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4142 Hwy 801S' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR OPERATION PERMIT Account #: 990005833 Tax PINIEH #: HJ800000028 Billed To: Tommy and Brenda Beck Subdivision > Info Reference Name: LocationlAddress: 4142 NC HWY 801 S.-27006 Proposed Facility: Residential Repair Property, Size.,,r.1 17 Acres ATC Number: 5889 **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. System Type: S.T. Manufacture—er Tank Date Tank Size_ Pump Tank Size j Bedrooms System Installed By: Inspector#: Date: -:3#4A012 GPS Coordinate: T Z1. 3,,�cJ A3§ Environmental Health Specialist: DCHD 11/06 (Revised) 0 010 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.'Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax # (336)753-1680 REPAIR IMPROVEMENT PERMIT AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005833 Billed To: Tommy and Brenda Beck Reference Name: Proposed Facility: Residential Repair ATC Number: 5889 Tax PINIEH #: HJ800000028 SuWivision Info: LocationiAddress: 4142 NC HWY 801 S.-27006 Property Size:- 1.17 Acres Site Type: Repair f<Expansion ( ) **NOTE** This IP/ Authorization 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 IP/ 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 chance. Residential Specifications: # Bedroomss # Bathrooms 2 # People 2 Basement❑ Basement plumbing r Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size Q t_ Type of Water Supply: DCounty/City Z.Well ❑Community Well System Specifications: Design Wastewater Flow,(GPD)36D Tank Size AL. Pump Tank /GAL. Trench Width Max. Trench Depth -VG Rock Depth LinearFt.-..;7 Site Modifications/Conditions/Other:�y Contact the Davie CountyEnvironinental Health Section for final inspection of this system between 8:30 – 9:30a.m. on the day of installation. Telephone # (336)753-6780. � r , .t a � ley D�HD 1,1`/0'6_(R.euised) a... d.: , w ... ;:. sa-. ..., .. � ,� m ..rs+.-"•_:�'f1 s e. r,�'. r • `M;..i r.sY r`... eap` < ... :. . ... - r ..,. ` .. .. .. ... '• , ..- 29 DAVIE COUNTY HEALTH= DEPARTMENT 5 . IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued 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 c) tyc'-' Ce. N e c.� " Date \ - 1 ' zS c7 N2 ¢� U Location �—. y0% - Subdivision Name. Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family_ Garbage Disposal YES-;[] NO gf Specifications ,for ,System: Auto Dish Washer'• YES "& NO Auto Wash Machine YES [V" . NO ❑ Type Water Supply _ 1$ *This permit Void if sewage system described be 0 'swot 'nstalle 1 within 36'months from date of issue. h Improvements permit by\ q-,'�,", �~ � *Contact wrepresentative 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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: 0 *The signing of this certificate shall Indic the standards set forth in the above regul satisfactorily for any given period of time �) a/ 0 rtificate of that the on, but sh; System Installed by pletion Date L _D 0 ',In m described above has been installed in compliance with NO way be taken as a guarantee that the system will function X0,% INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT PHONE NUMBER 4�ADDRESS �j / .T o�G '�����'l SUBDIVISION NAME 4Jv, , IVC- HIA �� ff`�j SUBDIVISION LOT 0 RECTIONS TO SITE G . / . D Q ST s D 1'J DATE SEPTIC SYSTEM INSTALLED 7 NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER SPECIFY PROBLEMS THAT ARE OCCURRING ALs, DATE REQUESTED: f ���` % INFORMATION TAKEN BY ` ZA& _ DAVIE COU J'I�Y4IiE�1 �E� MENT 4NZ lVellI!(/ !© �',5. ' (Septic, Tank) Improvements Permit and Certificate of Completion fidUvlwe (GroundAbsorption Sewage Dposal System- G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR �`'��'� /l �: � ��� DATE � i �-- >.w� _ r) n PERMIT 77006 LOCATION n �,�f fit �c'z.�N�i-F r~ `... ND 846 t _411•�'� . '1 S.R. NO. S BDIO�i NAME LOT N0. SECTION OR BLOCK N0. HOUSE MOBILE HOME ❑ BUSINESS ❑ NO. BELMS NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO .-',AUTO. DISHWASHER YES Q�NO 0 ❑ AUTO. WASH. MACHINE YES I�❑ SITE SUITABLE YES Lam' NO ❑ SIZE OF TANK 2 o,= gal NITRIFI I ON FIELD sq. ft. DEPTH OF' TONE IN LINES: � rr WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY' fi r CERTIFICATE OF CO14PLETI0N By (8/16/73) *Construction must comply LOT ARE i a House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 9 0 Ga 900 Sq. Ft. Four Bedroom House 10 Ga . 1200 Sq. Ft. 3371 INSTALLED 7.S � ti ) P�-Tit-G�-i'-t•-1� it-� �, Date th all other applicable State and local regulation