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153 Center Circle Lot 17Petiiuttee s DAVIE COUNTY HEALTH DEPARTMENT 'Name. r r-r�l�� .. �L7 Y .. Environmental Health Section - PROPERTY INFORMATION C".U:t�iCL.; I.�IttYt0.Wittli�CiLCiB�t�Goi4-0.0.Box848 'i My Directions to propert3: Mocksville, NC 27028 Subdivision Name: S ECC E ttiLG 6'� 1 k N I� l' j , . Phone # 336=751-8760 Section: Lor. l: �► AUTHORIZATION FOR *"i_2 " WASTEWATER Tax Office PIN:#' n p SYSTEM CONSTRUCTION AUTHORIZATION NO: ''2204 A Road Name:{ ` zip: P **NOTE** 7his Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior ro 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-ptcle 11 of .S, Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems) /.' /' - ' ! . ,) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION tf - Y/F" IG .IS VALID FOR A PERIOD OF FIVE YEARS. kXIMR T M AL CIALIST DATEISSU D ` -- RESIDENTIAL SPECIFICATION: BUILDING TYPE idw-e# BEDROOMS -3 # BATHS I # OCCUPANTS " . � GARBAGE DISPOSAL: Yes or No . COMMERCIAL SPECIFICATION: - FACILITY TYPE - .# PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No ��(vMMVfOt1� Wt%'S LOT SIZE I TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �NEW SITE REPAIRSITE SYSTEM SPECIFICATIONS: TANK SIZE TT� `GAL. PPUMPP T�AhN-K �t GGAAL. TRENCH WIDTH ROCK DEPTH I 2 - LINEAR FC. 200 . OTHER �/�p,,(.' REQUIRED SITE MODIFICATIONS/CONDITIONS: I t�STRU- ` i �"�^y1 ' IM/X, 1`/�%t��i "�Ot � I �"7 - **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 (j36)751 -V60., 2nme ua.i.c 2� yr v.a. annrAnn ijvn, ac ,,u o.vw uc.. r.s.. -----..... .,..., .. .... .,., .... GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME., _ DCHD 0202 (8 isan .. < 'tot [ A, P a r a 1 Perms e " 'Y DAVIE COUNTY HEALTH DEPARTMENT ;- Environmental Health Section PROPERTY INFORMATION ♦. t Y,}�� y�4 /walr,ml:k ollti s./ l edtit rl I,, LovI%."O. Box 848 - Directions to property: -f'' Mocksville, NC 27028. r Subdivision Name: •-' liar( It';'�'-" �•j� , Phone 336-751-87¢0 ,fsIVIL +� t l r Section: Lot: I `�', AUTHORIZATION FOR I - -4 # �, - .'-WASTEWATER'j. Tax Office PINN - - '� SYSTEM CONSTRUCTION 22041 AUTHORIZATION NO: A Road Name: `' _,;Itz' Zip: of **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv Environmental Health Section prior to issuance of any Building Permits. This FomdAuthorization Numbershould be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I I of G.S. Chapter 1130A Wastewater Systems, Sectwnn 1900 Sewage Treatment and Disposal Systems) 4 ycy, % ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION tr I -,'+ / ' �" / �`' t , +� (, tIS VALID FORA PERIOD OF FIVE YEARS > 11.ENYIROiYW1CNTAI�H @1.ITt4SP CIE�ALIST �DATEISSU D - RESIDENTIAL SPECIFICATION: BUILDING TYPE r tv>y�". [n BEUROOMS �7 # BATHS- 1 q OCCUPANTS i� GARBAGE DISPOSAI:i Yes or No ` COMMERCIALSPECIFICATION: FACILITY TYPE # PEOPLE _ # PEOPL&SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE,cam kr TYPE WATER SUPPLY �h'3NV�'. DESIGN WASTEWATER FLOWiy(GPD) ��' ONEW SITE -,REPAIR SITE "'.SYSTEM SPECIFICATIONS: TANKSIZE, GAEL, PUMP TANK GAL. TREJNCHWIDTH `-'� ROCK DEPTH �2_' LINEAR FT. OTHER tf l:. 1 1� (�t6 t lli� J.I.�KL.S REQUIRED SITE MODIFICATIONS/CONDITIONS:'rJ�'fI�U- G?J C-.O'�I�4;,V#`�'41i4"�l.f uKKGl�7 IG t.ii {LI CIA IMPROVEMENT PERMIT LAYOUT r 3 ��' . ' fat w ice— r2 c KKT> ;vinCf< n .5Sr (�a� t¢.vr) urJ�S **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 INSTALLED. BY: 1,< 11 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. DDHD 0=2(Revised) '+• - . u' 7tt- " " DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT No of cBedrooms Date 1_62 -`RJ I/ _ This permit is granted to jai _,Lc`r�i%. cm for the installation of a septic tank at the residence of Address Building Contractor : Address r Septic Tank Specifications:' Len h_ Width Depth Capa _ Gal. -7 p /, � � � Manufacturer's Name Q.0-�-Q ✓ -�=a/ � Address P/, No of lines_ width in. Total Length rift No. of Sq.- Ft. ,%© -?k o? Llz:� Type of filter material :#' /O c / �n Total tons used Minimum Requirements: House Trailer'. / Tank Cap. 800 Sq. ft. line 400; Two-bedroom.housc 800 600' Three ,bedroom house 900 900 No one shall install a septic tank' in Davie County without a permit from the'Health Officer or his agent. -7 Date of final approval c5 %off Signed: /1 7 nitarian I hereby certify that the above septic tank has been installed according to specifications. j Signed:(:Ae , Septic Tank Contractor Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville. 13. 17 DITUH? 11TJ.4all YT"O.TJOD ..W e1>7 VA 04 0.,.lo Za—cT C± ovo(b, c,111 O't lja; brva zfq,ria 'Ir.) %,ozd Ex Z.',Otrx�a Rt:("cralb to r Ijcai IlLf�c Of�Q 07 cz:il. YO.O'H to aw E��,oj lr�JOT-lo tz COO gzO -T 7 74 G'Jii 00i ri S cr--C,,rj, -.5OvIT VIT ovo(b, c,111 O't lja; brva zfq,ria 'Ir.) %,ozd Ex Z.',Otrx�a Rt:("cralb to r Ijcai IlLf�c Of�Q 07