The URL can be used to link to this page

142 Hartman Ln3v:""y r :a•ry . :: r ,�y-,� ,.�a.. � .e;tri.. r—+p. :.� .;—{�rr�<r., -4<..nr. Ai a+ x•n.,� �,1 ;r,��.k&v t �'y.� :Yj•v°�;v',¢t,.i:.rr °�}; ..Sf"' 1+' r :`.�} ;,jro'^°+k Ji f AUTHORIZATION NO: 'i 9 9 7 ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERT INFORMATION PgrmitteB' P.O. Box 848 Name: .� , Mocksville, NC 27028 Subdivision Name: Directions to property: /� Phone # 336-751-8760 •,r'`/�irfJJtlf✓.t�©.�r' Section:' Lot: .. AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - 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 `Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �' *. ✓ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Ef4VIRONMEN'AL HEALTH SPECIALIST: DATE ISSUED `ei 9 7 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERT INFORMATION . Pgrmittee'- Name: �Ma r, �' •') Subdivision Name: DirectionstQ property:,62 Y %'%! J ��e%F f Section:Lot: ' IMPROVEMENT - fj > �. PERMIT Tax Office PIN:# - Road Name: Zip: **NOTE** This. Improvement Permit DOES NOT authorize the construction' or installation of a septic tank system or any wastewater system. An AqI HOR1ZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/mstallation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. . RESIDENTIAL SPECIFICATION: BUILDING TYPE t # BE L DROOMS � #.BATHS �_ #OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No .LOT SIZE TYPE WATER SUPPLY `5 DESIGN WASTEWATER FLOW (GPA) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH J 6; ROCK DEPTH LINEAR FT. -,26 D OTHER i REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT*APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE* "CONTACT A REPRESE ATIVE 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 (IAY60- /6(y x (336)751-8760';, DCHD 05/96 (Revised) • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION • APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) mar/C YS' o7L- /t= V NAME n eNU 4 -T rn vo,tJ PHONE NUMBER / � Z �-�'i- /r A-� �/� �'`�� t F -e � rat. (,�,t,.lt- 7w- 3 8' G �' ADDRESS SUBDIVISION NAME �- LOT # DIRECTIONS TO SITE nr FA R-m.---�-l�S -5�-f 4-r &-,r- r• o ss + hti�L, T l �-/ 13 t't c�C �i o cu t "�A-� a x,/ -,I/ DATE SYSTEM INSTALLED % L NAME SYSTEM INSTALLED UNDER�s�-i��'+"��-� TYPE FACILITY NUMBER BEDROOMS "JC NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING �S 4- L test, h DATE REQUESTED 2 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. I11- � SIGNATURE OF OWNER OR AUTHORIZED AGENT .� C �' flev. 1/93 �-a o 0-A, Ifs a O 0 3 �� ,�;---, ;5:/7718- } t DAVIE COUNTY HEALTH DEPARTMENT • IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: lssued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name—_.o�_4 AAI C „� �t /ttJ� � — Date F Location 7-6 F _ Subdivision Name Lot No. - Sec. or Block No. Lot Size --House Mobile Home _ _ Business -- Speculation No. Bedrooms _�& .2 No. Baths — No. in Family — GarbaI YES NO ge D isposa U L Specifications for System: Auto Dish Washer YES q NO U �a �/C Auto Wash Machine YES Q NO U Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by *Contact a representative of the Davie County Health Department for final inspectionof this 'system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by _&t4K i Certificate of Completion �,� °a Date "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time.