P4990 Hwy 801S1Q
DAVIE. COUNTY HEALTH DEPARTMENT L '
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 Date
Location ?� O s.�- -� �. \. �� �r.x- =c ` �� �. �� Ci 1
Subdivision - Name `'"Lot No. Sec. or Block No.
Lot Size— House - Mobile Home ✓ Business Speculation
No. Bedrooms No.''Baths= No. in Family_
Garbage Disposal YES ❑ NO
'IN Specifications for System:
Auto Dish Washer YES ❑ NO {q
Auto Wash Machine YES Ep/1 NO /F]' �0 �: 4
Type Water Supply__—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
r
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 = �–
V i� z
Certificate of Completion �' Date U�
'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. .
I>avie (oz rrty Jfealtj I7ye
artmenf
and .kine Xealb ncy
210 HOSPITAL. STREET / P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
October 30, 1987
Betty Potts Realty
Rt. 3, Box 332
Advance, NC 27006
Re: 2 Site Evaluations
State Road #1620
Dear Realtor:
On October 29, 1987, as you requested a representative from this office
visited your site and found the soil provisionally suitable for the
installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health
Enclosure
1
RH/wd
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size
FArTr1RS ARFA 1 ARFA 2 AREA 3 ARFA d
1) Topography/ Landscape Position
S
S
S
PS
PS
PS
U
U
U
?) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
U
U
U
3) Soil Structure (12-36.in.)
S
S
S
Clayey Soils
PS
PS
PS
U
U
U
1) Soil Depth (inches)
S
S
S
S
PS
PS
PS
U
U
U
�) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
U
U
U
External
S
S
S
S
PS
PS
PS
U
U
U
�) Restrictive Horizons
Available Space
S
S
S
S
S
PS
PS
PS
U
U
U
U
Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Site Classification
f
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments: D
i
Described by
SITE DIAGRAM
\ DCMD (6.82)
Title �,�,Q�v Date AlK7
cis/��/s
10111, P