P1997 Walt Wilson Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
---------�� (Ground Absorption Sewage D/isposal�System - G.S. Chapter 30-Article 13C) "
('OWN
$�OR CONTRACTOR (`'� ;'%/ ;✓ //•,F DATE PERMIT ,
ATO
LOCATION < :p*,,)t, lr . 1997
`r S.R. NO.
SUBD4ISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE D MOBILE HOME E3 BUSINESS ❑
�) House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS c9""' N0. BATHROOMS l Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO '[J`� Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 4 NO ❑
SITE SUITABLE YES W NO ❑ 6~
SIZE OF TANK gal. �Ov
NITRIFICATION FIELD sq. ft.
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DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Pudic ❑ /�L)C) lc).
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. ' Chapter 130-Article 13C)
OWNER OR CONTRACTOR �`r`;, it`::` i�.r _.�C..�.�.r. DATE PERMIT
LOCATION 1\9 199
S.R. NO.
SUBDIkISIfON NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS j'. . NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO O' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO [ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE- YES Q NO ❑
SITE SUITABLE YES ® NO ❑ ,` f� 'f jam:
SIZE OF TANK gal. { L.�( ; .,� tt�/ �, r�1✓ ,.
NITRIFICATION FIELD sq. , ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual_A ❑ Public ❑
IMPROVEMENTS PERMIT BY ;'r�:'F ,� /�y rpt �.,Lc. INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable state and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT fU I
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME ' DATE ISSUED
ADDRESS� 'L'7 PERMIT N0. � — --
u-c.. ./y C'• X70 ?e�{'
Explanation of charge If
i
AMOUNT DUE /�j. �— SANITARIAN ti
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMra.
."!• "-_FSM
DAVIE COU1=7 HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NA.10_4�2 11t ��Q�A t�' �E� 6 � 4�tu 2r Me,
LOCATIOIN 4y W g td n_ y IC's#' A,.,,,fLl.,tt,�6-, -LJt A l 0- -Lr//tai, .cr/
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FINDINGS: HOLE 130. CONYMOTS
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LOT DIAGRAM
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