215 Dalton Rd101
Davie County, NC
WARNING: THIS IS NOT A SURVEY
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
Parcel Number:
J600000020
Township:
Mocksviile
NCPIN Number:
5757196206
Municipality:
Account Number:
8304065
Census Tract:
37059-807
Listed Owner 1:
DALTON CHARLES N
Voting Precinct:
SOUTH MOCKSVILLE
Mailing Address 1:
249 HEMLOCK STREET
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
.76 AC DALTON RD LIFE ESTATE
Fire Response District:
FORK
Assessed Acreage:
0.77
Elementary School Zone:
CORNATZER
Deed Date:
6/2014
Middle School Zone:
WILLIAM ELLIS
Deed Book f Page:
2014E0605
Soil Types:
WeB,MsD
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
-
Building Value:
0.00
Outbuilding & Extra
9450.00
Freatures Value:
Land Value:
13720.00
Total Market Value:
23170.00
Total Assessed Value:
23170.00
101
Davie County, NC
l data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold
harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
1.
Perniittee's'—..: DA IE COUNTY HEALTH DEPARTMENT _ . _._....:...
Name: "'. 'Lt'/��yl) ' �--•���� Environmental Health Section PROPERTY I FORTVIATION
P.O. Box 848
Directions to property: L-YL�%' �i L"�-��l_ Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002644 A Road Name: '� �� f r] iply'w ' 7/>
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Offtwhen applying for Building Permits.
(In compliar) ith Arta 11 of G.S. hap �r 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION OR WASTEWATER CONSTRUCTION
�.! / `:r✓ r� �" t? IS VALID FOR A PERIOD OF FIVE YEARS.
�`-'EFI�(i IME EAkEEAE $PECI 1:1ST DATE IS UED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ # BATHS 2— # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPd,V DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 12 LINEAR FT: 240
OTHER C I�I �Q IQt ..1 Z.J i.�'�J t Iunli�C
REQUIRED SITE MODIFICATIONS/CONDITIONS: CN+Q%R
IMPROVEMENT PERMIT LAYOUT L)
PIi 1"0 °L)` `ter
STt---'"""►
1tx�
l 1^x=`3 t ►'�
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
1
.1 Z,
A�L- b4 - 7D' Gtr
KA I
J_ /
AUTHORIZATION NO. `'U L4 1 OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE YSTEM SCR BED ABO EEN INSTALLED 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.
DCHD02102 (Rev,sm) 1 �� 397q
F..
A
errtiDAVIE COUNTY HEALTH DEPARTIVEN(f1
AV..., -,Named` I nviionm(ental Health Section ROPERTY INF6I�MATION
A ,t' P.O. Box 848
Directions to property: ' ' i..• Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION _ AUTHORIZATION NO: 002644 A Road Name:""'
ame ate" ' � �.--�( Zip N_ '�
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Bujj�ljpg Permits.
(In compliarl&94ith Article lJ of G.S.fChapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
--j141 f ; ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
t_ -t IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
_..-,.RFSIDENTI_ AL SPECIFICATION: BUILDING TYPE MV4 # BEDROOMS _3-# BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL+IVASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY-�/u,47�DESIGN WASTEWATER FLOW (GPD)NEW S,IE)ZEPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH tfi " LINEAR FT.
OTHER C-0 o� xt it 1
REQUIRED SITE MODIFICATIONS/CONDITIONS: ' -'L' " c->,) t'o'nco~
IMPROVEMENT PERMIT LAYOUT
-LAI is �T
I ,-7 ,r vr..i7,'�i)l.
I I
�---,
t� x� xI�
r•.
t uo' ice'
MSX -T LH Dd
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30- 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT �-- Al.-1�1,J
SYSTEM INSTALLED BY:
���x}G X►a ��
r�Z1,
�--13 M
- (AAT .�L L.L-Zt1
AUTHORIZATION NO. �fri n OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL.INDICATE THAT THE YSTEM D SCRIBED ABO EEN INSTALLED N COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY.GIVEN PERIOD OF TIME.
DCHU 02/02, (Revised) !, ! � �(�/ ?97q-
r
J
-LAI is �T
I ,-7 ,r vr..i7,'�i)l.
