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113 Cameron Court Lot DDavie County Health Department ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems) ***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 whe applying for Building Permits.*** NAME AUTHORIZATION NURBER T r DATE .7 /3J ` r 0 11 `' i A42rNAME ON IMPROVEMENT PERMI (If different thane� above) /` /� y SITE LOCATION }1. ✓✓/l ►°'� Xe,11—'7 / iy�1�� COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM *H*NDTICE*** THIS AUTHORIZATION FOR WASTE ATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL HEALTH SKCIALIST DATE DCHD 10/95 �,•„ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **MOTE#* 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/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) / r n r 3r`J11v PROPERTY ADDRESS A d r D 270(3(- DATE LOCATION SUBDIVISION NAME LOT NUMBER ?Q SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS -V # BATHS # OCCUPANTS —4�— GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY _ DESIGN WASTEWATER FLOW (CPD) P NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH --?/,_ ROCK DEPTH �Ijl '� LINEAR FT. -;� OTHER ��-`��lXi°� REQUIRED SITE MODIFICATIONS/CONDITIONS: IAr 1�f1%'i /P�r9. '.6�r�S ,�'.���'r��°/ /girl „1,ANv;1- *"THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM jjid 1pj �O�v pok d&, ir Pill 901, IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FIM. INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE I)AY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERA TIPN PERMIT p Q0.0 a SYSTEM INSTALLED BY o" // AUTHORIZATION N0.&12 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. DCHD 10/95 *�- DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **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/installation of a system or the issuance of a building permit. (In compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME !fr' PROPERTY ADDRESS RGi. 1 i c� !� :a; G ,� % J U �� DATE 6 LOCATION SUBDIVISION NAME %ii +��/ J r!`!'%/( LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE/%:?;.sr # BEDROOMS "/ # BATHS # OCCUPANTS _,Z— ,GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE 2� # PEOPLE/SHIFT # SEATS C INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW (GPD)"" NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH `�'� LINEAR FT.,,.,fJA f;3 OTHER- �� r. REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR•WASTEAWATER SYSTEM CONTRACTORMUST_ SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM< rp e 0 (It) i `*,� >j Jr/ J7,lr• 'CSC. J de� IMPROVEMENT PERMIT BY orf **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 DA,Y OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT 003 AUTHORIZATION NO. e94127 SYSTEM INSTALLED BY e_ OPERATION PERMIT BY i'/I /r� DATE F, **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 .1980 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT -SHALL IN NO WAY BE TAKEN AS A GRANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION y APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) `/ oe NAME Y i c PHONE NUMBER ADDRESS ©� SUBDIVISION NAME LOT # DIRECTIONS TO SITE 6 `ve la DATE SYSTEM INSTALLEDNAME SYSTEM INSTALLED UNDER f� TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY___4. SPECIFY PROBLEM OCCURRING DATE REQUESTED 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 I . �� �®fig• , DAVIE COUNTY HEALTH DEPARTMENT e`er IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOT�Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c ;mel a Treatment and Disp sal pules (10 NCAC 10A .1 934 968) Permit Number Name71 .� _� l/4 /&-1—VYto No I' / - 5692 Location )6%a/Y<<�4111 � �,Pr��,/ COu� T_. _: L��P�1/�- / f B � �-✓ �e' Subdivision Name Lot No. Sec. or Block No. Lot Size House —— Mobile Home — Business Speculation No, Bedrooms, No. Baths i— No. in Family Garbage Disposal YES C] NO ga- Specifications .for System: Auto Dish Washer YES NO ❑ r� Auto Wash Machine YES NO Type Water Supply. *This permit Void if sewage system described below is not installed within 36 months from date of issue. 61d Improvements permit by *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 day of completion.. Telephone Number: 704-634-5985, Final Installation Diagram: System Installed by j Certificate of Completion Date % *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will'function satisfactorily for any given period of time. DAVIE COUNTY- HEALTH DEPARTMENT •�:� ._. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `NOTE. Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c ` Se/wa a Treatment and Disp�saI Rules (10 NCAC 10A .1934-.1968), Permit Number Name's/7�l r=_ r'l// milli //L//,;ii/�;.D to//; /`� ' NO Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms J� No. Baths r_2 No. in Family _ Garbage Disposal YES p NO E]— Specifications for System: Auto Dish Washer YES E] NO p Auto Wash Machine YES C7 NO p Type; Water Supply _— *This permit Void if sewage system described below is not installed within 36 months from date of issue. I Improvements permit by *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by 7\ �.7 5~ Certificate of Completion / ���f- ✓ Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. f . j i 7\ �.7 5~ Certificate of Completion / ���f- ✓ Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND . CERTIFICATE OF ,COMPLETION "4NOTE:. Issued in Compliari"d&, iiith, G.S. of North Carolina Chapter 130 Article 13c" Sewage Treatment and "Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name Z?AN�N _S'Sf4L .Date %- 2 344.1 Location . Subdivision Name- Lot No. _ D Sec. or Block No. Lot" Size House Mobile Home _ Business Speculation No. Bedrooms 3 No. Baths Z No. in Family Garbage Disposal YES NO !SV. Tp g p �'Specifications for System: Auto Dish Washer YES 0 NO l] "`. e " - F .