The URL can be used to link to this page

1951 Farmington RdiPermittee'sDAVIE COUNTY HEALTH DEPARTMENT- - - -- -- ---'—" it i�=-��-�-s1 r Environmental Health Section PRO ERTY INFORMATION P.O. Box 848 c7 `rl)rections to property:J � o." I Mocksville, NC 27028 Subdivisio Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION NO: 2 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION A Tax Office PIN:# Road Name j Y__j **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 Building Permits. (In complian cq� wircle 1:] of G.S Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ¢i li• r '" �.�'� i IS VALID FOR A PERIOD OF FIVE YEARS. ENVIROrWENTAL HEALTH SPECT LIST j DAT9 1 UED RESIDENTIAL SPECIFICATION: BUILDING TYPE BEDROOMS Ll # BATHS " # OCCUPANTS —:: GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE t/z- �r`n�TYPE WATER SUPPLY 1A) DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE v SYSTEM SPECIFICATIONS: TANK SIZE �'"�y AL� MP TANK GAL. TRENCH WIDTH �, ROCK DEPTH 1 LINEAR FT. IL -C) OTHER- C� ` Vhf-'�Tt�G- REQUIRED SITE MODIFICATIONS/CONDITIONS: ' OJT �' � ` � � � �; ' G: IJP` 1 A01% ay -6 1 t &% L�- IMPROVEMENT PERMIT LAYOUT ..— '^ t 1�'—" ', S 1 1 `�J 1 ;V k?nS�tsaa►c L N IL; K'zv'tr2" J v 9Q �7 d �-1CA-al-S **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: SO/Tr_ r V 110&' T, AUTHORIZATION NO. 7 i� OPERATION PERMIT BY: DATE: o **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DE RIBED 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. DCHD 02/02 (Revised) COMPLAINT FORM DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION 4 - Date Received �s !o-L_o3 Name of Complainant , `' Woo ,, Received By 9 - Address 1 q 9 ��+ �A. Telephone - 2% 0 - 3 G O Y Complaint S•ys k �s ,�-e/.0 j s 'f-u�<« cl w 4 S h w ft. � 1 n +- -h- C- cl L 4 -"-So •-t�� 'f 'e�"% Person Responsible for Complaint i 4� C /40- �' LL- e Address — / �� nC �'� K -A Telephone ? J2?I Directions to Complaint CA:!,�e-4 Date Investigated _ Complaint Justified Action Taken _U Date _ (DCHD 1 03 Investigated By ✓ Complaint Not Justified a(0 D(LA I►J 00-1 7t,� -7-D SdPL `f.- 1—. SY F t -i I v A t,4 -i s 'fn Pak%71/T t9f_ CA L, Environmental Health Staff Signature s ' Co co � F— (1 .11A) Z 7286 -- cQ o „ y 1mm7 13 7063 00 (147) 349 1 (1.07A) o 7941 1 ____19 6bf (1.14A) H F -- 59 ARMINGTON 185 t� THODIST N RCH 695 7674 160 18 - -1 51c L 5 AD (2`,23 _ ) w (513) 1948 (1.74A) 5487 193 229 4 9 259.9 .. 3 f1933 2,�1 p}3�� X�3.1 � I� 33 0 ,;.1� 0 1.00A 345 0 70 (7 r K CD (28 a S30 M N -- _ - (1 .61A) 09Q9 18 � 269 1891 Q- � (12 -, 888 (5.88A) 5831 �. 9892 z1 00 0 --- ------------9669 0 FARMINGTON VOLVNI EM �, FIRE DEPARTMENT DAVIE COUNTY HEALTH DEPARTMENT ) %/?- 7i/I 10A (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR DATE PERMIT LOCATION } NO SUBDIVISION NAME S. R. NO. LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME ❑ BUSINESS NO. BEDROOMS NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLEL. YES ❑ NO ❑ SIZE OF TANK 43.- gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY�- CERTIFICATE (8/16/73) LOT AREA OF COMPLETION By *Construction must comply with all o t 61 1002: 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 � ' Date �' , 2 ~7� applicable State and local regulations ��AVI COUNTY HEALTH DEPARTMENT ame: `Ai -I \ fj �� `�! �� Environmental Health Section PROPERTY INFORMATION——" P.O. Box 848 IIArections toert : ro t' ;r ! tr``"� P P Y `Mocksville `NC 27028 Subdivision Name Phone #: 336-751-8760 Section: AUTHORIZATION FOR WASTEWATER Lot: SYSTEM CONSTRUCTION Tax Office PIN.# - AUTHORIZATION NO: IS t.r z A Road Name. Zip. **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 Officgg when applying for Building Permits. (In compliance4with Article 11 of G.S. Chapter 3OA, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems) �� ( �,'�C "`� ' ,� ' ,• "7 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION Lt. IS VALID FOR A PERIOD OF FIVE YEARS. ;NV(RO?4I tNTAL 9EAtAh SPr61ALjST DA E IS UED RESIDENTIAL SPECIFICATION: BUILDING TYPE �W5�_# BEDROOMS# BATHS Z'- # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE I # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY 0 0"4 --DESIGN WASTEWATER FLOW (GPD) � NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1C)CO GAL: PUMP TANK GAL. TRENCH WIDTH S(O ROCK DEPTH 1 ) LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: CJG'�)rtn IMPROVEMENT PERMIT LAYOUT 0,10 I IRS t r ��$ 1 t��"s t 0A P r�"Aii .A 4L { 1.1 ►na u 1,,. i`a 1 AP3 t -2 1 3�3{: 0 wc_� "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: L 130 KA.C4 I " IXA 1 Jv -r -7 rJ A T- 1 N5r=C_Ta1J - 'ia a: CCWV1P L,_—t0D g� t �c3c► ,tK t K 11TOTAL L IrJ W/o A6grJD0A'46 .L-611 cl AUTHORIZATION N0. 1' ? A OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRI D ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPO SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) jWA33 l%ftr' 6QA} , 00 32) g P i � t, (1.11A,) t 7286YN x a 200 j Q . y 1CD ( 772x in KH t 695 . ETR Afl t ` r '%,x ca �" M , ,t� 6 k CD 2a (4.36 1 421 JOIF ` (2 —�—� ' ...` 285},;�� r it �Y 3{ A ' �3 « Z020CP x 1 ,. 143 �� w•_ xn 41 e Y �.<; � � �' � `�' � � fix:.• " i p, "IL----- 9' .. ia,� 3k� , 1�LLQ it lv rv� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION nn tAPPLICATION FOR IMPROVEMENT PERMIT (REPAIR) �j 2 NAME `t'�N��'� PHONE NUM ER ` `✓121 ADDRESS f �iS� CST© SUBDIVISION N ME O LOT# /�4cjecll- DIRECTIONS TO SITE /l .s 'U' t [�``-J DATE SYSTEM INSTALLED �50NAME SYSTEM INSTA ED UNDER qolul— TYPE FACILITY NUMBER BEDROOMS --- NUMBER PEOPLE SERVED T' TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING Ie3 i�.� 51 OL ►-i T—C, DATE REQUESTED q I Ili I©?-,- 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. 1/93 1 'IU4 ^14' AJ L 1'.