230 Ashley Brook Ln Lot 13 `W --- -11-. - .--- ---- --- — -- - --- -- — ,.- .r.,.-..rI
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Co pliance with G.S. of North Carolina-Chapter 130—Articie 13c.
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Permit Number
Name rA veer, 1 tate / � 2.7•,42
y
Location I� Ll/�/i/ s�/ /'r s-y ;ay 45/
Subdivision Name ka �taN .E•�4S Lot No. Sec. or Block:No.
Lot Size f; .
House�Motiile Home _ �� Business� Speculation-
No. Bedrooms _ — No. Baths No.Sin Family.
Garbage Disposal'' YES Cp NO
Auto Dish Washer I� YES NO fl Specifications for 2Xtn:. ,
Auto Wash Machine i YES NO
Type-Water Supply' ,� - •
*This permit Void ifisewage system.described below is not installed.within'36'months from date of issue.
i
< els
Ave
r -
•c - 4 .,
I
Q Improvements,.permita.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:OP-1:30 P.M. on. day of completion. Telephone Number: 704-634-5985.
Firial Installation Diagram: System InstalfedVby �'y
5'h Cf Z4nA Pr-tJ
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Certificate of.Compietiori Date
,
*The signing of-1his'c'e" rtificate.shall indicate that.the system described above has been installed in•compliance'with
the standards set forth in the above regulation, but'shall in N.0 way be taken.as a guarantee that the system will function
satisfactorily fo ;any given period of lime. ?
DAVIE COUPTY HEALTH DEPART MITT
• ENVIZOPTI.i'EBTAL HEALTH SECTION
SOIL/SITE EVALUATIOF
I?AIS �/P.'G /p�vJt� DATE
ADDRE S SAI'`
LOCATIOi?
LOT SI7B
TOPOGRAPHY:
SOIL TE,',TURE: i'An��" 1`AC���Q Por elve,(C— toandC�_" �i/c
SOIL TFUCTURE: F,-,, I -�,� -"voo�
DEPTH:3�"
RESTRICTIVE HORIZOFS:
PERCOLATION FATE: Presoak bark & time Drop Time Pate/iiir.. Inch .
1. f 00le/✓_ //, 00 r
2.
3.
%*CLASSIFICATIOP?:Suitable Provisionall Suitable Unsuitable
C011HEI?TS:
/ SANITARIAH
SITE DIAGRAM
s� ✓ %��y �,,;/,� �, C;2-ala
01
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028 1
` (704) 634-5985 1
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME DATE
ADDRESS �v PERMIT NO.
00
EXPLANATION OF CHARGE / • '
AWUNT Dui;,: D. SANITARIAN
PLEASE MMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.