P514 Wagner Rd�-` - 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 - V-7-1' PERMIIl�T
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LOCATION �a`�n- /Q� /��b - /,-»i A- e -n lf-/t' � 514
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ,M MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS 3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK qOD gal.
NITRIFICATION FIELD 90D sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY E VN\a,.jn
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. -Ft.
Three Bedroom House "'900 Gal.) !300 Sq. Ft::
Four Bedroom House 1000 Ga -1. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION Bye YN Date
(8/16/73) *Construction must limply with all other applicable State and local regulations
LOT AREA
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