P1581 Davie Academy RdDAVIE 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`
,, ;i PERMIT
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LOCATION
-; �,. ,;:J ���;,, i:„�. .�� R�; �. �,� �,��: ,..� ��. ,-l�rc 1581
} — S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE]` MOBILE HOME ❑ BUSINESS
❑
NO. BEDROOMS _ NO. BATHROOMS
400
GARBAGE DISPOSAL UNIT YES ❑ NO a
Ft.
AUTO., DISHWASHER YES ❑ NO Q'
800
AUTO. WASH. MACHINE YES ja` NO ❑
600
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 40a a
Ft.
cgal.
900
NITRIFICATION FIELD /Dv sq. ft.
900
8
Ft.
DEPTH OF STONE IN LINES:
1000
WATER SUPPLY: Individual ❑ Public
1200
Sq.
Ft.
IMPROVEMENTS PERMIT BY.r�ry
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comply wiTth
all,
LOT AREA Z. '-y d�' " , e.4 ->
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.
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4C
INSSTALLED BY A�
7 Date - ' I
ther applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57Q'
HOCKSVILLE, N. C. 27028 a �[
(7 04) 634-5985 �I
Statement for Septic Tank Improvement Permits
/ and/or Site Evaluations
NAPI:E (��i,,.r! i� „:;ytca.+trn�,�it;:���� DATE ISSUED
ADDRESS
'�� PERiY1IT NO. ; ✓�
,,.'-r. 7
1�u/7
Explanation of charge
r
AMOUNT DUE ��, r'� SANITARIAPJ
J
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUNTY HEALTH DEPT.
PERK TEST RECORDS
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LOCATION22::
DATE
w
OMMENTS
FINDINGS: HOLE NO.1
HOLE N0.2
HOLE N0. 3 L,3
Sy BY
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LOT DIAGRAM
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