222 Shuler Rd DAVIE COUNTY HEALTH DEPARTMENT
k r 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 �c�' � /l�!�'%' Dated --� + i
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home r� Business Speculation
No. Bedrooms No. Baths �� No. in Family _
Garbage Disposal YES ❑ NO Q'` Specifications for System: y?
Auto Dish Washer YES NO
Auto Wash Machine YES NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 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.,=
/J
i
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
Name Jeffrey D. Joyner Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
!S7) PS PS PS
U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) S PS PS PS
U U U
3) Soil Structure (12-36 in.) S S
Clayey Soils PS PS
U U U
4) Soil Depth (inches) S S
PS PS
U U
5) Soil Drainage: Internal S S
SPS PS PS
U U U
External S S S
PS PS .
tel/ U U
6) Restrictive Horizons
7) Available Space 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
ldc-
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title Date
SITE DIAGRAM
DCHD(6.82) - /