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785 Turrentine Church Rd +i tMiiJS G p Hca!' - .w.,,�i. n1»....�1�t+ 1_._..,�.y•' aa:'•• f ._ y. AUTHORIZATION NO:` DAVIE COUNTY HEALTH DEPART ENT 'Environmental Health'Section 1 PROPERTY INFORMATION Permittees P.O.Box 848 ..,Name:' �� A - = Mocksville,NC 27028 S division Name: ections to property. 1 � "I� At--`I4'"-� Phone# 336-751-8760 Dir Section: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - ,SYSTEM-CONSTRUCTION A' c.U'T ,ivy t L-Lc # 7`b"�" Road Name: ` Zip: 7CZ. **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 Fonn/Authorization Numbershould be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 f G.S.Cha pter:130A,Wastewater Systems,Section.1900.Sewage Treatment and Disposal Systems) i ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIR�N E EALTH� PES IST DATE SU � ,- t".' q� r.,. ",t rte:• d wa. �} 7 a.e -, �,4; r N sDAVIE COUNTY HEALTH DEPART ENT42 2 z .e IMPROVEMENTAND OPERATION l PROPERTY INFORMATION Permtttee'� Name.` � iln r� .- t-- C 1 � i3 r division Name: Directions to property: �t""-i i. "1�,.' 1 A��� ^�' Section: Lot: ( IMPROVEMENT 9g-EH-D G,O�O� �� L.,44 J c: N L.r: ,,t+1 iJ>:. PERMIT - 1 Tax_Office PIN# Road Name. P **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of aseptic 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 f 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 ENVIR6NME T fIEALTII SP TAI DATE SSU D. { SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE .INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE M H 4 BEDROOMS 2 #BATHS #OCCUPANTS I GARBAGE DISPOSAL:Yes or Jo COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE' � �" TYPE WATER SUPPLY �-t- DESIGN WASTEWATER FLOW(GPD) J NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ' GAL. PUMP TANK' GAL. TRENCH WIDTH- ROCK DEPTH I«' LINEAR FT.�3 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: 't`as�4L-L (�n� �r.J'TD oe, yzz .�t IMPROVEMENT PERMIT LAYOUT =AppliOVED ECFLUEUT FILTER# *RISE Ii(S) IF 6" BELOWFIEtISHED ,Cs.4t4ill;a" tj D LL - �. � � rip � •� �. 11 ; Iry **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. OPERATION PERMIT SYSTEM INSTA LE r•)I,-)� 1^�0 -t� I t �T 1�� L� d� ►, . 1go�Lrt, Eska>� 'fv. (�aG►L Puy 31�� UP nn Nor.,. AUTHORIZATION NO. ` ' OPERATION PERMIT BY: DATE: 8 "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S S M DESCRIBED ABO AS BEEN INSTALL IN WI H ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 03/96(Revised) j: il 2 DAVIE COUNTY HEALTH DEPARTMENT ,/ IMPROVEMENT AND OPERATION PE Mj<T 1 PROPERTY INFORMATION �G �bdivision .N�.ame: 1<. _ s�<_�"� _� .�'l��` S r.� 1SName: Directjons to property:_a, ` y ..>.1,. 1 c►:t Section: Lot: IMPROVEMENT 6 FD,004, s ' ► t 3,.. ,} , (,, r`1 �t `.'� } , +PERMITTax Office PIN:# - 1� . l ,L .°+'1 !v � ..1'v1'.,1� L Road Name L **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of aseptic 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. 3 (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) r ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAi:HEALTH SPECIALIST DATE SSULD SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE • INSTALLING THE SYSTEM. ._ RESIDENTIAL SPECIFICATION:BUILDING TYPE H #BEDROOMS fir- #BATHS I#OCCUPANTS I GARBAGE DISPOSAL:Yes ord!o­-'*% COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY WL=� DESIGN WASTEWATER FLOW(GPD) 2 L4C) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH atz�l ROCK DEPTH 12 LINEAR FT.2'�� OTHER t tLTI(';t iij✓T10^aX REQUIRED SITE MODIFICATIONS/CONDITIONS: jr4'F-'�'\L-L- ©^, IMPROVEMENT PERMIT LAYOUT +APPROVED EFF'LUERT FILTER& $RISER(S) IF G" BELOW FIRISIIED GRADE& W-ra-1,1 v "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. s OPERATION PERMIT SYSTEM INSTA LE I�L��-�IL.- �k.J rJnJ I,J(7 1 a�p ��b �..(..t•J�=- N C'� cAn..Pt-�-rG t s CAsY-A), >j —soL,p fv\. AUTHORIZATION NO. �y� OPERATION PERMIT BY: DATE: Uhq "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S S M DESCRIBED ABO44 AS BEEN INSTAL4 IN COMPLIANCE WITH ARTICLE 11 OF G.S.�HAPTER 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 05/96(Revised) i