P2756 GreenbriarIMPS
*Note: Issued, in Compl
Name 091
Location
Subdivision Name G2�
t
Lot Size --
Bedrooms "
,/Garbage Disposal
'
-Auto Dish Washer
Auto Wash Machine
Type Water Supply
*This permit Void if sew
T
1
DAVIE COUNTYI HEALTH DEPARTMENT
VEMENTS PERMIT AND CERTIFICATE OF COMPLETION
ce with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
oda«4 7ql- 1v3Y, Date �, 2� g i i� 'a € 2756
Lot No. Sec. or Block No
House Mobile: Home _ Business Speculation
jNo. Baths No. in Family
ES t] NO_❑ .
Specifications' for System: 900 /0 0J
ES ❑ NO ❑
ES ❑ NO ❑ ZOO X 3 X /9 S 7-0 NIL -
system .described below is not installed within 36 months from date of issue.
i
�I
n
n
t
• 1
`Contact a representative. of.
9:30 A.M. or 1:00-1:30 RN
Final Installation Diagram:;,
'The signing of this certificate
the standards set forth in the a
satisfactorily for any given peri
p ` ,ll
ha
Certificate of CompletionDatesll indicate that the system de'scrib above has-been installed .in -compliance with
boVe regulation, but'shall in NO way be aken as a guarantee that the system will function
odof time.
DAVIE COUNTY HEALTH DEPARTMENT A ,/
--, EWIRONMEI1'AL HEALTH SECTION � �
P.O. BOX 57 y V J
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAMRE DATE (V ' 2G
ADDRESS 10 ?)R/4(4 APT PERMIT NO. G SSU
0ir4157z-', • SAc 1z,;►- N C_ 7-110 '/
EXPLANATIO14 OF CHARGE
l S I Tf 4 VA -L(/ 7.7 .,.—
AIMUNT Z Q
SANITARIAN -1",C -AS
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
Lot No. Tax Block:'
r lublivision Briar' Creek _ _ ;.pplicant:
Location: llavie , County _ Address
_ .._ 'ate:
a,
FT
PERCOUTION TSTS RESULTS
TEST HOLE RESULTS
20 Minutes per Inch
60 Minutes per Inch
190 Minutes per Inch
43.5 Minutcs per Inch
5 54 Minutes per Inch
6 60 Minutes per Inch
SATE TESTS COMPLETED May 14, 1974
I hereby certify that the above test results were obtained by
following the procedures outlined in this form and that these
results are accurate and correct.
Signed ZLG,," ..._�-
Vgistered Engineer.
;i .. � .c • .,.31:1'x' � i"'