251 Brier Creek RdDAVIE COUNTY HEALTH4 DEPARTMENT
t
(Septic Tank) Improvements Permit and Certificate of Completion
z Y 3
(GroundlAbsorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRA/CTOR c! DATE.. 1'' " 7'rt'' PERMIT ,�
LOCATION N 402
t S S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE L3 MOBILE HOME AQ BUSINESS
CERTIFICATE OF COMPLETION �rrn,�,�
BY Date
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA
House Trailer
800 Gal.
400 Sq..,_Ft.
NO. BEDROOMS v..
NO.
BATHROOMS
Two Bedroom House
CEL0
GARBAGE DISPOSAL UNIT
YES
❑ NO ❑
Three Bedroom House
900 Gal.
900 Sq. Ft.
AUTO. DISHWASHER
YES
❑ NO ❑
Four Bedroom House
1000 Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE
YES
❑ NO ❑
SITE SUITABLE
YES
❑ NO ❑
SIZE OF TANK$i fi l�
gal.
NITRIFICATION FIELD
3"a sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
i Public ❑
IMPROVEMENTS PERMIT BY
INSTALLED BY t` rr i :r.
y; 1, { n
CERTIFICATE OF COMPLETION �rrn,�,�
BY Date
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA
4 _
Lot No. z2 Block•___ -_,.--
Subdivision _'_pplicant:
Location: .'address
Date:
PERCOLATION TESTS RESULTS
TEST HOLE
RESULTS
1
Minutes
per
Inch
2 .�r�d.
Minutes
per
Inch
3 0
Minutes
per
Inch
4 014,0
Minutes
per
Inch
5 � ep% D
Minutes
per
Inch
6 `14,0
Minutes
per
Inch
DATE TESTS COMPLETED_es
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
-Registered Engineer
Ott (s :a 0/,,
Y
43&3
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