2513 Cornatzer Road Lot 3DAVIE 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) Permlt Number.
Name 1�r7 .�// .1./ /�Ir Date �� � /�'� Fi . 4364
Location //,- moi/ /';,- l / — ..r� / — ✓//i /fY / // a i ��i, < _
Subdivision Name ��r/ 7 �c �(! �,rldt No. Sec. or Block No.
u .
Lot Size—/ --n-/1 ^��
House — Mobile Home — Business Speculation
No. Bedrooms
No.
Baths I '? No.
in Family .f/
Garbage Disposal
YES
p NO J2--
Specifications for System:
Auto Dish Washer
YES
NO F]f%/-.
/ /
t
,
Auto Wash Machine
YES'
� NO
1
Type Water Supply
�g
_—
*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
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
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
FAMORR
ARFA 1 AREA 2
vo
Date cL4P/sem
Lot Size
AREA 3 AREA 4
Topography/ Landscape Position
SS
S
S
PS
PS
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
®
PS
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
®
PS
PS
PS
U
U
U
U
Soil Depth (inches)
(fp
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S
PS
PS
PS
U
U
U
U
External
S
S
S
S
PS
PS
PS
U
U
U
i) Restrictive Horizons
Available Space.
S
S
PS
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
I) Site Classification
'Pf
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS -Provisionally Suitable
Described by� Title
SITE DIAGRAM
fJ/AA��Y'�d
DCHD (6-62)-
b,