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3103 Hwy 64E � , .-,. � . „aw f � r. � �.,, tr; �. ,._, � . ,�' i, , f � � .. .,.o.;„ 'y, .• , r-:- i ._ . . � a Sk.r. a ; �x .�. ; ,. �v � s�. - ; .�.,.,..�.s , 9-a �. _ :. i u.,:.: ,,,;z°. � . .y. , ` Y' �,. ,i, _.. � Y�"� . . �i �,N,.�� . . . �W"tn Permittee' l ` DAVIE COUNTY HEALTH DEPARTMENT Name: ���-��'�'{ �!�^l'+�� 1 ��v''i�������' Environmental Health Section PROPERTY INFORMATION ':_.,. P.O. Box 848 Directions to property: �� �� �� G Mocksville,NC 27028 Subdivision Name: . � l �� .�"�� `'� ` �'r"�!G'�...�- Phone#: 336-751-8760 � Sec[ion: Lot: 3 ,,� AUTHORIZATION FOR ` �G�/'l� ,'rt �� J�� WASTEWATF.R x Office PIN:# �7 � 7 1 C:� -.� r �f ! SYSTEM CONSTRUCTION �j� � � AUTHORIZATION NO: Q�•���•� A Road Name:���`.�-f( �,{,�'�;,�; Zip:�l�l..�'l .^ **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pemlits.This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (ln compliance with Article 11 of G.S.Chapter 130A;Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ., _ .. ., '; `�' ***NOTICE***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,-'�'%�`.�.�,�►�'`�'U,.�"� �'1-� /-!� * IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - .,. _ . , . RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEllROOMS #BATHS -#OCCUPANTS GARBAGE DISPOSAL:Yes or No 4� COMMERCIAL SPECIFICATION: FACILITY 7'YPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No � �' LOT SIZE �'�� TYPE WATER SUPPLY� DESIGN WASTEWATER FLOW(GPD) �"'�"�NEW SITE REPAIR S1TE � � ' �r� -�j� t �� : ' � SYSTEM SPECIFICATIONS: TANK SIZE � GAL. PUM ANI(,--�_ft"^L. TRENCH WIDTH � ROCK DEPT�I��� LINEAR FT.� : ��!'J'� SGO Z OTHER C"Tl ��l!��f� c..c G 1 id p1 St�V•# 7Sb/ g REQUIRED SITE MODIFICATIONS/CONDITIONS: � �. . �'r. f r . . . . f . . , ,. I� ROVEMENT PERMIT LAYOUT � � �i M , . . � ' � . � . . � . . ' . . . �. . f ? /� � \..J i � j V N� �� �,h V : G . : J' , �. � f,' �1�� �� . � �l � � �,,i . � � � �"� � Ul `` `.�� � , � _ _ S ��j �� �,r �S i �' �`� a �` �<< �/� � � , � Gw. .. .. '. . . . � (^ ! •...` . . . , . ,. �f � . . �� �..� / � . . .. . . . _ . . . . ..- / .._.�., ,,...,.� • ' I O�v� •� �, �,....... .�..� ;� ...- • ��.` / ....,��� �- ^-- (J(y_�J�t , �,,_,�__ ----•-_ _-.'� / ��-- - �� °+ ---- ...---.--�- ,... . : i �..-.--..""'.. • : FOR FINAL INSPECfION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERA ION PERMIT, �J � �j ��.,,�� . C� `"� G`!' : , . : ; . . ��,1 ���tE� �3 7 , J!T � ' M INSTALLED BY:�' n ��, .n� ,�v'v�-r"' "`,, t �'� , `���.� �~'� ��' �r�� � � � � � ` "t \` ~ + '� �`�-"�""" I`�'� �� �a ' =�� E, r�c:� �' "v 1 ! 1 ���',,,,�.k,..� "'"""�' -� , � �� ""- -..._r � r � :'�„..'�C,,C__ tJ "`' r � � . t 3`�' � ' � � � � ' � , .,� � . T..- t �� �� " l�t� - � i � . � � • .. rct� � . �r� � � � � , r,�.' a � � t-, � �~����� / ' J ; r�/ f AUTHORIZATI�N NO. �-�' � / �� OPERATION PERMIT BX: ,�.'(,���������/ �1 .�y DATE: �f � - � � , •"THE ISSUANCE OF TH1S OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECI'ION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTO$ILY FOR ANY GIVEN PERIOD OF TIME. " DCHD 01/02(Revised) � . � f R99 . . Y:br�.!_�tL�{���y. -.,�.'.;a.`..�t•••:�'.�'"+'+g^'i`r Wrrka%;iirs...Ks':'�,.�''�+F+ti�.�� ��-.a_'",r'_�s'*i..+i '+d�.aF. y.'.r_ra:^i., s,`+�r�.k'r'':�� ...'q.."�i��,tir.4..�tti;<"�, '"r`�s. ;'�..�.y.s ��,,a:i 'i�e-4.7n.s �'y:• rS�w�Y..,�er -P=vp..r� . � _. : , . .. . , . .. . • Pernuttee•s � i ; ' DAVIE COUNTY HEALTH DEPARTMENT � Name: J �f��= � '.