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107 Idlewild Rd Lot 13 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section y, S P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account M 990003354 Tax PIN/EH#: 5862-34-9883.13 Billed To: H&V Construction Subdivision Info: Idlewild Lot#13 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility Residence Property Size: see map ATC Number: 4053 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSST�TRR/U,^y,C�TION IS VALID FOR A PERIOD OF FFIIVE YEARS. Environmental Health Specialist's Signature: / (/ Date: �/1�45 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completiop shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Articl I 1 f .S.Chapter 130A, Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY tak s a guarantee that the system will function satisfactorily for any given period of time. �6 Septic System Installed By: �'I! Environmental Health Specialist's Signature: 4c � Date: DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT - • Environmental Health Section t P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003354 Tax PIN/EH#: 5862-34-9883.13 Billed To: H&V Construction Subdivision Info: Idlewild Lot# 13 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility Residence Property Size: see map ATC Number: 4053 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction 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 11 of G.S.Chapter 130A,Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms k, #Baths 5 Dishwasher Garbage Disposal:/ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water SupplyDesign Wastewater Flow(GPD)_(, 4�) Site: Newer Repair❑ 9 System Specifications: Tank Size,4M) GAL. Pump Tank GAL. Trench Width��` Rock Depth Linear Ft.yb Other: Required Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to in.on the day of installation. Telephone#is(336)751-8760.**** - ,4, Dr Environmental Health Speciali 's Signature:� �� Date: 711J 2 11 S DCHD 05/99(Revised) • �� "or as Q4 M-138 cavi•counts oncocith 776 7S1 $768 f'•P j Pia tuv�u•nll _ _ e� a►y {ll►►►tQ7 itilSa2I0l CYdC1 m PlOC=WM lW Sal t YA_/ yQpppSldl H AsmC. Ida to H6 nme" of tOGU v bill SYb1 eCdeii• ^;�.. 1. W M M lilld �i LBu_ sTall't- i CO � (� iI. wllwwnttall�%utrdAce R✓a ,w.e,►.� . � aal�R!'�ll�'tu.SR�u1t •?NO3 �,�,,, b•7x +�?5�: . _ L s.a eoov=U atftrat so+hwv f}NI C ..,��„ ,•��s': .. AIlIgUMlle��11 '� aghut�IW �,»•._:..';,e j; 7. splU ads Uri a lite iniwtiml 1 {Y�q ''//LoemaC�P�mitJidtC 'y fl DO�iI" him a BaWie lieu a luiuu a II&SUY (� I. Uri q m upoedi i emau el a 6w"all NOW a Wradn t 1 ,1 a. 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