1895 Hwy 601S 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
rp. --
Name_- Date ' -
Location
a
Subdivision Name Lot No. Sec. or Block No.
Lot Size 112--F" House _!-/ Mobile Home _ Business _— Speculation
No. Bedrooms No. Baths i No. in Family___I
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO [}.
Auto Wash Machine YES g- NO ❑ - �'"� ,K
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
------------
Lit yv
f1
i
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(Tn o, nn
N11' ,U
ro')�"� j
1 z
Certificate of Completion Date
*The signing of this certificate shall indicate that the system describedjabove 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.
r
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name �'� Date b
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S . S S
dD PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) (—CT-S) PS PS
U U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils � Ps� PS PS
U U
4) Soil Depth (inches) S S S S
i U `�15 PS PS
-r
� ` - U U
5) Soil Drainage: Internal S S S S
4?— '" PS PS
U U U
External pS PS
U U U
6) Restrictive Horizons
7) Available Space S S. S S
PS PS
U U U
8) Other (Specify) S S - S S
PS PS PS PS
U U U U
9) Site Classification
U—UNSUITABLE S—SUITABLE 'PS—Provisionally Suitable
Recommendations/Comments:
Described by ^^ " Title �.�[r `"�`�'' Date
SITE DIAGRAM
�2
� 1
F
DCHD(8-82)
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 07NT-1- T4w%GS' Date N2 402
Location fools- T. 1eF4. ",L, ata LA, d.
Subdivision Name Lot No. Sec. or Block No.
Lot Size i'Z House ✓ Mobile Home _ Business Speculation
No. Bedrooms 2'• No. Baths I No. in Family i
Garbage Disposal YES ❑ NO 2-
Specifications for System: t0004Cam•
Auto Dish Washer YES E] NO 8-
Auto Wash Machine YES 2-- NO ❑
Type Water. Supply Cu--t!M
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
F
Improvements permit by M"n
*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
npoLt5e—
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.