The URL can be used to link to this page

1089 Hwy 801SPermittee'�sr / DAVIE COUNTY HEALTH' DEPARTMENTName: t�`�rirrrad/ Environmental Health Section PROPERTY INFORMATION P.O. Box 848 -'? �Diigections to property./ ' / a+� t� � Mocksville, NC 27028 Subdivision Name: '7 IV Phone #: 336-751-8760 fr --1 4,01, 1�r"��° .n /%� ; f rt'J Section: Lot: � •..T AUTHORIZATION FOR ` .w /5'- ,, r WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION AUTHORIZATION NO: 05 A Road Name: Zip: *NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv 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 Pen -nits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ��{.� **.*NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION /�_ =!';�! 2 IS VALID FOR A PERIOD OF FIVE YEARS. E .VIRONME TAL HEA TH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS �17 # BATHS_ # OCCUPANTS y GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: ,FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �/ NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. ;TRENCH WIDTH \ ROCK DEPTH LINEAR FTC>9eV OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: "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 1 SYSTEM INSTALLE BY AUTHORIZATION N 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. DCHD 02102 (Revised) NAM DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER_ / 1 U /'/0 7 ADDRESS ' © &-d 1 S SUBDIVISION NAME C- LOT # DIRECTIONS TO SITE g° 1 � c�C1AX- 1-a►-i� % sl p �% ��l��. DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER LO ✓�-,j� TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING W a—$ �^--�--`L- DATE REQUESTED �l 01 INFORMATION TAKEN BY DL 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 DAVIE COUNTY HEALTH DEPARTMENT of Bedrooms '� SEPTIC, TANK PERMIT "his permit is granted to (cU .it the residence of =�l?, Date- �' �� for the installation of a septic to uuilding Contractor r Address �Fvl « V Septic Tank S ' pecifications: plo Address Length _Width De th Manufacturer's Tdarne� P Capacit Gal. c Nc., of lines Address width 3in. Total Length 7yce of filter material 1 T _.��' ft. No." of S o -- -� c f q • Ft . Minimum Total tons used ementsti Requir: House Trai�er Two-bedroom house Tank Cap. 800 Three-bedroom house 800 Sq • ft . -line �+OU approval 900 6GG i+o one shall install a septic t Ohis agent. y without a 900 tank in Davie Count Date of final a permit from the Health Officer �,� I hereb / Signed: Y certify that the above septic tank has been installed r/ according ° ifri�- ita g to specifications• Signed: Note: Plake skethL of disposal Septic Tank Contractor P al system on back of sheet and mail to Health Center, Mocksvilh, i r � � 5�`�'� r ��p � =��s r � � > � � ,. , � i ,,,>� ' , ` , �--�--�1 " `� -' - . � _ . �, � � . �au --- .......__._ �'� _ _ .. .� �� _. ` } : �� ------_--� �,�,,.i� � ; ) l. � . . 5 _ �, l -t �