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147 Springhill DrPenmitteea-- _ t^ DAVIE COUNTY HEALTH DEPARTMENT Name: �-i�` �/i' t�1 Environmental Health Section PROPERTY INFORMATION � j 1 P.O. Box 848 Directions to property: 1-7 Mocksville, NC 27028 Subdivision Name:6�(._ r (j c-, fir'` cj yeti ' 4 •. c' E ir'(' ;' ,Phone #: 336-751-8760 • z - Section: Lot: AUTHORIZATION FOR _ _ r` /a, lx- Or e fir �j� WASTEWATER Tax Office PIN:# 7�� - `� � SYSTEM CONSTRUCTION Le AUTHORIZATION NO: 003028 A Road Name: 61-1-1° t.+'�°d Cf.r26p: **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) ��''t`� ►n Lj � 1 ��Ib ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION U UtL "� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALT SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE ase # 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 NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEQ � L. PUMP TANK GAL. TRENCH WIDTH .36 ROCK DEPTH10 LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT , t ( l _R ..f. 4""► rt I ,o l I I II FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. A OPERATION PERMIT :�� ' SYSTEM INSTALLED BYa� 'L;` -C— o Z 2 AUTHORIZATION NO. 0 Z ?OPERATION OPERATION PERMIT BY: a ' DATE: / ?© **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DE CRIBED ABOVE HAS BEEN INSTALLED W 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. DCHD 02/02 (Revised) pt 4617 5 `I y G 1 i 7 v•;u-- , 7 2 qY ,{ '��* }. �+ •tt n'µ}CV.,.,;,Ylr° `}Permittees DAME COU I T 1 HEALTH DEPARTMENT Name: /fir ` ��';'7 ' Environmental Health Section PROPERTY INFORMATION to ro ert :• Mo P.O. Box 848 Directions P P Y t ` cksville, NC 27028 Subdivision Name: 4=(•• �iR"i-t,k"L'rf�1 Phone #: 336-751.8760 Section: Lot: E<. 1 AUTHORIZATION FOR .> i • ,( ,_ e''''' w y {� 1 WASTEWATER 00 SYSTEM CONSTRUCTION Tax Office PIN:#, 028 AUTHORIZATION NO: o `� �i Road Name r �' ��f f.�- t" rz<► •J **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. TMs Form/Authorizdtion Number should be presented to the bavie County Building Inspections Office when applying for Building Permit (In compliance ith Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) n �,%***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION t1+V 1 7(12.-16 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALT(I 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 1 DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE (� SYSTEM SPECIFICATIONS: TANK SIZE kyLwjL. PUMP TANK GAL. TRENCH WIDTH 'M ROCK DEPTHA� a/- LINEAR FT. .2-6G l•C 1 OTHER /' % l 124&61 1&61 --v I C INA i v REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT rr 1,o cr _) _,.( cam`► FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: 1;'LtVq AUTHORIZATION NO. 30 Z (i OPERATION PERMIT BY: DATE: 2 �D **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DE CRIBED 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. oellnotioz(Revises) -pj i/r^!7•i� « Y U —7, v i 2 q