P3264 Chinquapin RdDAVIE 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 Date'�''�`�' �r <<3' y L?.A
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 ❑ Specifications for System:
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 Diagra
by
/�57)
l;9„
Certificate of Completion F. c -C1 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.
Address /
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size LL�
AREA 1
ARFA 2 AREA 3 AREA 4
Topography/ Landscape Position
S
S
S
�S
C r�-/CVF�—PS
PS
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
�
�S,�--�,
S
PS
S
PS
Loamy, Clayey, (note 2:1 Clay)
U
U
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
S
<f99:71
S
Q�
S
PS
S
PS
U
U
U
U
Soil Depth (inches)
S
S
®
S
PS
S
PS
U
U
U
U
)Soil Drainage: Internal
�
�
S
PS
S
PS
U
U
U
U
External
dc)
S
S
PS
PS
PS
PS
U
U
U
U
1) Restrictive Horizons
)Available Space
C �5�.-�
p
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
-
i I
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments: -f 12mi
Described by Title ��''' Date
SITE DIAGRAM
DCHD (6-82)
Address
Ger.TnRc
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Date
Lot Size
APPA 1 ARFA 9
AREA 3 AREA 4
Topography/ Landscape Position
S
®
,S�,
�
S
PS
S
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
®
�S-,
U
S
PS
S
PS
U
U
U
U
o) Soil Structure (12-36 in.)
Cf`Y Soils
S
S
S
PS
S
PS
U
U
Soil Depth (inches)
SS
PS
S
PS
U
U
U
Soil Drainage: Internal
S
S
S
PS
S
PS
U
U
U
External
S
S
PS
PS
U
U
U
U
i) Restrictive HorizonsN�
Available Space
®
S.S
en
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Classification
1/
!) Site
U—UNSUITABLE y S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by�Title >� Date
SITE DIAGRAM
/s—d
DCHD (6-82)