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513 Madison Rd (2).Pemuttee's .' ... r �"t,C D COUNTY HEALTH DEPARTMENT , - Name.s7 �`:1�1'`� .' Environmental Health Section PROPERTY INFORMATION < h} P.O. Box 848 ID tions to property-Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION 2135 AUTHORIZATION NO: A Road N me'-- zip: **NOTE** This Authorization for Wastewater System Constriction 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 w• -Artie a 11 f G.S. Chapter 130A: Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) y / j ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 7S VALID FOR A PERIOD OF FIVE YEARS. ENVIR T ' eALTH SPECIALIST DATE ISSUED RESIDENTIAL, SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No . �i�hj�i>tIQV COMMERCIAL SPECIFICATION: FACILITY TYPE / #PEOPLE # PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE: Yes o� LOT SIZE' S� LT PE WATER SUPPLY -�J DESIGN WASTEWATER FLOW (GPD )ii� NEW SITE REPAIR SITE r SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH I -�— LINEAR FT.� OTHER I 1J1�'�t Q.1 �t�TItT�6?G .REQUIRED SITE MODIFICATIONS/CONDITIONS: 1)� V 1� 1 � V ��"t�' � 1�Ajt' Q 1 &J -tv I OPERATION PERMIT SYSTEM INSTALLED BY: vhf F2v,v.- stl.q'Ur R2-&.jT y – 7 L 7-00 X3L,,.)-g' r � ' Z a AUTHORIZATION NO. 0 XA OPERATION PERMIT B 100 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBE VE HAS BEEN S LLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHA IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. 1 DCHD 02/02 (Revised) ,. / DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE. OF COMPLETION •� 6r *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Qq �� �y Sanitary Sew ge Systems Permit Number QQ Name t/ �° ! ti�/J✓ _ /.'' NO 7 6 6 S Location F/ /O.% /':' Y V �� �" .�:l�r�; _ �r� `fes!' </ /r�/ , Subdivision Name Lot No. Sec. or Block No. Lot, Size _ ��` House Mobile Home _T Business -v Industry No.' Bedrooms & &) . No. Baths No. in Family _ Public Assembly Other Garbage Disposal YES ❑ NO p Specifications for System: .Auto Dish Washer. YES ❑ NO ❑ Auto Wash Ma thine YES p NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion Date signing of this certificate shall indicate that the 'system described above has been installed in compliance with ndards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function ..stactorily for any given period of time. 3. g .mxu .v.. .. . .. . . _+N;-sm.may . a ..c-:,.� � .. ., m' � . .... '•_.�:�.> -.:.. ...._�. . ' �, `... ..., ..� >......� ..::. K .� ,r,.. 3,. < .;e . . . ... 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