P2588 Liberty Church RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
Subdivision Name
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
House
_ No. Baths
YES ❑ NO 0''r
YES ❑ NO D-
YES p'` NO C❑
Lot No
Sec. or Block No.
Mobile Home _' Business Speculation
No. in Family ,/
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
. .-,,r ��� / sp,J _�''�'•.}fit/
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��
d
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 �e taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTilEUT
ENVIRONIMITAL HEALTH SECTION
SOIL/SITE EVALUATIO17
IIAI� DATE
ADDRESS S?
t/, F LOCATIOd
LOT SIZv-,5—,-:�7
TOPOGRAPHY:
SOIL TE,,TURE: j' T�(/y -
SOIL STRUCTURE: �S 5��� /— r/' 't' It �P
DEPTH:�I�
RESTRICTIVE HORIZONS: �r��%/`� S`�'(� �� r'�O• ���'/
PERCOLATION RATE:
�-1
***CLASSIFICATIOPI:
Suitable
1.
2.
3.
Presoak
time
Drop
Time
Pate iiia. Inch
/J
�Har/k'&
COMMENTS:
Provisionally Suitable Unsuitable
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