2318 Hwy 601S/
DAVIE COUNTY HEALTH DEPARTMENT /00N
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit_ Number
Name / /, , Date
Location
l
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ f Business Speculation
No. Bedrooms No. Baths T— No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
'Auto Dish Washer YES p NO ❑
Auto Wash Machine YES p NO ❑ �/,
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit byA—'4 / L
*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 S}rIF610-ArJ �vNN
Certificate of Completion s 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.
j
i
i
f
I
i
z
Improvements permit byA—'4 / L
*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 S}rIF610-ArJ �vNN
Certificate of Completion s 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.
1
-' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
J
Name Date
Address Lot Size
CAt�'MDQ AREA i AREA 9 APFA A APPA A
Topography/ Landscape Position
S
S
PS
PS
PS
PS
U
U
U
U
!) Soil Texture 12-36 in.) Sandy,
Loamy, laye ote 2:1 Clay)
S
a
SS
PS
S
PS
U
U
U
I) Soil Structure (12-36 in.)
Clayey Soils
S
S
<M�
S
PS
S
PS
U
U
U
U
G) Soil Depth (inches) y����
SSS
�S�
PS
S
PS
S
PS
PS
U
U
U
U
Soil Drainage: Internal
S
pS4P
S
PS
S
PS
U
U
U
External
0
<97
S
S
PS
PS
PS
PS
U
U
U
U
i) Restrictive Horizons
') Available Space
�S�
PS
PS
S
PS
S
PS
U
U
U
U
3) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
,O
t) Site Classification
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS—Provisionally Suitable
Described by ',41 / Title Date
SITE DIAGRAM
6
DCHD (6-82)