P271 Pineville RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate, of Completion
(Ground Absorption Sewage Diisosal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR So Ch,i�,Ce,S.S DATE PERMIT r�
LOCATION 2 ( 1
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
LE HOME p BUSINESS
NO. BEDROOMS -
NO.
BATHROOMS .4..
GARBAGE DISPOSAL UNIT
YES
❑
NO
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
0
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK /.'•.
gal.
NITRIFICATION FIELD
r�,
sq. ft.
DEPTH OF STONE IN LINES: i
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.
WATER SUPPLY: Individual .0 Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY _n�..,, („a�,,, r11tg•.�
CERTIFICATE OF COMPLETION
By �. e�ACi Date 10 -'1 p
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms-— Date
This permit is granted to -r er, e for the install ion of a se tic?tank
at the residence of nr�LrZ; ; /�/r�,s c Address ney: /-eccZ,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. f�
Manufacturer's Name C_ Q r/ S Address J o n os ✓ 1 �� C
No of lines _/ width in. Total Length ft. No. of Sq. Ft. �l 32 ---
Type
2_."Type of filter.material-^�-� Total tons used 16 _
Minimum Requirements: House Trailex%`- Tank Cap.8001 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without,a permit from the Health
Officer or his agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signe' ..�-e ��-�-� /
Septic Tank Ontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, b.
Mocksville .
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