219 Granada Drive Lot 69AUTHORIZATION NO: DAVIE COUNTY HEALTH DEPARTMENT ------ -- '�
Environmental Health Section PROPERTY INFORMATION
Permittee's \ 1 P.O. Box 848 /
Name: U -� �2 Mocksville, NC 27028 Subdivision Name:
Phone # 336-751-8760
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Directions to property: 1 CJ �-.oeIl1iZE� - Section: Lot:
AUTHORIZATION FOR lG
Ua-� l �a �✓id�✓1 �/i �". WASTEWATER ' / D7
SYSTEM CONSTRUCTION Tax O fice PIN.#
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Road Name: 2 Zip. % C
**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 1 ]/of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
•- f y IS VALID FOR A PERIOD OF FIVE YEARS.
kL HEALTH SPECIAL ST D F. ISSUED
2 0 `1 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
-
`'DD /
a =t ;! i r..IN-1 Subdivision Name:
Nanie: i
'Directions to property: t t i r > c C.t�3l\ a 2+~;s Section: Lot: fL
.. IMPROVEMENT 17
PERMIT' % Q
i r) `"r41f1.-:" PERMIT Tax ice PIN:#
A IAZ-t t
Road Name: i i { :.i J «� Z,p:,
**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 Hof G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
} ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
m PLANS OR THE IlVTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONNIi'NTAL HEALTH SPECIALIST TE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
l INSTALLING THE SYSTEM.
a
RESIDENTIAL S ,
PECIFICATION: BUILDING TYPE M H #BEDROOMS �2.. #BATHS �_ # OCCUPANTS GARBAGE DISPOSAL: Yes o No
COMMERCIAL SPECIFICATION: FACILITY TYPE# PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE:: :Yes orNo
LOT SIZL 7 && TYPE WATER SUPPLO-j2:?6IT y DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE "'- GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1, LINEAR FT.
OTHER ' 4;1,�2`t tjftO.J
REQUIRED SITE MODIFICATIONS/CONDITIONS:T4t-�-
IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER* wRISER(S) IF 600 BELDI FIRISHED GRADE*
TJoy-
01PT k)0- FF a7l-L
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"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:
*D -D L'I'u
Ntn Acot �P
PLAIT) 0, TC. < <., -raa u.
(ZVI f'
AUTHORIZATION NO. OPERATION PERMIT BY: V P DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE VUM DESCRIBED AB HAS BEEN INSTALLED i COMPLIANCE
WITH ARTICLE 1 I 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 05/96 (Revised)
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} a 7 eq DAVIE C UNTY HEALTH DEPARTMENT44 1
i
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
i�e�f�,s s l
Name. ; l��
y'Directions to property:
Subdivision Name: DDL//a lle 1' I
Section: Lot:
IMPROVEMENT C v / — �
PERMIT Tax Of ice PIN:# - �,g
!-� � f j/'�1 ..1 � � �...4.
Road Name 1 .i 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/installation of a system or the issuance of a building permit.
(In compliance with Article l I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ENVIRONMENTAL HEALTH SPECIALIST GATE
j ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE -
l9 / PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
SUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE M N # BEDROOMS # BATHS �_ # OCCUPANTS_ GARBAGE DISPOSAL: Yes oCNo�)
t
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE`.'. TYPE WATER SUPPL I `� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE-- GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 2� LINEAR FT. rw
OTHER_(i r � SmCti 9,J Ti
REQUIRED SITE MODIFICATIONS/`CONDITIONS:
t_
IMPROVEMENT PERMIT LAYOUT `
1:4 -APPROVED EF'FLUEKT FILTER* `RISCR(S) IF 611 BELOW FIBISPED GRADE*
1t= TO CUD Lt �� r ".� EXIST►•�1 Cv
TAly
�S t4VT �vLL
M. VAvm-c
**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
F2c It,r31 ae-CL AC,0
SYSTEM INSTALLED BY: KA P)
N� 0av,,-
`zy
AUTHORIZATION NO.. _ OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S M DESCRIBED AB HAS BEEN INSTALLED 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 FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)