1519 Underpass Road Lot 12DAVIE COUNTY HEALTH DEPARTMENT' 3
:IMPROVEMEN.TS PERMIT AND ' CERTIFICATE OF ,COMPLETION
*NOTE: Issued. in Compliance twith G;S of North Carolina Chapter 130 Article' 13c'
Sewage Treatment.and Disposal Rules (10 NCAC 10A .1934-.1968) -: " Permit Number
Nameyc� 4� -. cTN Date g - 1 �d�7 �q 4 929
Location } L. �a-T�----t X:.4g, N c_g .� 0 C), ocz
E
Sutidi3isioh Iva7Yie b :G� Lof No.' Sec. or Block No. =
-Lot Size w House MAbile Home'_' BusiWhss- Speculation
No. Bedrooms No. Baths:; No)iin Family' y F
Garbage Disposals-•,,,, YES�F.,j NO -
'! a 'Specifications, for- System:
Auto Dish Washer, YES �NO
. { � �`�> c _ • 4r 'ate �� ��� � � �" � �. �i.
Auto Wash Machine;,, ,YES VNO,
,Type .Water Supply Com,— --
*This permit Void if sewage s;ste described below is -not installed within 36 months from d to of issue.
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.• S .moi " .+ J
• � ? LY �!--� ' �• ` 4 of y, � `;SSV
E
Improvements permit by r
*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
70
Certificate of Completion - Date 1`d r vx
'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.
aµ a�.r-...,...aax.s'..s...-i'.i..ui....v. r.:.a+J'_... ...,Y-,✓'.>+.Wv+.w.. ti. ^-.^✓aa++.+...wr*a •(4h:tF+..i..``w.. hJs ..Y.N aaVrcv-... u Yr. -..r'- •. .. i .... . .. +.,
'! DAVIE COUNTY HEALTH DEPARTMENT 2
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name �`. -- \ s — Date T r. rf-f ; a`;`;1
y .—
Location
S6bdivi816h Name,`�.,;�� �??�%- =� ~' �t, Lot No. Sec. or Block No.
Lot Size ----House Mobile Home
No. Bedrooms ��-- No. Baths No. in Family
r
Garbage Disposal YES 0 NO E
Auto Dish Washer YES [�` NO 0
Auto Wash Machine YES NO
Type Water Supply_ --
Business __ Speculation
Specifications for System:
*This permit Void if sewage system
described below is not installed within 36 months from dpte of issue.
� � t
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
i U
70,
Certificate of Completion - 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.
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 -=` :--��_;--.: ��� jf Clr.e.�• DATE .7 PERMIT
LOCATION .t ts; c, d ::, :, r, C•' 1\ 1903
S.R. NO.
SUBDIVISION NAME.�-)7"t LOT NO. 1 SECTION OR BLOCK NO.
HOUSE Ea— MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS s3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES a- NO ❑
AUTO. WASH. MACHINE YES 0— NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �
r�dt
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY
CERTIFICA
(8/16/73)
LOT AREA
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.
119t V
APO
/INSTALLED BY �1i71i�4Le
OF COMPLETION By ���C�/l �D^Date �` 7`7/
*Construction must comply with alb other applicable State and local regulations
�� /TW
V
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME ►✓1G,r.1~�li C�,.SI � ' DATE ISSUED
ADDRESS !;)''0 7�-t $0.5 PERMIT NO. /943
C1CmmdN,S : N .('. 9 7n/
Explanation of chargee
AMOUNT
DUE �
SANITARIAN
PLEASE REMIT
THE ABOVE AMOUNT
ON RECEIPT OF
THIS STATEMENT.
D APpalt INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER
ADDRESS �-�. 3 , `a„� {ZOrA SUBDIVISION NAME
OJy- 7,7ecla
1 g -2,43
tdesd e
SUBDIVISION LOT # / 7 -
DIRECTIONS
DIRECTIONS TO SITE 261
- 7. `e�^t' cn.
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DATE SEPTIC SYSTEM INSTALLED 3-7- 7
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER 1/4- U 6-54'
SPECIFY PROBLEMS THAT ARE OCCURRING V ¢��, �,��-� ; r. ud, S.�sy• �u •r� �� �p
DATE REQUESTED INFORMATION TAKEN BY