P61 Davie Academy RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposaj,,_System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE
61
LOCATION
a.
S. R.
NO.
SUBDIVISION NAME
LOT
NO. SECTION OR
BLOCK
NO.
HOUSE ❑ MOBILE
HOMEBUSINESS
.�
❑
House Trailer 8
Gal.
40,Q Sq.
Ft.
NO. BEDROOMS
NO.
BATHROOMS
Two Bedroom House L800
Gal.
LQ001Sq.
Ft.
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 ❑
SIZE OF TANK 2 40 gal.
NO ❑
--
NITRIFICATION FIELD
sq. ft.
/
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ -Public
IMPROVEMENTS PERMIT BY V. -
INSTALLED BY� / / l d a
CERTIFICATE OF COMPLETION
BY Y .-t! ��'►�/.�'�'it'1.....6 Date
(8/16/73) *Construction must comply wll6h all other applicable State and local regulations
LOT AREAS r