3043 Hwy 64E (2) ' DAVIE 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 � 1119
S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
r HOUSE In MOBILE HOME BUSINESS ❑
' N0. DR00 S � N0. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House .800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES NO x5, ""�� Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YE `� NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ f • ¢�t J
SITE SUITABLE b 4 YES NO [3
SIZE
+� '�"� �'
SIZE OF TANK gal.
NITRIFICATION FIELD 4 q sq. ft.
DEPTH OF STONE IN LINES: "" �
WATER SUPPLY: Individual Public ❑ r
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must com wi a 1 other applicable S e and loca regulatio s
LOT AREA r .
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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.
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! . / DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
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No* of Bedrooms ,� � Date
This permit is grants to � for the sta latio of a septic tank
at the residence of Address ' C
Building Contractor Address P7'4,
�
Septic Tank Specifications: Lengt .--Width Depth Capacity Gal.
Manufacturer's Name ,cr �,7 :&-_ 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'bavie 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.
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�:•_ 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
Name Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths 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
aw �
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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.