2871 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note:.l6"'gued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Subdivision Name
Lot Size
No. Bedrooms 3
Lot No. Sec. or Block No
House Mobile Home
No. Baths No. in Family.
Z_
Business
Speculation
Garbage Disposal YES ❑ NO ❑
Specifications for System: 70 U �
Auto DishWasher YES E]NO ❑ . f
Auto Wash Machine YES El NO ❑ -zoo n 3 n J'? S Tu N`
Type Water Supply Gou,� y _—I C)
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
7
Improvements permit by — f
'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: 704-63475985— 4
I I r
�•�%i:,���:�.��7—
Final Installation Diagram:
System Installed by
�� �'
f �
� J
S; -
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.
Permit Number
Name i �. Z
�I tJGLAI J'j
Date
Location -, n"µ
/\/ �r� �� �� �,- D
Subdivision Name
Lot Size
No. Bedrooms 3
Lot No. Sec. or Block No
House Mobile Home
No. Baths No. in Family.
Z_
Business
Speculation
Garbage Disposal YES ❑ NO ❑
Specifications for System: 70 U �
Auto DishWasher YES E]NO ❑ . f
Auto Wash Machine YES El NO ❑ -zoo n 3 n J'? S Tu N`
Type Water Supply Gou,� y _—I C)
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
7
Improvements permit by — f
'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: 704-63475985— 4
I I r
�•�%i:,���:�.��7—
Final Installation Diagram:
System Installed by
�� �'
f �
� J
S; -
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.
a
DAVIE COTITTY HEALTH DEPART' IE1TT
ENVIR01,41ENTAL HEALTH SECTION
SOIL/SITE EVALUATIOU
i
ITA14E S t 0C L -C -rL- DATE
ADDRESS KT. Z-
AbJAN C `z 9 9,9 • Iq LOCATIO14 6q W TU gD I
Vj " "Z FZ 113,¢7 / -IFA
LOT SIZE AGi/ZRGf-
TOPOGRAPHY: 6-r 7
SOIL TEZTURE : 5A-tJ?7 `,
SOIL STRUCTU
DEPTH:
RESTRICTIVE HORIZOFS:
PERCOLATION PATE:
1.
2.
3.
Presoak
Idark & time
Drop
Time
Rate/iii%. Inch
3"
I0,
*** CLASSIFICATIOIT:Suitable Provisionally Suitable Unsuitable
COMIEUTS:
5,714
SANITARIA11 S?L
SITE DIAGFA
b�
r1'
DAVIE COUNTY HEALTH DEPAP.TMrNT �
EINVIR011'MENTAL hr-ALTH SIECTION (I %
P.O. BOX 57
MOCKSVILI,:'; 1•I. C. 27028 V
(704) 634-5985
STAMIM11T FOR SEPTIC TANK IMPROVEFE2TS PERMITS AND/OR SITE EVALUATIONS
WAPIE M I rd 7 i-_ DATE �i S
ADDRESS ��. PEI MI:' mo. Z I -S /
EXP11MATION OF CI ARGE _5 17 � - ✓''K C! /"k -7-Z,n.-
KIOLVIT U
SANITARIAN AS
S
PLEASE RE'11IT THE ABOVE AMOUNT OF RECEIPT OF THIS STATFIIE14T.
*NOTICE • Evaluation(.,l) can not ba cocu,��l�at:d until payment is received.
Inprovi�mc nts P�,.rmiL (a) can n:.t be issues until payment is received.