO ❑
�; ,-
/ Cl �� ,,
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
�. .�.�,*a= ,•u�> ,mac=, ��.� (� .•tG
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
Coca/
S..r
Certificate of Completion �� Date
N - ,
'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.
T DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name s�/, �L� Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/ Landscape Position
�)
�S
rte/
��----LST
S
S
PS
S
PS
U
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
S
j
S
PS
S
PS
U
U
3) Soil Structure (12-36 in.)
Clayey Soils
S
�
S
S
PS
S
PS
U
U
I) Soil Depth (inches)
S
S
S
PS
S
PS
U
U
Soil Drainage: Internal
S
I-AKU
S
CT
S
PS
S
PS
U
External
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Restrictive Horizons
Available Space
S
S
PS
S
PS
U
U
U
U
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
6)
S)
9) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
Described by _
SITE DIAGRAM
DCHD (6-82)
S—SUITABLE PS—Pro, visionally Suitable_
Title - Date
in