3043 Hwy 64E (3)DAVIE COUNTY HEALTH DEPARTMENT 3043 GAS �qe' ?
(Septic Tank) Improvements Permit and Certificate of Completion l
(Ground Absorp pewage Digsa�l System - G.S. Chapter 130- rt'cle 13C)
OWNER OR CONTRACTOR �.`� �j•Q-�1. tx.t��y • DATE/=_ PERMIT
LOCATION N9 1119
. SUBDIVISION NAME LOT NO.
HOUSE MOBILE HOME C] BUSINESS Cl
N0. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES NO paW
AUTO. DISHWASHER YES ,r NO
AUTO. WASH. MACHINE YES Ep NO ❑
SITE SUITABLE i p YES NO ❑
SIZE OF TANK gal
NITRIFICATION FIELD �.� sq. ft.
DEPTH OF STONE IN LINES: 7'""�
WATER SUPPLY: Individual �d Public ❑
IMPROVEMENTS PERMIT BY �'K �• •-i•'-"'t %^`..f •'..
7
CERTIFICATE OF COMPLETION By
(8/16/73) *Construction must c
LOT AREA
S. R. NO.
SECTION OR BLOCK NO.
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.
da :sem 7 /.^hN r 4%.C.. L4a
{
INSTAZLED BYy
t.--.• C'LL- Date 3
9a,1 other applicable a and local regulation
A-5--�''"'*
• DAVIE COUNTY HEALTH DEPARTMENT 5 073 W S �q g' ?
(SepXic Tank) Improvements Permit and Certificate of Completion f
(Ground Absor t wae Di G.S. Chapter 130 -rt 1e 13C
r%OWNER OR CONTRACTOR ,,,,,sDATE PERMIT
� / ,�'' }..,
LOCATION %y �l' `ir e -« jy"am- Qy 1� 9 1119
�1
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS El•' NO. B DE ROOMS ti�! NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES NOP[3r
_,.--AUTO. DISHWASHER YES NO
AUTO. WASH. MACHINE YES Ep NO
SITE SUITABLE p p YES P NO ❑
SIZE OF TANK gal.��
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �, ,.: �' i••-�•=�'�''�}°'..
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)JSq. Ft.
AO r-
vv�
INST LED
CERTIFICATE OF COMPLETIONBY Date
(8/16/73) *Construction must com64 wi ra 1 other applicable a and local regulati
LOT AREA
-- . •... DAV ,�.,,, ,
IE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
.. (Ground Absorpt Sewage Di a System - G.S. Chapter 130 -Article 13"6)
OWNER OR CONTRACTOR ' DATE r r PERMIT
LOCATION ' ». .• ,. Q l� 1119
S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSeDROOS
MOBILE HOME ❑ BUSINESS ElN0.3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES NO 71,11
AUTO. DISHWASHER YE `� NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE b 4 YES NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD _ ar_b
_fq. ft.
DEPTH OF STONE IN LINES: "" �
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY���'
House Trailer 800 Gal.
Two Bedroom House .800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
INSTALLED BY T
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
C? 0 (!
CERTIFICATE OF COMPLETION By—Ai$ Date
(8/16/73) *Construction must com wi a 1 other, applicable S&tAMe and loca regulatio s
LOT AREA r
'j
z
t
7DAVIE
SOL � ISS Hva( C7Cl ? '.3644 COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT `-
No.' of, Bedrooms ,3 Date
This permit is gra nte to for the st latiorl of a septic tank
at the residence of Address✓oZ.
Building Contractor c Address
Septic Tank Specifications:' Lengt _Width Depth Capacity Gal._
Manufacturer's Name -75 -7 S%7 --,e e . Address J� �'✓I -2
No of lines_ width in. Total Length 3,po ft. No. of Sq. Ft. a o
Type of filter material V/0 Total tons used --3 .3
-'t Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit �rom�-the Health
Officer or his agent.
' Date of final approval Signed:
Sanitarian
+ I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
f -
r
0
1
/ P
�LL
j
n� 1
M.
9
41
Q
! . / DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT .........
.
�.
No* of Bedrooms ,� Date J'-' o2 %-- j R
This permit is grante to for the stalatio of a septic tank
at the residence of Address A,") • 7
Building Contractor Address
Septic Tank Specifications: Lengt _--Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines �� width in. Total Length ,poo ft. No. of Sq. Ft. ,9n a
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100
Tvo--bedroom house 800 600
..Three-bedroom house 900 900
No one shall install a septic tank `in'Davie County without a permit �rom�the Health.
Officer or his•agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
t•• -•-t,_ t �\ l �_....J < <.r\! ..a ��
iJri_,r Ii'!ll
r i
_
cr
cl
..._._ _.,__...�....__�...�._..._._.. ...,. �t .,_� r •� ILC.
t
s
000 ,:1f lT u~r.. r. -.(l:ji.._- i`�1:.,.�z 7"2 �t. `✓�P� r
+. int":'
./•
�:•_ DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
_ Permit Number
.-
Location
Date > >-<�
Subdivision Name Lot No. Sec. or Block No.
Lot Size
House
Mobile Home — Business Speculation
No. Bedrooms
No. Baths
i
No. in Family '—
Garbage Disposal
YES !❑ NO
p'
` `' r
Specifications for System: (7 °;o ::,,-. r .7'.
Auto Dish Washer
YES ❑ NO
Auto Wash Machine
YES ❑ NO
�❑'
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by �! {
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion `-h\ '� Date
"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.