166 Rex Ln �c
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance v�iith G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatme t and Di posal Rules (10 NCAC 1 A .19 4-.1928) Permit Number
Name 1a.T . ,�►' ��: y;f, ' l �a�`��' 4993
Location �i� �. I7
Subdivision Name Lot No. Sec. or Block No.
Lot Size 2j& House Mobile Home kip Business Speculation
No. Bedrooms No. Baths _ No. in Family _
Garbage Disposal YES 0 NO O Specifications for System: r
Auto Dish Washer YES p NO 0 -4,
Auto Wash Machine YES p NO {] J . I •�%�"
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
A("
0
r \ /ll•fro%r�
IV
ail
�
0100
-_--
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
vlte
f �
f
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.
Dfli e Cozgt Ylealt§ 7ye
arfnenf
and .dame Ylealtl rrcy
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE:(704)634-5985
January 25, 1988
Douglas Rex Carter
Rt. 6, box 96
Advance, NC 27006
Re: Off State Rd. 1453
Davie County
The on-site sewage treatment and disposal system installed at the above
mentioned location, is of such design that an Operation Permit is required
from this office. This Operation Permit is issued instead of a Certificate
of Completion. As of January 1, 1984 G.S. 1130A-337(b) ] requires an
Operation Permit for any system that has the following:
Pumps and/or grease traps, any alternative system, systems
with a flow rate greater than 480 GPD,' and systems serving
mobile home parks.
This Operation Permit is valid as long as the sewage treatment land
disposal system is in compliance with Article it of G.S. Chapter 130 A, and
all conditions imposed by the Operation Permit.
This letter shall serve as the Operation Permit for the sewage
treatment and disposal system at the above mention d location.
Date of Issuance I�S/�� By �
Title � �