P2843 Pine Ridge RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Namet �% Date ,!�-��.�/ 2843
Location
Subdivision Name Lot No. Sec. or Block No
Lot Size House -- Mobile Home — Business Speculation
No. Bedrooms � 2 No. Baths ,! No. in Family
Garbage Disposal YES p NO p Specifications for; System:
Auto Dish Washer YES Q NO
Auto Wash Machine YES p NO p
Type Water Supply _— -
*This permit Void if sewage system described below is not installed,nrithin` 36 months from date of issue.
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
Ste-' �t ' � �� rr-�=` � W •
Certificate of Completion`
}id 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.
DAVIE COUNTY HEALTH DEPART'HENT
ENVIRONMENTAL HEALTH SECTION
SOIL/SITE, EVALUATIOU
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ADDRESS
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DATE
LOCAT IO:4
LOT SIZE /
TOPOGRAPHY:
SOIL TE;,,.TURE :
SOIL STRUCTURE
DEPTH:
RESTRICTITPE HORIZOFS:
PERCOLATION RATE:
1.
2.
3.
Presoak
l'iark & time
Dr
Tim
Fate ihn. Inch
***CLASSIFICATIOY1:Suit2ble ��Prov�ision�ally�Suita�bl Unsuitable
COMMEYTTS :
SARITARIATI
SITE DIAGPIAM