` - p D -AP 'X 3'X, Auto Wash Machine YES [f' NO.:fl Type Water Supply. -- *This permit Void .if sewage system .cIesc ' ed beIr is not installed within 36 months from date of issue. l' 7- 9- 1-71 -1-7' tr' Improvements.. permit by YV\a-,:A '_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 day of completion. Telephone Number: 704-634-5985.. Final Installation Diagram:System Installed by LF Certificate of Completion I/, Z,�, - / Date The signing of this certificate shall indicate that the system described Ulbove has been installed in compliancy with the standards set forth in the above regulation, but shall in NO way.be taken as a guarantee that the system will fun�tion satisfactorily for any given period of time. bd�Jv/1 �a DAVIE COUNTY' HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND, CERTIFICATE OF.COMPLETION jNOTE.' Is ued in Compliance with G.S: of North Carolina Chapter 130 Article_ 1_3c ` f ,•. Sewage Treatment and Disposal Rules (10 NCAC. 1 OA- .1934-.1968) Pelrmlt lumber Name Ssea Date• 44 Location Subdivision Name /�%���%�'� a`` �f/�l �'� Lot No. Sec. or Block No Lot Size House. Mobile Home _ _ Business Speculation '7 - No. Bedrooms-- 3 No. Baths' No. in Family Garbage. Disposal YES fl NO E� Sy�• T� b G, ��uy e `aa,, �. r ,JC. Auto Dish Washer. YES NO y Specifications for System: ,,•-- F 0"' fl .' 2 r o au �Q .. C%I a .,? e� - Z c�pC - 2un 1jl j',Y / Auto Wash Machine YES Cj NO C] Type Water Supply�.rI' *This permit Void if sewage system Oesc ed beLaw is not installed' within 36 months from date of issue. Improvements permit by *Contact a .representative of the Davie County Health Department for final inspection of this. system between 8:30- 930 A.M. or 1.:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.' ; Final. Installation Diagram System Installed by '� C�A-r• 1 L :`41 L rll Y 41 Certificate of Completion - Date } �' 'The signing of this certificate shall indicate that' -the system described above has :been installed in"compliance with- -the standards set forth in the ab-ove 'regulation, but shall in'NO way betaken as a guarantee that the system will function satisfactorily for any given period of time. 1. Permit F 2. Address 0 T (J APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 3. Property Owner if Different than Above Address Home Phone V y� -A �2 6 �L Business Phone fAlo N 4. Permit To: a) InstalI e�Alter Repair b) Privy Conventional Other Type— Grounq Absorption c) Sub -Division ►vSec... Lot No. 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people uwc � 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions ay '� o Bed Rooms_ Bath Rooms c� Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals — garbage disposal lavatory showers — washing machine dishwasher 1 sinks i 8. a) Type water supply: Public f Private Community b) Has the water supply system been approved? Yes ---'--No 9. a) Property Dimensions SPC 0//27` /9, b) Land area designated to building site v D c) Sewage Disposal Contractor- 10. ontractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best f my knowledge. �I Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing -1 4 . • pttbie (gauntV Pealth Pgyartment ttn� xume Xculth '�gencv P. O. BOX 665 ciockswille, cNurth (garolina 27Q28 OFFICE OF THE DIRECTOR TELEPHONE May 15t 1984 17041 034.5083 Mr, Randy Sisell Route 3. Box 247-0 Advance, N.C. 27006 Re; Sewage Treatment and Disposal System for Lot D, in Raintree Additions Davie County. The on-site sewage treatment and disposal system installed at the above mentioned location, is of such design that an Operation Permit is required from this office. This Operation Permit is issued instead of a Certificate of Completion. As of January,l, 1984 G.S. [130A -337(b)] requires an Operation Permit for any system that has the following: Pumps and/or grease traps, any alternative system, systems with a flow rate greater than 480 GPD, and systems serving mobile home parks. This Operation Permit is valid as long as the sewage treatment and disposal system is in compliance with Article 11 of G.S. Chapter 130 A, and all conditions imposed by the Operation Permit. This letter shall serve as the Operation Permit for the sewage treatment and disposal system at the above mentioned location. Date of Issuance -/r'".I`� By a./"" Title. y Davie County Heath Department andHome Health agency Environmenta(Heaf& Section P.O. Box 848 / 210 HOSPITAL STREET COURIER #09-40-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 September 13, 1996 Robert Gorgia 113 Cameron Court Advance, NC 27006 Re: Repair Permit/ATC #0427 Raintree Addition/113 Cameron Court Dear Mr. Gorgia: This letter is in regard to the repair that was done on the septic tank system that serves your residence at• 113 Cameron Court in Advance. On September 6, 1996, Mr. Robert Fuge pumped your septic tank. He reported to me that there was a large stream of water coming into the tank as he pumped. The plumbing fixtures should be checked in your home to make sure there are no leaking commodes or faucets. I Water use figures obtained from the Davie County Water System reveal an average daily usage of 450 gallons per day. This figure is at the top end of design flow for your septic tank system. This office recommends that reduce flow shower heads be installed for each shower and baffles be installed in commode tanks to reduce water usage. The area over the new drainfield should be sown with grass as soon as possible. RH/wd If you have any questions, feel free to call this office. Sincerely, Robert P. Hall, Jr., R.S. Environmental Health Section