P4289 Indian Hills `co .;r.Z ..»r
DAVIE COUNTY HEALTH DEPARTMENT
- 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— •� �; /r� =ter J Date //-'.,�r' �/'✓ �?rt.' 12
Location.. .
Subdivision Name JMattaAg Lot No. _ Sec. or Block No.
Lot SizeC House ��r Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths 4— No. in Family _
Garbage Disposal YES ❑ NO ❑ i
Specifications.,fol System:
Auto Dish Washer YES ❑ NO ❑ C .�
Auto Wash Machine YES ❑ NO ❑ �/����
CJ
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
t �
T"1
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
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.
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y = DAVIE COUNTY HEALTH DEPARTMENT
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) l Permit Number
Name � � :�,� %�y r— ,,;-�' Date
Location_. '`� .r ' -1/ 'f=,, �` ---' ;y. i ✓ '/,! ��.71 -
Subdivision Name Lot No. Sec. or Block No.
Lot Size House L''� Mobile Home _ Business Speculation
No. Bedrooms ? -- No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ r
Specifications. for System:
Auto Dish Washer YES ❑ NO '❑ ! =�
Auto Wash Machine YES ❑ NO ❑ J _. ;
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
----------
Improvements
_.-_-____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
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.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
D
Nzme �/l'' � Date
Address Lot Size ��
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
A) PPS PS PS
U U U
2) 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 S
Clayey Soils P PS PS
U U U
4) Soil Depth (inches) S S S S
PS PS PS
U U U
5) Soil Drainage: Internal S S S S
PS P PS PS
U U
External S S S
p PS PS
U U
6) Restrictive Horizons
7) Available SpaceS S
PS CVS PS PS
U U U U
8) Other (Specify) S S
PS S PS PS
U U U U
9) Site Classification ,
U—UNSU BEE S—SUI BLE PS—Provisi na/lly Suitabl
Recommendation Comments: • C'�� �a �' a� ����"� �'���/K Un
Described by ' `� Title ��!'� Date ?Z-
SITE DIAGRAM
DCHD(6-82)