P1571A Hinkle Dr )RIZATION NO: 7 `�A DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's < P.O.Box 848
Name: Luc —=L-!�'`y� ��I�wl��aasville;NC 27028 Subdivision Name: LAVe LN3i�
Directions to property: (,w� '1�� Phone# 336-751-8760 Section: l�l r
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# �
SYSTEM CONSTRUCTION
s) Road Name: 07-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 applyin for Building Permits.
(In compliance with Article 11 G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION.FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
NVIRONM TH SPECIAy# DA E IS UED
RESIDENTIAL SPECIFICATION:BUILDING TYPE-M ij #BEDROOMS:S:_#BAS THS S�Z #OCCUPANTS GARBAGE DISPOSAL:Yes ito
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
' LOT SIZE26 ft-1--\C'TVPE WATER SUPPLY�1 DESIGN WASTEWATER FLOW(GPD)21-(VC NEW SITE_ REPAIR SITE
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I it
'
SYSTEM SPECIFICATIONS: TANK SIZE I 0 LOCAL PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 2� LINEAR Fr. / i
S
OTHER I �T(�► [ TI c�rl3C
1 REQUIRED SITE MODIFICATIONS/CONDTITONS: Gk t` ' �'�"•1 -�''�'j *-�%�t' 'y f F � +. tJS-7A(-t-
� c:uJQ
IMPROVEMENT PERMIT LAYOUT*APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE*
NI a UNIT
-70
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*"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
i BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(70t AW t x
(336)751-9760
I OPERATION PERMIT
SYSTEM INSTALLED BY: �L
I
I T
tt
AUTHORIZATION NO.. OPERATION PERMIT la DATE: q�
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THA S TEM DESCRIBEDO HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SY TEMS",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)
1
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AUTHORIZATION NO: 1 J7 CSA DAVIE COUNTY HEALTH DEPARTui- MENT
Environmental Health Section PROPERTY INFORMATION
Permittee's O. Box 848
Name: oc sville,NC 27028 Subdivision Name: LW4,;
.I�, AUTHORIZATION FOR Section: 4n it,Phone# 336-751-8760 /�rc
Directions to property: s Lot: U 1 1
;t
'
WASTEWATER 7N 7 Tax Office PIN:# --'
� SYSTEM CONSTRUCTION i
Road Name: �'t"1V-L-i- 1-��Zip:L,?L)-Z�'`
.**NOTE**'Ibis Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This 176rm/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/ IS VALID FOR PERIOD OF FIVE YEARS.
EIiodEWTAIMEALTH PECIA ST DAfE I UED
._.__. ..._:SiE I - -- ..�:-BU-..._._ -E ` S � .�#OCCUPANTS GARBAGE D`
RESIDENTIAL SPECIFICATION:BUILDING TYPE _ #BEDROOM-' � DISPOSAL:Yes o 0
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLF/SHIFT� #SEATS INDUSTRIAL WASTE:Yes or No
a
LOT SIZL3-' (c f &C TYPE WATER SUPPLY�^�Y DESIGN WASTEWATER FLOW(GPD)76F��4
SITE REPAIR SITE
pl'r ► 't ,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRER46H WIDTH_� ROCK DEPTH LINEAR FT. SO
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: I�TQu O� C j,y-n0,)Q.
IMPROVEMENTPERMITLAYOUT*APPROVED LUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE*
F
�,d Q
11L7
1 � 1
, FP/
)T.4 L f-i
**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(7jQJ W7§%x
OPERATION PERMIT C��
SYSTEM INSTALLED BY:- --M'QA V-�
v
AUTHORIZATION NO. OPERATION PERMIT B DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT ST=EM S BEEN INSTALLED INCOMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREA ENT 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)
'AUTHORIZATION NO. 106 9A DAVIE COUNTY HEALTH bEPARTMLNT �---- -
Environmental Health Section PROPERTY INFORMATION
Permittee'sC P.O. Box 848
Name: F�J2 `'1'S V� r-.1. Aocksville,NC 27028 Subdivision Name: LPX&,
/ Phone# 336-751-8760 aa-1 ,: 'vi L M iS "7 q8
Directions to property: f / i —ru Section:,zaks q,4 Lot:
r AUTHORIZATION FOR
� SYSTEM CONSTRUCTION Tax WASTEWATER
Office PIN:#-57y 7 �y -. '1
Road Name' tit*J IL L-e1_14ip: 70
ZR
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building-Permim.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In complianc with Article 11 S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
XO &ALtEALTH
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVI PE AT DA E IS ED
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROQMS _#BATHS, �/. #OCCUPANTS GARBAGE DISPOSAL. Yes o fVo
(2-3 SQ M N�
COMMERCIAL SPECIFICATION: FACILITY TYPE ,� #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes orNo
LOT SIZE TYPE WATER SUPPLY�� / DESIGN WASTEWATER FLOW(GPD) �� NEW SITE REPAIR SITE V
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 5W ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: ids"LL 0,j DN 1 ootz
IMPROVEMENT PERMIT LAYOUT*APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE*.
Ir
r 2r.
**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 J?W A$WMA
OPERATION PERMIT � QY /
SYSTEM INSTALLED BY: `Q 1 IC IL
AUTHORIZATION NO. 6`s✓``k OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT DESCRIBE OVE HAS BEEN INSTALLED COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BE TAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
•ACRD 05/96(Revised) .
4