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246 Danner Road Lot 46 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account M 990001671 Tax PIN/EH M 5820.65-2567 Billed To: Jeff Wilson Subdivision Info: Pepperstone Lot#46 Reference Name: Location/Address: Danner Road-27028 Pro osed Facility: Residence Property Size: see ma ATC Number. 3013 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 I I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATEY-69NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. A&V Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. Septic System Installed By: Environmental Health Specialist's Signature: Date: o- DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT a • Environmental Health SectionP.O.Boz 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001671 Tax PIN/EH M 5820-65-2567 Billed To: Jeff Wilson Subdivision Info: Pepperstone Lot#46 Reference Name: Qy,,-r- .=r &,-/.t.), P~s Location/Address: Danner Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3013 **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 TypeA _ #People 7 #Bedrooms 3 #Baths Dishwasher: E!r Garbage Disposal: ❑ Washing Machine: 0' 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) -T45d Site: New Repair❑ System Specifications: Tank Size/ goO GAL. Pump Tank GAL. Trench Width,- �Rock Depth Linear Ft. � Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6°G BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Dav' tyHealth Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the da o i stallation. Telephone#is(336)751-8760.**** r Environmental Health Specialist's Signature: ° Date: P � DCHD 05/99(Revised) AnnWAY N IN WE EVAILIMMOV1111111SOVDAEK PFRUTT A ATC Davie County Mono Depaeb"M an*VftfiMWWHP.O. Boa 8Rospiba street Hootaville, 21C 27028 D:r-E V E (996)751-8760. ••*nmQ UJM*•• =13 LPPLICR21(m cum"sr PROs U=v mass ALL Tse R:Quit m NOV 16 2001 =MNOMOtt Is PRdvIDLD. Refer to the nWov t=mi l umgTIN for instructions. 1. KOM to be slued Congos estrus ' tt�tliae advise.. e r• muse rhos. c G?� F1:1tlRON,'PTAL eatr/stete/ap awls... rhea. '` Cl3 DNECOUNly 2. w.aa on sesait/arc As 6d 1 nftees/e�nt/�6hpo��syo ye S 61OULp add"" P!V &,Y, C1Wst4Wx1r a. Applloation Fors /its !valuation 42tgprovameat Parnit/ATC ❑ Both 4. aretea to a.r.ie., $Bonne ❑ mobilo Rose ❑ Bpsi—as ❑ Industry ❑ Mar S. It Reetdwice: i Peopls e Bedroo" r •Rathrooms l.heae6er n mete"biepeeel 91—I my%Sba"M a 0 Msrr+t/me elvsbine S. It eyealiy two a aeople a stake r Coenod.e I s:weese a Nriman!F_• a Neter coeless Ir mODnxnc z: #t seats astinsted tracer usage (eallen.per der) 1. Type o: "etas supply: iConatr/City ❑ van ❑ community e. Do you andc1pate oddidoua or e:penbm of the heft thissystem Is Intended to serve? ❑Yes 1WQo uyea.w>uu type? •••IMPORTANT'••CIJVMMUSTtIOMPLEMTN6 XWLIAMPROPERTY INFORMATION REQULWW BF.WW. EldwraPLAT or/SIT "AN HUSTDRSU•SM)TMb theelkat with THISAPPLtCATION. Property Dimenslods: r�;y41+�df���X//J:tWRfrR DIRst:nONs(am MM/«hM#e)to PROrEirrv: Tax omeePINt toil1aa F-S—/37Ala-L4RAF''�_ ► 6o/ Property Address: Read Naso u R 1CJlR/Jt/JLQ�� !