225 Westridge Road Lot 20DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF. COMPLETION
*NOTE: Issued in Compliance with G.S. of 1\16rth4Carolina Chapter 130 ,Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name-�.9.�,�ci '.� �i 7,�a /,�i /% /� Date ��/�8�� No 5071
Location -er,
" Subdivision Name. Lot No. Sec. or,Block No.
Lot . Size House Mobile Home — Business Speculation
No. Bedrooms No: Baths No. in Family J
Garbage Disposal YES Q 'NO Specifications for, System:
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 fromdate of issue.
/t/e/�'
lm rovements ` permit b
; P P Y
'bntact 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 b
C/Z�W /:9,' 01�1Z
Certificate of Completion Date / l
'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. r
�: - -
`-- --�, DAVIE COUNTY HEALTH DEPARTMENT
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 �; `��� i! , _ Date
Location 2
Subdivision Name
Lot No. Sec. or Block No
Lot Size House Mobile Home _ _ Business —_ Speculation
No. Bedrooms _ No. Baths c=' No. in Family -S _
Garbage Disposal YES ❑ NO Q- Specifications for System:
Auto Dish Washer YES M NO ❑ ,,
Auto Wash Machine YES [f] NO ❑ G '�
Type Water Supply !�I __—
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
1�
Improvements permit by ell�
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 X"
V
1�
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 !~ ; .' ( r ...E } , 66. DATEF'` PERMIT
LOCATION N9 1676
S.R. NO.
SUBDIVISION NAME i � LOT NO. SECTION OR BLOCK NO.
HOUSE [9'" MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS «3 NO. BATHROOMS 2. -
GARBAGE DISPOSAL UNIT YES ❑ NO QM -
AUTO. DISHWASHER YES (a NO ❑
AUTO. WASH. MACHINE YES Er- NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK 'cA- ga 1.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ..
WATER SUPPLY: Individual 0""0)Pj&1&,C
IMPROVEMENTS PERMIT BY
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.
INSTALLED BY
CERTIFICATE OF COMPLETION ("% ` . ` // �",T �/
(8/16/73)
LOT AREA
By Date
*Construction must co h o applicable -State and local r
Q yYj
DAVIE COUNTY HEALTH DEPARTIMENT i
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME i'„ ,. DATE ISSUED
ADDRESS PERMIT NO, /i. -r/,
Explanation of charge ,_; ~. ( #,- 2,N I, %,.
AMOUNT DUEL ,', Ui7 SANITARIAN � !;-,v\.,
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.