•�'''",} ' ,�'�>, � ��s`£��.`� �'J=�"' Environmental Health Section " PROPERTY INFORMATION " 'y ,� '' � P.O. Box 848 � 'Directi s to�prop rty: '�'�� �' �� ��- Mocksville,NC 27028 Subdivision Name: "` ��.",'` r Phone#: 336-751-8760 � 1 �� '� �f�`� . � ��,'.-,,, . Section: Lot: }, ,�J � AUTHORIZATION FOR � •� ��'��.��� � ��:.. N'ASTEWATER '�� 7!7 I �.; - �� �� � � � �'.J� � �< � Tax Office PIN:# �� � i , w SYSTF.M CONSTRUCTION ,., ,AUTHORIZATION NO: ��'���� A Road Name. - �y' ' ���' � j f' �� {` � � �r`�T .� Z�p `^' �'';�l�' , **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 For►n/Authorization Numt�er should be presented to the Davie County Building Inspections " Office when'applying for Building Permits. , : 3 (ln compliance with Artide 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Dispasai Systems) � �^ �,r.�,� �,,,�� ,�+'� { / ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �`�. ,�,;,r,�"'�" ?�.+"`,,,+'r>�;w.='.',�/..'��`_. _ . ��.� / �`[ �,,r IS VALID FOR A PERIOD OF FIVE YEARS. . ENVIRONMENTAL HEALTH SPECIALIST�: DATE 1SSUED . � , . , ,. _. . , , . ; -. ,.:,., � ; . ;q , _ , � ;. _. ' . ;- . ' .,,': . , , RESIDENfIAL SPECIFICATION:BUILDING TYPE � `+ #BEllROOMS #BATHS -#OCCUPANTS GARBAGE DISPOSAL:Yes or No . s� � ,,� COMMERCIAL SPECIFICATION: FACILITY TYPE ��� f#PEOPLE #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or No � �_ LOT SIZE �'��� TYPE WATER SUPPLY`l` ,,j DESIGN WASTEWATER FLOW(GPD) ���NEW SITE REPAIR SITE � 1 { t/� � ' � � i � SYSTEM SPECIFICATIONS: TANK SIZE �� f G�. PUMP�I'ANK--���"rCL. TRENCH WIDTH ? + ROCK DEPT�I���-f— LINEAR FT.�� ,r'J�r1'�1 ,a Gv Z OTHER., Csl ��(��r c� c..� c.t ,b�( ;1/�v�� 7:q1 � REQUIRED SITE MODIFICATIONS/CONDITIONS: . ! _ � .I1�tRROVEMENT PERMIT LAYOUT � � , � l ' `~ L� ' a /j` (� r✓` �� .��- � �� � � . f � . . . p ,� . \ . . . . 1 ..-- ' �id� .�' �f ,- , r'` '� � t , �,.^ j �.- ' ..� ; f� i,"� --� �'(� � ;� - �- , t << � , i � � � � � ��,�G } ; � �0 ,, f , i � \. a ; � � ,�, ..�. � 1 ,�` �C� rY► /� , , � } 4� � . �'e"' . . (� . ,^ . _ . . C . ' r J . , r, i / f � '�,`h .� � — _ _ _ , � .._. _.- . � ,•;, � -- ^ t](s v �c..��_` '`- --,-1 � ` . �--- ------ ----.. f � ' , � ,r-�--- ......-._._... T,s ,_.._„__.___� , �.. _. ; ,_.,...__._---- � __ _ t • { FOR FINAL INSPEGTION OF THIS SYSTEM PLEASE CALL BETWEEN 830-9:30 A.M:ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. � f ' OPERA ON PERMIT� y�,J 'x�,-r �'�a R< ,�I . U �"! �'f ' ' �,"i ' (,.,4I �' ,'x�';C)� � � , ''-�..�.....:_�..._.,,gYSTEM INSTALLED BY:7 \.o .� y 1�Tn }�. x F'',•' r° -� � � ^� ' /,�� <' � � ; �, � ���./�/`�i'� �'l „� .��, � �.,. �:.� � ..,. i '^�, .. �, � iJ � � .... ,,.,,. �. . .—__._.,_....,._. "^-/ ----�-., ^� , r :i r ,I, � -. \.�. � � ���! ���. . �' '.. � !I/�� ��'C , � .-"'--'` '""', > . .� 4-.... �r __..�..j.----A..,..,.�,r, � %''' � ; ,� � I�'.f:'�' J� S� 4.: � tl �*.. . � . . . ,•,,.,....wr;ao.�.��; � , � „ � � � 1 .�t! .-- � '; _ _ �.. i, ,.-.� f, i �� �� � �' � . �,r � .� � �� ( �^ � ^,,� �� � ~ ~�� � � � �"� �----'. � � , � � �� r.� r _ ti � �, � -� ,: � �ry .�� : ; t � l � � /,� AUTHORIZATIbN NO��-.' � ''� OPERATION PERMIT BY: ��+�.�-{'''f���T" r�� ��-d,'� �'''� DATE: r� � •'THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE : WTTH 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 FUNCTTON SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. � �o�«�����- .L999 �� � : . ; . . , � _ . � .