The URL can be used to link to this page

114 Autumn Ct Lot 5 : DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH#: 5708-06-7210.05 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.1 Lot#5 Reference Name: Larry McDaniel Builders Inc. Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: 0.690 Acre ATC Number: 2199 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type TT #People #Bedrooms C3 #Baths- Dishwasher: 0 Garbage Disposal: ❑ Washing Machine:S2r Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Jfa Site: New la' Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width 2� Rock Depth 1,2 • Linear Ft,—?2D Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 K BELOW FINISHED GRADE. ****NOTICE: Contact a rep es tive of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1: 0 .m.on the day of installation. Telephone#is(336)751-8760.**** -F±J L^ Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900063 Tax PIN/EH#: 5708-06-7210.05 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.1 Lot#5 Reference Name: Larry McDaniel Builders Inc. Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: 0.690 Acre ATC Number: 2199 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: / Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion s all'n irate the system described on Improvement/Operation Permit has been installed in compliance with Article 1 of . .Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be td en s guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) nrrua Arturo ruts WIL EVALUAIIUN/IMPROVEMENT PERMIT do ATC r, a Davie County Health Department EnvftanmentafHMO SWUM P.O. Bos 848/210 Hospital Street OCT i 3 (999 MocksviIle# NC 27028 (336)751-8760 ***IH80RTAN"** THIS APPLICATION CWWM HH PROCESSED UNLESS ALL TM REQUIRED - - INFORMATION IS PROVIDED. Refer to the INrORMATION BULLBTIN for instructions. 1. name to be Bill Contact Person Wailing Address 5ri fl. � no" Phone city/state/zipfl) 5 ar1 ok Bnsines. Phone Z. Bast. on Permit/ATC If Different thaanAb�ove t� Waaiiing Address Pn zcn/(n nq _1 Ci t7/state/LiP L R1 of a. Application For: ite Zvaluation RlMrovemnt Permit/ATC 0 Both s. systats to service: .4jHouse 0 Mobile Hoard 0 Business 0 Industry 0 Other a. If Residence: # People # Bedroom # Bathrooms r _ ,�Olshwasher 0 Oasba9e Disposal Nashitrg Machine C Basement/Pluodw a Basement/no Pluabing 6. If Business/Indsstry/other: Specify type - # People # sinks # Commodes # showers # urinals # water Coolers Ip TOODSERVICB: Seats 8atimated Nater Osage (gallons per day) 7. Type of nater supply: 1�\�unty/City 0 Nell 0 Cowamanity a. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes,what type' ***IMPbRTANT'**CLIENTS AtUSTC AfPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITIED by the client with THIS APPLICATION. Property Dimensions: 2L Del x ) WRITE DIRECTIONS(from Moduville)to PROPERTY: Tax Otiice PIN: # 3 A OP;-70k-0(0- r7@ Property Address: Road Name City/Zip I I (2m DnAA 1-0 1yJCfT)1(J If In a Subdivision provide laformatlon,as follows: Name: jn,12 2,-)4 �4 A/1 !LS or11 Section: �_ Block: Lot: Date Property flagged: Ibis Is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation,If the site plans or intended use change,or if the information submitted In this application is falsified or changed. I,also,andawmdthat I wn mVomiblejor all charges Incurred front this applicadon. 1,hereby,give consent to the Authorized Representative of th Davie C—on ty ealth D`ep men to enter upon above described property located in Davie County and owned b. VU to conduct all testing procedures as necessary to determine the site suitability. DATE r 1C) I SIGNATURE • THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structuns, setbacks, and septic locations). age .aq' �O 4 un Accot No. c/ � Revised DCHD(07/98) a g�.�}� t Invoice Na ��✓ ,... ucitituiv rues hitt tVALt1All0N/IMPIl0VEMENI PEBMI1&AIC Davie County Health Department F[APR Envltonmenfof Health SL-cffon P.O. Box 868/210 Hospital Street 0 1999 Mookaville, NC 27028 (336)751-8760 ENVIRONMENTA TH ***IMPORTANT*** THIS APPLICATION camwT BE PROCESSED UNLESS ALL THE IRe INFORMATION IS PROVIDED. Refer to the IMVPMATIOH BULLETIN for instruation�s/.