P95 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
y (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR 1...1 r° , 3 ,; U �¢�� DATE PERMIT
j N° 95
LOCATION
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS til 'r" -.3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
3'r
AUTO.
DISHWASHER
YES
C3s
NO
Q'j
AUTO.
WASH. MACHINE
YES
Ci"
NO
❑
SITE
SUITABLE
YES
[Qf
NO
❑
SIZE
OF TANK
gal.
NITRIFICATION FIELD r, ,=a! `7 0 0 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual „ a Public ❑
IMPROVEMENTS PERMIT BY r. f`.-, - /
House Trailer 8a Gal. r4QDSq. Ft.
Two Bedroom House r 00 dal. {r600.Sq. Ft.
Three Bedroom House '.._,90,0 a1. 9-6.)Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION ,,�
By r f �... Date
(8/16/73) *Construction must,c mpj9 with aft other applicable State and loca regulations
LOT AREA
Zill
i
O
F