2888 Hwy 801N (2)l' z DAVIE COUNTY HEALTH DEPARTMENT ,,DI
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatme t and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
a/
Name / - �f % F j Date 4281
Location �'f � ` �� �� �` .�: r % -�• -�'� % - �'t' — � �� ��/ G'-'� !'�/�..
Subdivision Name Lot No. -/ Seca or Block No.
Lot Size`-=?'P'i//C_� House Mobile Home Business Speculation
No. Bedrooms `�� No. Baths No. in Family
Garbage Disposal YES p NO Ell' Specifications for 5ystem:
Auto Dish Washer YES g NO ❑ ,-ri f' ,` %' '- ry
Auto Wash Machine YE$ NO ,E]
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
7
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-J��
Final Installation Diagram:
Syst m -I n
Certificate of Completion 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.
l/
Jame
ddress
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
FACTORS AREA 1 ARFA 2
Date 1
Lot Size
AREA 3 AREA A
I
Topography/ Landscape Position
S
S
S
S
Pr"
P
S
051U
_
Soil Texture (12-36 in.) Sandy, -
%
s
.S
S
$
Loamy, Clayey, (note 2:1 Clay)
PS
PS
SS
�
u,
U
Soil Structure (12-36 in.) t
Clayey Soils �,
S
PS
S
PS`
S
PS
S
Soil Depth (inches)
S
S
S
S
PS
Cup
PS
PS
�,
G
Soil Drainage: Internal
S
S
S
S
UPS
�,�
;
External
S
S
S
S
S_.
PS
Cw
_PS
u
Restrictive Horizons
Available Spaced
PS
PS
ITS
S
-- ._. _�g•`
U
U
U
U
Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
Site Classification
U—UNSUI B
ecommendations/Comments:
ascribed by
TE DIAGRAM
r� D
�� Jae
f
S—SUITABLE �PS—Provisionally Suitable
HOlh 92)