P0612 McKnight Rd 4- qn, DAVIE COUNTY HEALTH DEPARTMENT 'x,410
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's d
Name: Q Subdivision Name: L,
Directions to property: #'"� ;�,: =. l� ` Section: Lot:
4r IMPROVEMENT
PERMIT Tax Office PIN:#
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Road Name:-1-1 ,, f. ii 6tA,4j : A,10-106
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1 I 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 TYPENI%- �l� #BEDROOMS #BATHS Z _#OCCUPANTS GARBAGE DISPOSAL:Yes o nN
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:YesorNo
LOT SIZETYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE 12-0—')—GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. +
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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**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(704)634-8760.
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OPERATION PERMIT
SYSTEM INSTALLED BY:
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AUTHORIZATION NO. 2 OPERATION PERMIT BY. ry�i �sl, \c*-�,�^J DATE: '' I
**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 ti•,
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised)
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