P4513 Hwy 801StJ
r�r c DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION( S
*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, / f ; rr ' �. Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business __ Speculation t —
No. Bedrooms c No. Baths No. in Family
Garbage Disposal YES ❑ NO
Auto Dish Washer YES NO ❑ let
Specifications for System:
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
i
'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
l/tL'
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.
lame—
.ddress
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
I
Date
Lot Sizes=��'!'i
PAr-TnRc ARFA 1 AREA 2 AREA 3 AREA 4
Topography/ Landscape Position
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S
PS '
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U
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Soil Texture (12-36 in.) Sandy,
Ste-
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S
PS
S
PS
Loamy, Clayey, (note 2:1 Clay)
PS
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U
U
Soil Structure (12-36 in.)
SS
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PS
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PS
Clayey Soils
PS
--U
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U
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Soil Depth (inches)
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S
PS
PS
U
`U
U
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Soil Drainage: Internal�
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S
PS
S
PS
S
PS
U
U'
U
U
External
I)PS)`
S
PS
S
PS
U
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U
U
Restrictive Horizons
Available Space
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(SPS
S
S
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PS
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U
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Other (Specify)
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PS
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PS
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PS
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PS
U
U
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i) Site Classification
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U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
lecommendations/Comments: —
described by ���%�' Title `��Date
31TE DIAGRAM
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DCHD to 821