The URL can be used to link to this page

116 Pepperstone Place Lot 29 DAVIE COUNTY HEALTH DEPARTMENT • _ - Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900284 Tax PIN/EH M 5820-65-9431 Billed To: Piedmont Triad Construction Subdivision Info: Pepperston Acres Sec.1 Lot#29 Reference Name: Kyle Swicegood Location/Address: Pepperstone Way-27028 Proposed Facility: Residence Property Size: 112 x 270 ATC Number: 2170 **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 Q)3 #People #Bedrooms 3 #Baths 2— Dishwasher: Dishwasher: l" Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Id A2270Type Water Supply Cbor ny Design Wastewater Flow(GPD)�� Site: New DalRepair❑ r� i! System Specifications: Tank Size GAL. Pump Tank GAL. Trench Widthj&L Rock Depth JZ Linear Ft.Z3001 Other: Required Site Modifications/Conditions: t;;rJ C-A0.- 100 k� K--ja' It er-�p IR20P irt� =>; -S!t9�pp CIS, IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW NISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this s tem between 8:30;k. to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** L�pA2ow.53' _ fQ�Ung p' N t° 3 ,so o Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900284 Tax PIN/EH#: 5820-65-9431 Billed To: Piedmont Triad Construction Subdivision Info: Pepperston Acres Sec.1 Lot#29 Reference Name: Kyle Swicegood Location/Address: Pepperstone Way-27028 Proposed Facility: Residence Property Size: 112 x 270 ATC Number: 2170 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 Treatm d Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE S TION IS V OR A PERIOD/SOF FIVE YEARS. Environmental Health Specialist's Signature: ate: "/ l,�10 In CER IFICA OF COMPLETION N **NOTE** The issuance of this Certificate omple on shall indicate the system described on Improvement/Operation Permit has been installed in compliancw th Art' le 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. x r 8' Septic System Installed By: Environmental Health Specialist's Signature: Date: 7 do DCHD 05/99(Revised) APPUCAMON FOR SITE EVAWATION/INPROVEINENF PERMR de A Gavle County Health Department 16M9 Envlrvnmanb1 Health Section 9.0. Box 848/210 Hospital Street Brooksville, NC 27028EN1►IRONMENTAL HEALTH (336)751-9760 DAVIE COUNTY ***I)JPC rTaNT*** THIS "'IMICA210H CANNOT SB PROCBOMM V=88 RM M RZQUUMD IHTOIMMII)H I8 PROVIDZD. Roger to the INTORM Itui BULLETIN for instructions. 1. Mame to be tilled r4 contact "coonr�� W leeVaA4 Meiling Address ©• /1)z y /j70 � sone Phone //J�/ /Q/6 city/state/azt 1f C'K S y/"/fY Business Phone -- a2� L� a. gratis on Await/ATC it DUlerent than Abore Wiling address city/state/sip a. Application Tor: 0 Site evaluation 0 Improvement Verait/ATC aeoth e. systen to sardoe: 0/ons* 0 mobile Ron* 0 Business 0 Industry 0 Other s. It�Residences # people i Bedrooms _3 s Bathrooms Rlt ishwshar 0 Garbage Disposal tip✓dashing Machine 0 Moment/Plumbing 0 Beswnt/Ho Plumbing !. z! Business/zndustry/Other: specift type # People # finks i Commodes i showers I Urinals I water coolers IT TOt 83MICS: # Seats Zstimated grater Usage Isallons pm day) 1. Type of water supply: B4O& my/City a Well 0 ccamusaity e. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Ya "o If yes,what type? � ***IHPORTANT***CUENTS HUSTCO'MPLENTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED ky the client with THIS APPUCATION. Property Dimensions: X ?J�i WRITE DIRECTIONS(from Moeksville)to PROPERTY: Tax 081ce PIN: # �`Sa d - 6/6'-94131 &14/ Al 7U da hhw v /'ONgor/ 11,kA, Property Address: Road Name, fD,06;r,0r576h e .!/av -fiD ,/54 d Al;-if citynip r�7Uo2 INj t Of U in a Subdivision provide information,as follows: Name: �4 Section: _�_ Block: Loh r GA=L.. Date Property Flagged: This b to certify that the infbrmflon provided Is correct to the best of my knowledge. T understand that any permit(s) Issued hereafter are subject to suspension or revocation,If the site plan or intended use change,or if the Information submitted in this application Is fshilled or changed 1,also,undemand that I an responsible for aU charges lncurrtdf vm this application. D,hereby,give consent to the Authorised Representative of the Davis county Health Department to enter upon above described property located In Davie county and owned by to conduct all testing procedures as necessary to determine the site suitability. r DATE �` l5r 1�/ SIGNATURDI , TM8 AREA MAY HE USED FOR DRAWING YOUR SITE P (Include all of the followingt Existing and proposed property lana and dimensions, stractnres, setbaclu, and septic locations Site Revisit Charge Dah(s)t Client Notification Date: EAS: Account No. �� Revised DCHD(07!99) Invoice No. J