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817 Liberty Church Rd:"� r -"-r.. 'S. :.:'a.° �... n.e9'�_ �;'.,-r. t.:__ � :'.�v w!„r .!'-e y.� _. e. .a -I! ♦1 �i Y / _ F ., _ .- - f. .a _ _ -.. '�rer nitfee s r . _ DAVIE COUNTY HEALTH DEPARTMENT Nar.,y�. • < '' ° t" "¢' ° ° ''� Environmental Health SectionPEIj7l X IN!2RWTION ' P.O. Box 848 /(( Directions to property: I"' 'I t , Nlocksville,; NC 27028 Subdivision Name: t r.b :/.,'�;.' Phone #: 336-751-8760 "' Section: Lot: AUTHORIZATION FOR WASTEWATER. Tax Office PIN:# _ - SYSTEM CONSTRUCTION —t— AUTHORIZATION NO: 22 / A Road Name �: Ll «r Zip: f' r _ **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.] 900 Sewage Treatment and Disposal Systems) r � ***NOTI.CE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. '-rNN I RONIM Ej AL SPECIA IST.. DA E ISSU D RESIDENTIAL SPECIFICATION: BUILDING TYPE Tt�V% # BEDROOMS # BATHS_ #OCCUPANTS 1 GARBAGE DISPOSAL: Yes or No COMMERCIAL `SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE ' PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 00D NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER ' .'etc �� "��X REQUIRED SITE MODIFICATIONS/CONDITIONS.. � �` � �-� d�- "" �`'^'' ` """ LA) IMPROVEMENT PERMIT LAYOUT 10 Lf "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: -S, o, AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T STEM DESC IBED ROVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 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. DCfiD 01M (Revised �� v 3 ? 98' __._..._ .. _._.___'. .__... �,: t 4 ��,� �'»�•� a ,r ��. �' ��'� � 6 � r � � � p� s�SrN. � s, ��`��»r�� �'�";c � � 4 �, ��*�», ��;, �; �; i w � s �, -,�e ��u,b'.wa �,.y'"s ��� �ww' � � �'� m a� '� �. & � ���� �� �A �s�, tc� r�^t d� ,:� ,� ��_ � �:��§ �a.*�' a �z Yd1'� �z�%� , � s�u�� � t .�� 4 �� �� � � Y4In����� ��4��$�� t '�,� q�ru����^"�ty'.���ap� � {y�y4"��i' �';�f � �� �3��� � �` �a �������a ���� ��� ,� �,� ;a�,��,���� � � ��,� � � �� � � � �� ��s��w� �?y�,�yx ��tir ' �s�" „�g� , ��� ���`� �� a;« z�`"'-�, , �,� �,rt�a��g . 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