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173 Raintree Road Lot 9AUTHORIZATION NO: 0758 DAVIE COUNTY HEALTH DEPARTMENT F��-� �a � 3 � ,U V . ;. Environmental Health Section PROPERTY INFORMATION ; 3� Permittee' . P.O. Box 848 Name: �� t� C� \ ? �`�`�" Mocksville, NC 27028 Subdivision Name: Phone #: 704-634-8760 Directions to property: ` �= — �'��ri Section: Lot: AUTHORIZATION FOR _ *`, "i? i�, WASTEWATER }-`l ?`'`' �� y.v�'. s `��� .�h-- " �" SYSTEM CONSTRUCTION Tax Office PIN:# - - Road Name: Zip: U0 **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) ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. 7 . f DAME COUNTYHEALTH IIDEPARTMENT}d+, ,4 t IMPROVEMENT AND;OPERATION PERMITS PROPERTY INFORMATIO Fi Subdivision Name: Fx Directions to property. w� :� � Section: Lot: a PERMIT Tax Office PIN:# , Road Name: t�yo v —,q, `k Zip:. GA *NOTE** `This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewyste�n An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to, the const uction/iristallation of a system or the issuance of a building permit (In compliane�owitlAticle 11 of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems) a •-- ***NOTICE*s* TALS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE YOUR wASTEWATEIt ENVIRONMENTAL SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THLS PERMIT BEFORE HEALTH p : INSTALLING THE SYSTEM. r RESIDENTIAL SPECIFICATION: BUILDING TYPE'ha,i� # BEDROOMS 7 # BATHS #OCCUPANTS GARBAGE DIS Y�s No COMMERCIAL SPECIFICATION; FACILM TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE 7< Of,^ . TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 6 � NEW SITE IAIR SITE f SYSTEM SPECIFICATIONS: TANK SIZE) GAL. PUMP TANK GAL. TRENCH WIDTH 3 ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: �. J IMPROVEMENT PERMIT LAYOUT "CONTACT A REPRESENTATIVE OF THE,DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECIION,OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00. - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760. i DAVIE COUNTY HEALTH DEPARTMENT 1 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pemiittee's Name. - i.. �`� � • ' ' ` Subdivision Name:Directions to to property: t? Section:—T Lot: _ . IMPROVEMENT ' PERMIT Tax Office PIN:# Road Name. Zip: ' **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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/mstallation 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) J ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED / SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE (1--t- # BEDROOMS # BATHS # OCCUPANTS 4 GARBAGE DISPOSAL Yes-ot No COMMERCIAL SPECIFICATION: FACILITY TYPE (� # PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE J< c z=.P''> TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) JA O NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE!L' a ' GAL. PUMP TANK GAL. TRENCH WIDTH �"� ROCK DEPTH LINEAR Fr. U OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: a IMPROVEMENT PERMIT LAYOUT 1-i 1 i 1 n ". "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 (704) 6348760. OPERATION PERMIT SYSTEM INSTALLED BY:`��k. N its-• • � � 'tJ Q.S, AUTHORIZATION NSD OPERATION PERMIT BYDATEA ^ "THE ISSUANCE OF THIS OPERATION PERMIT SHALLINDICATE THAf:THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 FUiCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. LA -nu wroo tKevisea) - e ♦ 4 t, � .. e. 1. ,. ��°'jy r DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) -Improvements Permit, and Certificate of Completion_ r (Ggrounyd �bsorpt on Sewage Disposal Sy'stem� - G.S. Chapte •30&ticle 13C) . ,.OWNER ORtCONTRACTO , ! .:!��� •/�� DATE 'r`i ��� PERMIT Z �N . s... LOCATION 1811 i S.R. NO. SUBDIVISION NAME �! LOT N0. SECTION OR BLOCK NO. HOUSE MOBILE HOME BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. . : _N0. BEDROOMS NO. BATHROOMS800 _ Two Bedroom House Gal. 600 Sq. Ft. • GARBAGE DISPOSAL UNIT YES ©+ N0 ❑ Three Bedroom House 900 Gal. 900 Sq..Ft. AUTO. DISHWASHER YES ( NO ❑ Four. Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES NO ❑ '1 SITE - SUITABLE YES ❑ NO ❑ tk ._ SIZE OF TANK gal..Ado., NITRIFI CATION. FIELD' sq. ft. pEPTH OF'STONE IN LINESsIry �/ �- , .WATER SUPPLY: ` Individual ❑ Public - ❑ IMPROVEMENTS PERMIT- BY INSTALLED BY�a, }jam r �•- CERTIFICATE OF COMPLETION By ND Date (8/16/73) *Construction must comply with ll other applicable State and local egulations " LOT AREA G . :�O 9 Q °� y . l_ • DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27023 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAVE ""/ ���, DATE ISSUED ADDRESS v r39Y IN1 PERMIT NO. tij- S, A/, Explanation of charge AMOUNT DUE /" SANITARIAN PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT. ria DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME R A h `A TV, PHONE NUMBER �� g ' tD 3 �1 ADDRESS �� �A�`tJ�\ZQe �a SUBDIVISION NAME c� I 'P"N c.Isk s N 'e et� � �� LOT # DIRECTIONS TO SITE b F - �\ a`� �'0� S I -A o-� DATE SYSTEM INSTALLED I01 ­1g NAME SYSTEM INSTALLED UNDER UA\x TYPE FACILITY Z-o-� NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED 4 TYPE WATER SUPPLY Q -1c,, SPECIFY PROBLEM OCCURRING o DATE REQUESTED y^ q, INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 J • cBaVie (naun#g Pealth Department Unb game xea th '�geurg P. O. BOX 665 Pachsbifle, �Tarfh (guralinu 27028 OFFICE OF THE DIRECTOR May 27, 1987 Ann Forrest Rt. 3, Box 247-C Advance, NC 27006 Re: Sewage Disposal System Check Old Section/Raintree Estates Dear Ms. Forrest: As per your request, a representative from this office visited the aforementioned site on May 27, 1987. The purpose of this visit was to determine the condition of the sewage disposal system. At the time of the visit, there was no evidence of any problems and everything appeared to be functioning properly. Please advise should this office be of further assistance. Sincerely, Charles Little, R.S. Environmental Health Enclosure CL/wd TELEPHONE (7041 634.5965