Loading...
137 Westridge Road Lot 31DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR OPERATION PERMIT ACGOunt #: 990005906 Tax P€N/EH #: E811 OA002 Billed To: Brian Groce Subdivision Info: West Ridge Estates Lot # 31 Reference Name: Rem+ r Location/Address: 137 West Ridge Road -27006 Proposed Facility: Residential Repair Property Size: 0.51 ATC Number: 5956 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type: S.T. Manufacturer Tank Date Tank Size Pump Tank Size Bedrooms System Installed By: Installer#: Date: GPS Coordinate: F Environmental Health Specialist: DCHD 11/06 (Revised) Date: 't DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR Name ?rt L Telephone Number Address ( 3'1 C - Mailing Address (if different from a ove) Email Address: rT11 e -b -- Subdivision Name J Lot # � Directions Date System Installed — Name System Installed Under L� Type Facility Rts, ) fy-�( Number Bedrooms Number People Served Water Supply Specific Problem ON— Ic-�bL SI L, pLafiTYPe Cx 1 I., W 4S a+5{-. "J,,, Is —R,-i�?ex ILI V'S Date Requested q — II — 1 - Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION POVIDED IS CORRECT TO fhE BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent '� a Initial Fee Date REHS Revisit Charge Date Reason Revised 2-2011 C< DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION ACGOUnt #: 990005906 Tax PIN/EH #: E811OA002 Billed To: Brian Groce Subdivision. Info: West Ridge Estates Lot # 31 . Reference Name: Repair Loc tionlAddress: 137 West Ridge Road -27006 Proposed Facility: Residential Repair PropeW gF:. %yT XZepair ❑Expansion . ** T�,, ** Thi 4horization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental ��Tl eal "c on pr9 orr to -issuance of any building permit(s) '(in compliance'with Article 1 I of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms_ # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size_ Type of Water Supply: OCounty/City OWell ❑Community Well System Specifications: Design Wastewater Flow (GPD)Tank SizeI*L. Pump Tank / GAL. Trench Width ✓ Max. Trench Depth Rock Depth / Linear Ft. i Site Modifications/Conditions/Other: Contact the Davie County Environmental Hedlth Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. Re 141C ,Jim jtaFatk tiuo A 764k- a?rrb" "# a5 C_ Environmental Health Specialist VY Y Dater �� DCHD 11/06 (Revised) ��7� DAVIE COUNTY HEALTH DEPARTMENT '. • • (Septic Tank) Improvements Permit and Certificate of Completion 800 ' (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR ' ..1� , :,! {,s ;r•- .,, } .;';, . DATE ,;,/77 PERMIT LOCATION i •_ r4 •. n n r fir • `' � n i,t;'� , k--..; . e_.- f N0 1316 L$ U S.R. NO. SUBDIVISION NAME LOT NO. t3I SECTION OR BLOCK NO. BUSINESS SIZE OF TANK Z2 gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: 07 0/1 /!u t/ WATER SUPPLY: Individuals Public ❑ IMPROVEMENTS PERMIT BY Q0P J1A,00-.3 CERTIFICATE (8/16/73) LOT AREA OF COMPLETION BY— *Construction must House Trailer 800 Gal. 400 Sq. NO. BEDROOMS .?.t NO. BATHROOMS Gal. GARBAGE DISPOSAL UNIT YES ❑ NO L$ AUTO. DISHWASHER YES Q NO ❑ AUTO. WASH. MACHINE YES Q NO ❑ SITE SUITABLE YES © NO ❑ SIZE OF TANK Z2 gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: 07 0/1 /!u t/ WATER SUPPLY: Individuals Public ❑ IMPROVEMENTS PERMIT BY Q0P J1A,00-.3 CERTIFICATE (8/16/73) LOT AREA OF COMPLETION BY— *Construction must House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. ��k �t " UJ - «:1 INSTALLED BY L, P f}%24.- Date ��z -72 ly with all other applicable State and local regulations �, Sa.. -x:09 � cv-�- ' ! �� o�'�• �a.../i N v1,01I