� �L 1. Name to be Billed Ld"all C&'ecl ez / fiCSContact Person L I /i1 i C gyp/►'/ �t�Ju r E/ Nailing Address D 5 •�� _ Home Phone g&, /' " 1 l Q � l`i�✓ City/State/LIP U S v/ �% J� Q //��B"iness Phone Zk -- s. Name on Pewit/ATC if Different than Above Nailing Address �JD�GJ`7 City/State/Lip /1/OLf�sy- /�/✓C ��D� -�J a. Application For: U Site Evaluation AImprovement Permit/ATC ❑ Both 4. system to Service: House ❑ Mobile Home 0 Business 0 Industry ❑ Other a. If Residence: # Peoplems _ / Bedrooms / Bathroom ,kDishwasher D Garbage DisposalNashing machine 0 Basement/Plumbing Il Basement/no Plumbing 6. If Business/industry/other: Specify type # People # Sinks # Caamodes # Showers # Urinals # Nater Coolers IF FOODSERVICE: I Seats Estimated stater Usage (gallons per day) 7. Type of water supply: County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes,what type' ***1MP0RTANT***CLIENTS AfUSTC0A1PLEIETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PIAT or SITE PLAN MUST BESUR&OZTED 4y the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksvilie)to PROPERTY: Tax Office PIN: # � .3 P.:1""�,�/L�ey o6 " F `B Property Address: Road Name City/Zip Ar 141 I/G /��o7i a r✓ Do-tf.•t- If in a Subdivision provide information,as follows: 131 Name: Section: Block: Lot: Date Property Flagged: This is to certify that the information provided Is correct to the best of my knowledge. 1 understand that any permi (s) Issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if.the information submitted in this application is falsified or changed I,also,understand that I am reVonsMlefor all charges Incurred from this application. 1,hereby,give consent to the Authorized Representative or the Pa*County H th Department. � to enter upon above described property located in Davie County and owned be ar�J to conduct all testing procedures as necessary to determine the die sui DATE 774Z4�J SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD(07/98) Invoice No. APPUCA710N FOR SHE EVAWAMON/IMPROVEMENT PERMIT do All `VJ Davie County Health Department t ' • EBox 848C/ Hosfal pital ospitfth on P.O Street NOV 1 8 1998 Mookaville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***ZHPCRTANr*** THIS APPLICATION CHID OT BE PROCESSED ONLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFOPIMION BULLETIN for instructions. 1. same to be Billed LA p, Contact Person Mailing Address �� Ad`� acme Phone / City/state/Zip TIr„1��j �s��. / IlJ • �. d-� <K1 Business phone F� Z. same on Permit/A=19 Different than Above Mailing Address City/state/Zip 3. Application For: + Site Evaluation 0 Improvement Permit/ATC 0 Both a. system to Service: 2 House 0 Mobile Home 0 Business 0 Industry 0 Other s. If Residence: # People # Bedrooms # Bathrooms 0 Dishwasher D Garbage Disposal 0 Washing Machine 0 Basement/Plumbing 0 Basement/so Plumbing 6. if Business/industry/other: Specify type # People # Sinks # Commodes # shovers # urinals # Water Coolers IP FOODSERVICE: / Seats _ Estimated Water Osage (gallons per day) 7. Type of Mater supply: t�'County/City 0 Well 0 Community e. Do you anticipate additions or e:pauslons of the facility this system Is intended to serve! 0 Yes 0 No If yes,what type.' ""IMPORTANT'*"CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT orSITEPLAN MUSTBESUBMITTED by the client with THIS APPLICATION. A Property Dimensions: __ ,, , DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # J Property Address: Road Name b Aw' at-Ale-my r-h Jr-n,"J It J .r" 4-J City/Zip if in a Subdivision provide Information, Informatiion,as c If �9( A : y2z Name: . l ill � ► �� tile Jb 04L-l- AIN Section: "� Block: Lot: � Date Property Flagged: Tifi-�* This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or Intended use change,or if the information submitted in this application Is falsitled or changed J,also,understand thaf I am reWonsible for all charges Incurred fro m this appU a don. I,hereby,give consent to the Authorized Representative of the Davie ounty Health Department to enter upon above described property located in Davie County and owned by o�CI to conduct all testing procedures as necessary to determine the site suitability. S�4'Lv-e DATE 1, SIGNATURE L � of THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Inc�ie l of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD(07/98) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT 5 Soil/Site Evaluation APPLICANT'S NAME /JAl✓1 4 r DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE ��Y we SUBDIVISION d izq z� vL ROAD NAME rDAdi l Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence i Structure /c ! Mineralogyj HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE L SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD(01.90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■e■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■Mee■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■Mee■■■■Mee■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MEMO ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■e■e■■■■■■■■■■■■Mee■■■■■ ■■■■■■■■■■■■■■■I■■■I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■III■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■■■■■■■■■■Mee■■■■ ■■■■■■■■■■■■■■■■■■■■■Mee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Mee■■■■■■■■■ UMMEMEM MEMNON MMMEME iMEEMME MEMNONMEMNONMEMNONMEMENE ■■■■■■■■■■■■Mee■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ee■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■Mee■■■eee■eeeee■■eee■■eeeeee■■■ ■■■■■■■■■■■■■■■■■■■■E■■e■■■■■■■■FA■■■■ONION■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■e■■■■■■■■■III■■■■■E■■■■■■■■■■■■■■■■IIEO■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■E■■■■■■■■■■■■■■■■■■■O■■M■■■■■■■I■I■O■OEE■■■■■■III■■■■■■MMI■■■■■■ ■■■■eeeeee■■■■■■■■■■■■■■e■■■■■■■■■■■■■Mee■■■■■■■■■■■■■■■■■e■■■■■■■ ■■■■■■■■■■■O■■■■■■M■■■■■■■■■■■■■■■■■■■■IO■■■■e■■E■■■IMI■■■■■■■■■■■ ■■■■■■■■■■■■■■■Mee■■■■■■■■ecce■■■■■■■■■■e■e■■■■■■■■■■■■eee■■■■■■■■ ■Mee■■■■■■■■■■■■Mee■■■■■■■■eee■■ ■■I■■M■■■■■■■M■■■■M■■■■■■■■■■■■■ 309 "OAKLAND HEIGHTS" s!• PB 4 O PG 122 Z N �r �► TOtO/ 0 •r. ryy 3 A287.29°26'25 oN8•f0'25" 'z28 X88 G •ZV2„ EIR Ben .N 10 NO �� ',0 v moo •`� ,� O '� O ; Old House Sr ,t•., L-15� � ^� c vo � � � '' �3,26E 46.2 � N 24.1125"W 287.9T y N 22.23'50"Wg.g535 3a r N 'o �1 4 L'3 �, • 1�� • L-5 :— 2r2a,20"W 285.95' N 23.28'35"W 167.11' _.._ - }Yr Permitte_e's „ DAVIE COUNTY HEALTH DEPARTMENT Name: "t i ( '��0 1/r�z Environmental Health Section PROPERTY INFORMATION P.O. Box 848:" y Directions to properiy: /�✓' ; ��n /�, r 1 Mocksville,NC 27028 Subdivision Name: " Phone#:336-751-8760 --- }tt::�/� Lr"tw/fi s1+./ �•'' Section: .f Lot: r AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION . AUTHORIZATION NO: 229. 1A 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 comQliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) } /'�•°! .t ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION / IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEAL'THH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE_� #BEDROOMS #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 DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL., PUMP TANK GAL. TRENCH WIDTq- ROCK DEPTH LINEAR FT � OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT *,*CONTACT A REPRESENTATIVE 4HE 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: ; AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 02/02(Revised) Perms tee's DAVIE COUNTY HEALTH DEPARTMENT y - L�Tameu ' Environmental Health Section PROPERTY INFORMATION �• .:. P.O:Box 848 Direction§oto property: ��,/ Mocksville,NC 27028 Subdivision Name: v�'' ', f•% r 336-751-8760 Phone#: �- '� ,�f Section: Lot: ' AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION NO: 2291 A 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 f ;/ +� c'„ ✓.�j IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST. DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE_ #BEDROOMS #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 DESIGN WASTEWATER FLOW(GPD)-7<�<) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANKGAL. TRENCH WIDTH' ROCK DEPTH / LINEAR FT: OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT `✓�'�j i A **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. i OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. 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. c} DCHD 02/02(Revised) � 7