130 Wig Street - Westpark . W
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 - DATE PERMIT
LOCATION / ) 1 - N� 1274
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 0 MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS _ - Two Bedroom House 800 Gal.. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ElNO ❑ Three Bedroom House 900 Gal.': 900 Sq. _Ft.
AUTO. DISHWASHER YES ❑' NO ❑ Four Bedroom House 1000 Gala 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. X 3
DEPTH OF STONE IN LINES: 9oo�Q �t.
WATER SUPPLY: Individual ❑ Public ❑ * u��
IMPROVEMENTS PERMIT BY - INSTALLED BY
CERTIFICATE OF COMPLETION — r
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
7
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DAVIE COUNTY HEALTH DEPT.
PERK TEST RECORDS
DATE 6Z --/?-9�
NAME
LOCATION
COMMENTS
FINDINGS: HOLE N0.1
HOLE N@'.2
HOLE NO. 3
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LOT DIAGRAM
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