P420 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR !!,, ' ; DATE ; ' PERMIT
T c�
LOCATION n "� 1 �` ? ff + lr ? 4 2 U
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS c�),
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE
er`f
YES
❑
NO
❑
SIZE OF TANK ' �'
gal.
NITRIFICATION FIELD
,'•. ,
sq. ft.
DEPTH OF STONE IN LINES:
!r "
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BYE'.. t.�' •
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.
INSTALLED BY
CERTIFICATE OF COMPLETION sp -Z 1' P„ /•-
By ,,., �,x +l Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
t
1'
i
y�
t
,ss
1
t