P3394 Wood Valley Lot 18r
r +`
,r DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION p
'"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 yr;� r ; f• %�f Date`s "I
i
Location
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 ❑
Specifications for Sy tem:
Auto Dish Washer
YES NO
�'":/'
Auto Wash Machine
YES E]NO E]
!J
Type Water Supply
z'e _—
b
`This permit Void if sewage system described below is not installed
within 36 months from date of issue.
Y -
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:
v
System Installed b-
<'�
Certificate of Completion Date -
*The signing of this certificate shall indicate that the system dnb� aboveeschas been installed in compliance with
the standards set forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function
satisfactorily for any given period of time.
�� '• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
�;c�oo�/vA/fie
Name Date
Address Lot Size
FACTnRR ARFA 1 ARFA 2 ARFA 3 ARFA d
1) Topography/ Landscape Position
S
S
(to
&
PS
PS
U
U
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, 2:1 Clay)
b
S
PS
S
PS
(note
U
U
U
U
3) Soil Structure (12-36 in.)S
Clayey Soils
&
--d35
PS
S
PS
U
U
U
U
1) Soil Depth (inches)
S
S
S
S
PS
PS
U
U
U
i) Soil Drainage: Internal
S
S
ZPTS,
S
PS
S
PS
(!9>1
U
U
U
U
External
�
C
A
PS
PS
Ute'
U
U
U
1) Restrictive Horizons
Available Space
S
S.
S
S
PS
PS
U
U
U
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Site Classification
U—UNSUITABLE S—SUITABLE fS=Provisionally Sui#ble
Recommendations/Comments:
Described by Title ��'� Date
SITE DIAGRAM
DCHD (6-82)