3038 Hwy 601N 1 "
` - 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 ':: - • ,��. ic- a _/ Date �'�'�' 4971
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 Q
Specifications for.System:,
Auto Dish Washer YES NO ❑ / `y`�'"
Auto Wash Machine YES g NO ❑
Type Water Supply --- `
"This permit Void if sewage system described below is not installed wit in 3 months from date of issue.
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Improvements permit by,/-"'T
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`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. r�
Final Installation Diagram: System Installed by --
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Certificate of Completion Y� �C) 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
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION / /
Name Date �0 �o
Address Lot Size 42—
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S S
PS" PS PS PS
U 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 U
3) Soil Structure (12-36 in.) S S S
Clayey Soils � PS PS PS
U U U U
4) Soil Depth (inches) SS S S S
-11 PS PS PS
U U U
5) Soil Drainage: Internal S S S S
(ETD PS PS PS
U U U U
External S S S S
PS PS PS
may/ U U U
6) Restrictive Horizons
7) Available Space S. S S
PS PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification
U—UNSUITABLE S—SUITAB E PS—Provisionally Suitable
Recommendations/Comments:
Described by Title
Date
SITE DIAGRAM
DCHD(6-82)