�lR 70.2- uis a SebdirWoo provide inforutalloe,a hilaim G! New. 7/%A a�%l��.Si/� 'd/l �✓� Seedou• Biodts Lot: -36 Date Property Flagged: This It to esrtiy that the talbmdon provided Is coered to the beet of say knowledge. I understand that soy permit(s) Waled herestler are subject to suspensl.n or revocation,Utht dk pleas or Intended we change,or U the Information mbtsUlad Is this appHead s k fabdf6d w ehenged. I,efso,tradentand tAall our rapeaslNe for all charger iscurrd from tAh applicsllou. I,hereby,ghee contest to the Anthort"Representative of the Dade County Heakh Department to enter upon above described property located to Dade Comely and owned by—* to eoeduct sit testing procedures m necessary to determine the site snits illry _ DATE 1Gt. �b 1 SIGNATURE ,�/J'✓ THIS AREA MAY BE USED FOR DRAWING YOUR STIE PLAN a stt of the hilowlsg: Eztstlag end proposed property tines and dimsoaloss, sttxtarea, setbecb, and septic Wtims). Site Revolt Charge Dsk(a): Client Notification Date: EHst yy I C(r---•— S,vF Lf t r Account No. V U / � Revised DCIID(07/9 __ r f Lrelee No f i w a■� mlmsa2aY .1'S,tt...�... jS �4A.,,.ar..� �� 1 s l au» s7r - f.ti.■1—� m a1. Yr■. _— f cc•T++•• R OP RPPROYAL or _ �—-—_ M f[lR1rR1■I M It few / M6 TM ��-Z fS•S1tlT e !STOyA.e S ].IT _ mr w 1�1��w�■�. ema s �.Y°•' I+o.ar- �7 .�••+m a I�w.�7R+'� •f IfRIRR o M / K r--- - ]o_]y _ i■a1�tYt Rrs Or+srOa r �s/.1V !17 3 s6■.s s.s s Rt■ai1■ol s IPa R■ /Oast a ire — IV lTs`a f1 y2 Va.L. bl 2.1 1.0 .nu�w �' -140,31 ej s Wu„j �y a om/'■�' ' i t1?� 3 _JOS.sy b 6!•raPRMa 7P.. I•RWR2 alrOt•RIR 11■O■■rM� � �— e ��a � / '�'G °• R� e b ; •/� LOTS s"Veo bT. Dw ai+J /°t -Ie n e i ; • PRIVATE L/OIVIOUAL IIRR R R A Z 3 • MO ORIVG'w ATS lllAll 4. e i ; °r A ST eeT Rf°MT ZONEo R-A R"•001 . A' • Ip R• l+ Y Q ^ i •2675 La1U.R PELT C ]d RGM 7flS, m IY SIDE \l `O 'A A id J \\ a• f iO.2f"]y #10, ]y 'OOpo x $$ EE Q A 40. u H T � s a. PEPPERST \ !_ ZSO ��R'�,�� Di 9 O aL \\c \�C2� Z z ~ 1 i o SUB Tai z • OWNER Op f o •P - irs�p- CLAUDf n 190 NORT MOCKWLU �'pN• /ti° Ri' Ils, IS 7/`• soh _- TELEPHONE: e _ +s1' 1 1uBLIC I G4 3 ..'► Z BEING TAX LO' cirm f 2 P+Y° RECORDED IN DEE 1p °•;�a ; -�� _ es-- e r»'.raN E CLARKS O ei 3 - --- la�of� DAME © xI 3 a s O7 k'o s N•s~w-R n var SURVEYED e n ; 3 �.7ev • BY KENA ® R REleRVGD TI4LT m ^ !c • 9 : 3 i i // =s1 0 'I 0•: � .•i O � Rma O! TOTAL AREA IV e.w a R' r......•i / M1.221lf.20• !0Oy71p e =AyhrD, s,uw2r ,/ N�a"+�tla rr ^ofq f!ltivsr E k°y GUPTON—FOSTI R ar S1w2P. R. 767.lY , 2fy7. N 7` Iffy t.mom r-IMOO / sri ENGINEERS-PL L.-23LM L-2M.2T RIn N • 2200 SU GRAPHIC SCALE f.ATMe■IYP aPR '•Sf, 2jlf jjpp0 ]a2* S ,. . TALI LOT s 73MAPas '9 w- s n•rar w ,,,, ,��,aN WINSTON-S OEM BOOR 36 PAYETELEPHONE » TwX LOT♦ 7.ruP Y4 ; oeea aooc at Pwef Ios I��� ' MnTt tau P AT eT RR Iwr!Ga OTNddff!4rrr.n