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126 McClamrock RdAUTHORIZATION NO: 00M,4 A AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION ly - - x„ 1�, 9' � r "J "�� Road Name .1 --i i ' r_ �� -" 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, applying for Building Permits. (In -compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) v, ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION _•–• f �'i a t 7 IS VALH) FOR A PERIOD OF FIVE YEARS. •TH SPECIALIST. DATEIISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE I _kJ — # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT . # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE fTYPE WATER SUPPLY,��tr� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE %ter SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK _GAL. TRENCH WIDTH.a'" ' ROCK DEPTH )1, LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS'frj IOPERATION PERMIT 11STALLED BY: I AUTHORIZATION NO. ,lYY `r�JJJ Eli OPERATION PERMIT BY: t1b DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED A`�OVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SY MS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEMyWILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 07!02 (Revised) -Avf / h /i/0 -:1-AJ V, 'C Z30 Permittee's ! `` 1- _ r, DAVIE COUNTY HEALTH DEPARTMENT Name: ' ` N .�tT�%(=g Environmental Health Section PROPERTY INFORMATION ,......... p �} I(l/ P.O. Box 848 Directions to property: Mocksville, NC 27028 Subdivision Name: J,)I 1.'� % Jy y '�' tom` — Phone #: 336-751-E760 Section: Lot: AUTHORIZATION NO: 00M,4 A AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION ly - - x„ 1�, 9' � r "J "�� Road Name .1 --i i ' r_ �� -" 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, applying for Building Permits. (In -compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) v, ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION _•–• f �'i a t 7 IS VALH) FOR A PERIOD OF FIVE YEARS. •TH SPECIALIST. DATEIISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE I _kJ — # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT . # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE fTYPE WATER SUPPLY,��tr� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE %ter SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK _GAL. TRENCH WIDTH.a'" ' ROCK DEPTH )1, LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS'frj IOPERATION PERMIT 11STALLED BY: I AUTHORIZATION NO. ,lYY `r�JJJ Eli OPERATION PERMIT BY: t1b DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED A`�OVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SY MS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEMyWILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 07!02 (Revised) -Avf / h /i/0 -:1-AJ V, 'C Z30 AUTHORIZATION NO: 0027q4 A AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION i ` . j w Road Name f ` ` i; of .--1. zip:, ip **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 Buildine Permits. (In compliance with Article I 1 of G.S. Chter 13 A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 4SU' ***NOTICE*** THISAUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL-HBALTH SP.ECI LIST, DA 4 RESIDENTIAL SPECIFICATION: BUILDING TYPE 1') # BEDROOMS # BATHS r # OCCUPANTS �_ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY L.{ i 1 DESIGN WASTEWATER FLOW (GPD) 7 t� NEW SITE REPAIR SITE / SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK �„�GAL. TRENCH WIDTH U1 ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: �� / l i �)< Lnod lo' oh" OPERATION PERMIT 'U '! S S,T Ivf,i STALLED BY: 5 h -<' 6. "1 do-t t�- 1e"7 ' `�..--�`"'� �t°I ............I /, 19, 50 7 AUTHORIZATION NO. OPERATION PERMIT BY: ��%� /V� /. �1 5 DATE: / **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 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 FUNGTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised)�� r/Y� (vvo _:7A1U,' Z30 Permittee saa '' R-. , Y (i r DAVIE COUNTY HEALTH DEPARTMENT - Namer 'k= 't 1 ��=1~� Environmental Health Section PROPERTY INFORMATIOIa1 , P.O. Box 848 f, Directions.to property: '' Mocksville, NC 27028 Subdivision Name: ` 1 ( v'` b�,7 � Phone #: 336-751-8760 ^ Section: Lo[: AUTHORIZATION NO: 0027q4 A AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION i ` . j w Road Name f ` ` i; of .--1. zip:, ip **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 Buildine Permits. (In compliance with Article I 1 of G.S. Chter 13 A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 4SU' ***NOTICE*** THISAUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL-HBALTH SP.ECI LIST, DA 4 RESIDENTIAL SPECIFICATION: BUILDING TYPE 1') # BEDROOMS # BATHS r # OCCUPANTS �_ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY L.{ i 1 DESIGN WASTEWATER FLOW (GPD) 7 t� NEW SITE REPAIR SITE / SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK �„�GAL. TRENCH WIDTH U1 ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: �� / l i �)< Lnod lo' oh" OPERATION PERMIT 'U '! S S,T Ivf,i STALLED BY: 5 h -<' 6. "1 do-t t�- 1e"7 ' `�..--�`"'� �t°I ............I /, 19, 50 7 AUTHORIZATION NO. OPERATION PERMIT BY: ��%� /V� /. �1 5 DATE: / **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 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 FUNGTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised)�� r/Y� (vvo _:7A1U,' Z30 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION &zd9d, APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME Jtq//C>✓ twn et"' PHONE NUMBER 175 i7/ �'IaC�Ia`r�r�c� G�. �YlocKsv�Il�. N� ��07 ADDRESS_ SUBDIVISION NAME LOT # DIRECTIONS TO SITE 17-&/�� 'G hjle -h d tf e, 1 1/1 DATE SYSTEM INSTALLED s 'NAME SYSTEM I RT -ED UNDER 1 /Lf6'Il� %;�` TYPE FACILITYAft6e, NUMBER BEDROOMS NUMBER EOPLE SERVED / TYPE W TER SUPPLY l i'1 SPECIFY PROBLEM OCCURRING ��/ /op DATE REQUESTED 79 w—INFORMATION TAKEN BY � U This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev, 1/93 Mip Frame Davie County, NC - GIS/Mapping System Page I of I Click Here To Start Over Quick Search: (County ID i Active Layer. PO Us.. Map Tips 0 0 tj 4e .' PARCELS (Map Tips Available) -1 Map Layers I Results I http://maps.co.davie.nc.us/GoMaps/map/mapframe.cfm?CFID=4129&CFTOKEN=616408... 7/11/2007 GoMaps GIS Page 1 of 6 http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=4129&CFTOKEN=61640881 7/11/2007 4AW DAVIE COUNTY HEALTH DEPARTMENT ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION "NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c r ,, = Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name l , R — Date Location -� Subdivision Name Lot No. Sec. or Block No. Lot Size __ House _ Mobile Home __ Business __ Speculation No. Bedrooms No. Baths _ No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ �, Auto Wash Machine YES ❑ NO ❑ +' Type Water Supply __— *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion(1 Date 'The signing of this certificate shall indicate that the system describ4 above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time.