143 Oak Tree Drive Lot 135-136i..lw•-+-9w'M.Rs�'�^-+�'�'.T -.-, _ L. ,...r .. -.._.. ., _ .+%il..7.%e...-%:e�'fi;:d'. -
�Permittee's /� AVIE.COUNTYHEALTUDEPARTMENT
Naive: �`,: . Environmental Health Section PROPERTY INFORMATION
✓r f} :r» P.O., Box 8481:
a 'Directions to roT.�l+i/ :iYNt
P Pe Y: .-,Mocksville, NC 27028• Subdivision Name:
Phone #:.336 751-8760 `
Section: f Lot:
AUTHORIZATION EOR
sg w� WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
AUTHORIZATION NO _ A Road Name. Zip:
-� '
**NOTE** This Authorization for Wastewater System Construction MUST BE.ISS•UED.by the Davie County. Environmental Health Section,prior
to issuance of -an Building. Permits. This Form/Authorization Number should be presented to the Davie County Building,lnspections
Office when applying for Building Permits;
(ln cor)pliance with Article I I of G.S. Chapter 130A, Wasfe%vater Systems, Section .1900 Sewage Treatment and Disposal Systems)
/ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
lY. t J IS VALID FOR A. PERIOD OF FIVE YEARS..,
EN IRONMENTAI EALTH SPECIALIST' DATE IS UED
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
' a
LOT SIZE TYPE WATER SUPPLY •DESIGN WASTEWATER FLOW (GPD) EW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANI{•SIZE GAL. PUMP TANK, GAL TRENCH WIDTH ROCK DEPTH LINEAR FT: '
OTHER'
:REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT (C t
n, --s-
f04
/:
**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.
"'
Permittee's `AVIE COUNTY HEALTH DEPARTMENT
Name:/r'r J `�.yf Environmental Health Section PROPERTY INFORMATION
P.O: Box 848`
Directions to property: , . .. /'fir" ` r w�% Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760 j
Section: / Lot: ,✓s
` r AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
AUTHORIZATION NO:A Road Name: Zip:
**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.] 900 Sewage Treatment and Disposal Systems)
a ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
C • I <'ar �.; Y %'f f it 4 IS VALID FOR A PERIOD OF FIVE YEARS.
'iENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROO # BATHS J # OCCUPANTS, GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY _� DESIGN WASTEWATER FLOW (GPD) ��/ iNEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Z.4 —LINEAR FT..
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
n d d X),�a4� ((--') C- s ,
0��/6
QI oln s �01)A /o����
i
S -
/LqP
w , V) /,7 , L/-), , e 41,
**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:
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.
DCHD 01!02 (Revised)�977 B 0 W
't DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name �- �'� _ Date /a�
Location _
Subdivision Name 1
Lot Size-rL�L`- House Y
No. Bedrooms No. Baths
–
Garbage Disposal YES p NO Er --
Auto Dish Washer YES NO
Auto Wash Machine YES NO p
Type Water Supply
Lot No
Sec. or Block No.
Mobile Home _ Business Speculation
No. in Family _
Specifications for System:
"This permit Void if sewage system described below 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-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
i
F
System Installed by
Certificate of Completion"'
"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.
4pDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name `'' �/� Date AlZ
Location
1\
Subdivision Name .(
Lot Size Lz` House —
No. Bedrooms_ No. Baths
—
Garbage Disposal YES E] NO -e�
Auto Dish Washer YES NO F-1
Auto Wash Machine YES j NO 0
Type Water Supply
Lot No
Sec. or Block No.
Mobile Home Business -- Speculation
No. in Family _..,
Specifications, for System:
`This permit Void if sewage system described below 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-
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
I6 l
19
Z—
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.
J
DAVIE COUFTY HEALTH DEPART :TE ?T
ENVI.0111-MUTAL HEALTH SECTION
SOIL/SITE EVALUATIOV
DATE
LOCATIOt1 ����
LOT SIZr / � L --->e/
TOP OGP.APIIY I
SOIL TEZTURE s
SOIL STRUCTURE':
DEPTH: 1�
'E STRICTME HGPIZOVS e ` �✓�
PERCOLATION FATE:
1.
2.
3.
C0MMUTS a
SITE DIAGF.APa
Presoak
Fark & time I
Drop Time Rate/1-dr. Inch
lly Suitable Unsuitable
SAVITARIAI-?