425 Farmington Rd11-2)u- 9' A DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption SeFAge Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR `y's :;� u' k t� t? "�: , •7.y (:i ,+ : r,i t w `y -"DATE PERMIT
N° 193
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME{ ❑ BUSINESS
NO. BEDROOMS N0. BATHROOMS + .
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ IO ❑
SIZE OF TANK / 4$6 0 gal. "
NITRIFICATION FIELD 0 5 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual X Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
By .1a= �.L4 Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
El