171 Castle Ln (3) ' DAVIE COUNTY ENVIRONMENTAL HEALTH t
P.O.Box 848/210 Hospital Street `
Mocksville,NC 27028 \
(336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
Account #: 990002902 Tax PINIEH#: H20000002801
Billed To: David Beck Subdivision info:
Reference Name: REPAIR PERMIT Location/Address: 171 Castle Drive-27028
Proposed Facility: Residential Repair Property Sizo::, 6.17 Acres
ATC Number: 5922
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"
but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of
time. n v
System Type: `fL S.T.Manufacturer .7 �� Tank Date /`- Tank Size
Pump Tank.Size Bedrooms 3 Q,
System Installed By: a -Pr Inspector#: Date:
GPS Coordinate: -
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Environmental Health Sr ecialist:V Date: ✓��/'
DCHD 11/06(Revised)
• DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990002902 Tax PINIEH#: H2O000002801
Billed To: David Beck Subdivision Info:
Reference Blame: REPAIR PERMIT Location/Address:; 171 Castle Drive-27028
Proposed Facility: Residential Repair Prope��y z : 617 Acres
Site ype ❑Kew ❑Repair ❑Expansion ( Pf0(sc. {a h
AT4 rhiM&horization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
Health Section prior to.issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specifications: #Bedrooms _#Bathrooms #People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions ofFacility).
Lot Size Type of Water Supply: ❑County/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD)�3(a 0 Tank Siz hQGAL.Pump Tank GAL.
Trench Width J(c Max. Trench Depth Rock Depth-VJbq Linear Ft. 60 23%
Site Modifications/Conditions/Other:
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760.
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Environmental Health Specialist Date:
� �71z ,
DCHD 11/06 (Revised)
Davie County Health Dep
@1,
Environmental Health S- ti P.O. Box 848 APR 0 2012210 Hospital StreetdYl
20 201? A Courier# : 09-40-061911
p Mocksville, NC 27028
Phone:(336)-753-6780 ON--SrM WASTEWATER CERTIFICATIONFi�x:(336)-753-1680
(Check One) Replacement Remodeling Reconnection /`II J�,Z/Z6 S
Name: d Re e-,lC... Phone Number .� (Home)
Mailing Address: P/ �Z !' ��-7 _(Work)
MEmail Address:
��jj // r� Q / � 1 �,
Detirections To Site: /<< V dlvk Fr& (_ante/-� L-C- 0/110
A0161 JdlVe QA) I-QAol-/7/
. 0,000000=1
Property Address:
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility: ���•/1 X51t-�%
Date System Installed(Month/Date/Year): MVO Number Of Bedrooms.__`
Number Of People:
Is The Facility Currently Vacant? Yves No If Yes,For How Long?
Any Known Problems? Yes /No)If Yes,Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: Number Of Bedrooms: Number of People
Pool Size: Garage Size: Othe :
equested By: a Requested: /Z
(Signatur
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function properly for any given pe,PoY of time.
Payment• Cash Check Money Order # Amount:$ 10 Date:
Paid By: a Received By: l zMI)le .
Account#: o7i Invoice#:
-, •rr i
Davie County Health Department
4o�s r� Environmental Health Section
P.O. Box 818
,S 210 Hospital Street
C� -
O U 1�� Courier# : 09740-06 1911
Mocksville, NC 27028
Phone:(336)-753 6780 1„;ON-SITE WASTEWATER CERTIFICATION Fes.(a36). 753-1680
(Check One) Replacement Remodeling. Reconnection
m`
Name: { /T Phone Number f Home
Mailing Address: Pi` �l/ /' Q � (Work)
�1017 Email Address:
Detailed Directions To Site: d1v7 / TSR � ,61;F1 � LP� 0A110.
r 0000osm
Properly Address:
Please Fill In The Following Information About The EXISTING Facility: �✓
Name System Installed Under: ! :Type Of Facility: r •/I P-5��^ /U�( ,
Date System Installed(Month/Date/Year): (�U Number Of Bedrooms: Number Of People
Is The Facility Currently Vacant? Yes-/No ,If Yes,For How Long?
Any,Known Problems? Yes _�./ f-y-es'Explain:----r
Please Fill In The Following formation About The NEW Facility:
Type Of Facilit 49f NiSmber Of Bedrooms: Number of People,,
Pool Size: 10 ll t/ Garage Size: ; `• �:�Othe ::
t�uested By i t to Requested: tZ�.
1 \ +'7
(Signaturey.
ForkEnvironmental Hgalt]lOffice Use Only
Approve! Disapproved
1 Comments:
Environmental Health Specialist ' 'Date:
*The signingbf this form by the Environmental.Health-,Staff is in no way intended,nor should be taken as a guarantee
r
(extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment. Cash Check Money Order`# — f Amount:$ U- Date: O Z-
Paid By: ` �!{ r ( { (�s'.:G' eceiY�dB �/(/l�2
Account#: 0 �7i r` Invoice#:
GoMAPS - Davie County NC Public Access
E] WATERSHED STRUCTURES
WATER BODIES
COUNTY BOUNDARY
✓ T.{;�, _ ADDRESS
f� �✓
DRIVES
_ ` _ _ _' STREETS
RAILROAD_CENTERLINE
.i .. rT .•. -. E-1 PARCELS
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� - 2010Aerlal_PM[os
q O BERMUDA RUN
'- COOLEENEE
P oW VIE COV1rY
- O MOCNBVILLE
Lima
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Friday, April 20 2012
••'WARNING:TIflS IS NOT A SURVEY!***
This map is prepared for the inventory of real property found within this jurisdiction,and is compiled from recorded
deeds, plats,and other public records and data. Users of this map are hereby notified that the aforementioned public
primary information sources should be consulted for verification of the information contained on this map.The
County and mapping company assume no legal responsibility for the information contained on this map.
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