I I
�---,
t� x� xI�
r•.
t uo' ice'
MSX -T LH Dd
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30- 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT �-- Al.-1�1,J
SYSTEM INSTALLED BY:
���x}G X►a ��
r�Z1,
�--13 M
- (AAT .�L L.L-Zt1
AUTHORIZATION NO. �fri n OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL.INDICATE THAT THE YSTEM D SCRIBED ABO EEN INSTALLED N COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY.GIVEN PERIOD OF TIME.
DCHU 02/02, (Revised) !, ! � �(�/ ?97q-
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
21
NAME I AILD MLT�� PHONE NUMBER g g-7
ADDRESS 21f 17L7o� (ADULs SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED /0 'S NAME SYSTEM INSTALLED UNDER /
TYPE FACILITY Mmt; NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY CtotvtTy SPECIFY PROBLEM OCCURRING -�51AKAOA F
1
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge. and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
Y .
APPLICANT INFORMATION
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
PROPERTY INFORMATION
Account #: Tax PIN/EH #:
Billed To: ���-� Subdivision Info:
Reference Na Location/Address: Q�
Proposed Facility: Property Size: Date Evaluated:
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L•
Slope %
/c/o
aIORIZON I DEPTH
o' 12-
2Consistence
Consistence
Structure
Mineralogy
HORIZON 11 DEPTH
Z r
Texture group%
Consistence
Structuie: '
Mineralo
HORIZON III DEPTH
---
Texture roup
Consistence
Structure
;
Mineralogy
HORIZON IV DEPTH
Texture grobp
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
PIS
LONG-TERM ACCEPTANCE RATE
U 3
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
EVALUATION BY:
OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape Position
R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope
CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope
Texture
S - Sand LS -Loamy sand SL - Sandy loam L - Loam SI - Silt
SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C - Clay
CONSISTENCE
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
Wet
NS Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
Structure
SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralogy
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD 05/99 (Revised)
a
CC CC"C MEN OWN
CC � CC:CCCCCCCCCCCCCCCC::CCCC■■C::C:::C::C:C:::C:E:::C::6:::CC
'C�'C ■■■■....................................■............■■.■■.
C=C....■s..■...■.■■■.■■..■...■■■.■.....■..e.■■■■.ee...■■■e.e■
■ ■■ ■■/s■■■■■...■■.■■■■■■ ■.■■■■■■■.■.■e■.■■■■■■■.e■■■..■.■■■■
MEN on ■CCNow
....■..........C■■.■■..■...■■.■■...........■■..■.■■■
no . ■ .......■........■..... . ..........................■....
■■.■C. .....■....■.....■........i�.........................■■■...
■ ■■■■■■■■......■■■...■.....■ ■./.■■..■.■■■............■■■..■
C ■ ■.■■ ■...■.■...■■■..■■■....■■..■...■..■..■■..■■■■■■■■■..■
. C■ ■■.C■ ■..■..■■■.........■...........■.............■■■..■
.C...C■..■.C.............................................■....
C
INN Minn ■ i ■ ■■e
'C 'CCC
C ■/■■■■■■■■■.■.■/■■■.■.■■.■.■■■■■■■.a■■■■■■■■■■.■.■■.■■■■C■■■
CCCCC'CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC:CCCCCCC:CCCCCCCCC
■■■..C......■■............■■..../■................../...■/../..■.
........■........................................................
Now OEM
no ■.■. ■.■■■■.■.■■■■■■■■■■/e■■■.............■.................
■ .■ ■...■■...■■.■■■...■.■■■ ../iu1J1�....■..■.■■.■.■.■■■.�■■■■
■ ■CImul OEM= ■■.■/■ ■11■■■■ ■■e■■■ ■\■..■ ■■/.■■ ■■.■■/
..■.■■....■..■■.■■/.■11■.■■.■■■■.......i1.■■.■®D/....■e■/..■■
CC iiiiiiiiiiiisiCCCCCCCCCCCCCCCCCCCiiiiCi��JCCUVcCiCCCCCCiia'/CA®�®
..C■■C■■■/■■■■■/■■■■■C■■.■■■■■■■ ■■IIr�3i.eea■/■.■■■■/..ee■.e■/..■
on
■■ ■■.■■■■■■■■■■.■.■■■■....■■■■■■II■Tri■■.■■■...■■■■■./.■■C■■■.■
■.■...■ ...■e.■■..■■■■■.■■■e■■e■■.■■/le.e■■■..■e■■■■/■■■■e■■ ■■■■■
■ ■■ ■■■■.■■■■.■■■■■■■..■.■■■■■■■�4►�.■■■■■■■■■■■■o■■■.■■//■■.■■
IMMUCCCCCCCCCCCCCCCCCCCCCCCCCC�CC: CCCCCCCCCCCCCCCCCCCCCCCCCCC
■■.■.■■■■■■■■■■■■■■■■■.■.■■■■■■■■■..■■■■.■/■■■.■■■..■■■■■■■■../ i
CCC�CCC�CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
■■■ No ■■■.■■■■■■■■...■■■■■■■■e■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■
" No
"CCCCCCCCCCCCCCCCCCCCCCCCCCD�iCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
'''CCCCCCCCCCCCCCCCCCBCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
C.C.■ ■■.■...■./..■.....■■.■.■...■.■■■■■■.■■■.■■e■e■■■■■.■■e.■■■■
■■. ■ ■.■..■e...■■..■■■■.■■■■■■■■■■■■■■■■■■■■.■■■■.■■■■■■....Ce.■
■■■C■ ■.■■■.■...■.././■.■...■■./■...................■■....... .■■
■■.C..■.■■..■...■...■..........■ ...............................
.................................................................
ittee'a A IE COUNTY HEALTH` DEPARTMENT
Name: I "'� Environmental Health Section PROPERTY INFORlaI TION
P.O. Box 848
Directions to property: ? e1�1�' Mocksville, NC 27028 Subdivision Name:
DINPhone #: 336-751-8760
1 M_ Cts)' Section:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002644 A
Tax Office PIN:#
Road Name: 9 1
Lot:
**NOTP-** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying -for Building Pen -nits.
(In complianeeAith Article 1r1 of G.S.Thapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
] i ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
1-RVI12QNMENTAL NEAETA SPECIALIST DA EIS UED
RESIDENTIAL SPECIFICATION: BUILDING TYPE MNA # BEDROOMS __'15. # BATHS _� # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT`�/^ # SEATS INDUSTRIAL WASTE: YesorNo
LOT SIZE TYPE WATER SUPPLa�/bESIGN WASTEWATER FLOW (GPD) W r. ' NEW SITE REPAIR SITE c✓
// 1
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK _ GAL. TRENCH WIDTI 1� ROCK DEPTH 12' LINEAR FT.:Oc
.1� o
REQUIRED SITE MODIFICATIONS/CONDITIONS: 1' A)5`^l !A'LJ_- 00 .09 W ,
IMPROVEMENT PERMIT LAYOUT
6
1 "C Ct==i
VJdV
f
evo
10 0
X t
jLP -p
T
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT DAL--, t
SYSTEM INSTALLED BY: n , ��
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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.
ncHonsmzre�.Viwdi D !11W 1y 7! !
COMPLAINT FORM
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION j J r
Date Received
Name of Complainant �2sn// E'(� SN) Received By
Address / / -Telephone"����
Complaint Line / L?/ ,A 7 S
Person Responsible for Com lai t
Address
kd
Directions
Telephone I ' k73
Date Investigated j ZI Q Investigated By
Complaint Justified dZ Complaint Not Justified
Action Taken Li."Pir W�s LAD/ i .j i tn1 s� X11 � � 6,A f- 1 J Ir l r'
}i T r� Z i 6-) U)A� 0 114))
UP IIA)- "-b 4- 4 -W-17C+ AS -
Date Environmental Health Staff Signature
(OCHO 1/85)
rain `
DAVIE COUNTY HEALTH DEPARTMENT
Name: 1-� ' - ""' Environmental Health Section PROPERTY INFORIvIAT10N
P.O. Box 848 ,
Directions to property: 1,r1 i (. \' i:�� ,C.�� Nlocksville, NC 27028 Subdivision Name:
1 Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
AUTHORIZATION. NO: 002644 A► Road Name
Ztp
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
O,ffr e when applying for Building Permits.
(In compliance;<vith Article 11 of G.S.`ChapJer 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION fOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
-EN Q MEI4TA� I EALTH SPET CIALIST DATE ISSUED
•yam, •...
'RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ # BATHS 'Z # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY-% P DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
1
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH )?. LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/COND[TIONS: l," C --),j
IMPROVEMENT PERMIT LAYOUT
_ r p.
j 1 1 b'4 �.. r1 ill
,, ,n5•- `
r
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
>1
{:
_ r p.
j 1 1 b'4 �.. r1 ill
,, ,n5•- `
r
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.