208 Pinebrook School Rd ' � DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax# (336)753-1680
REPAIR OPERATION PERMIT
Accou�t �: 990005925 ' ' T�x�'1�iEH#: F600000043A
�ifled To: �ichard &Betty Beeding Suf�t�ivi:�iari Ir����:
Refer�E�ce N�n��: REPAIR PERMIT '� LocationiA��r��S:.� �08 Pinebrook Drive-27028 -
F�ro�c�s�i9 F;�cifity: Residential Repair : : � ; � P�t��er#y��i�e`�� �4:87 Acres • � - '
t�TC hEumb�r: 5964 . ... .-�
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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 function satisfactorily for any given period of .
time.
System Type: -i�._ S.T.Manufacturer ` Tank Date i Tank Size i
Pump Tank Size ._.- Bedrooms 3—���
System Installed By��ri�y� ���(�.� Installer#: Date: �3
GPS Coordinate:
,,� j,as�a,l/l� b�,l,l�uu�.
��� �� s�,.c�
� .-- d��� sy�,��� �' �'
.��,���,o�e�.-�-� t�c:�/:
.. «
� `N� 'U�C. T 1�
��-" Z,
' ' � � �`'
� ��
�' `
���0 3%0
�,'�� ��G� _
�'I�_�,,.%— , — , , — _ ` �
� �� • i
��;+�N0.,w� �
. -- — - .. ' (
• ' �,�
,� - _ _ - _ - - - S�ra�',
�e�=:
__ _---
�' ,
, ______._.._.
Environmental Health Specialist: Date: � o�� '
DCHD 11/06(Revised) • � gZC�/
�ivua�ee
. . ,
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
, � Mocksville, NC 27028
(336)753-6780/Fax#(336)753-1680 .
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRLJCTION �
AGCUt�t�t #: 990005925 T�x F'IErfiEH#: F600000043A
Bille:c�To: richard &Betty Beeding Su�atii�fivic�n'lrif�:
Re�fer�E�ce P�a��e: REPAIR PERMIT � '�::LocaiioniAd�ir�ss:' 208 Pinebrook Drive-27028
f�ropc�sQc9 F��:ilify: Residential Repair �-�� '� !'ro�i���i�� 0�18v���air ❑Expansion
**�Q T�,�.,** Thi All horization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
p,Tl�eal�"�c�ion pr�io�to.issuance of any building permit(s);(in'compliance'with Article 11 of G.S.Chapter I30A' �
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specifications: #Bedrooms 3 #Bathrooms #People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats �
Square Footage(or Dimensions ofFacility) �
Lot Size_��_ Type of Water Supply: C►�County/City ❑Well �Comrnunity Well
System Specifications: Design Wastewater Flow(GPD)�Tank Size��;��AL.Pump Tank�GAL.
Trench Width �`� Max. Trench Deptii� 'y�" Rock Depth/V!/', Linear Ft. ���"�j�,
—r��— �cE��M.(l'ee
Site Modifications/Conditions/Other: �
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760.
3 x��G�--;
__-_--------
4
�U ,
�
JH
Cd�� � 2a h�
�
_ `
Ci(i • • _ ` \''` .
c ` �„ �{��bt'�' f �
� . � '
� � �. �. + `i �'
' ' /
i � �
� � �
. ' �."""___.."_" /�
t� 1 � ---
Environmental Health Specialist • Date:
DCHD 11/06 (Revised) ' �:� � �3/a� Z
• �w �(� f�f ' � �NAl��2 in
' DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME �� � i PHONE NUMBER GT�I�� c3Z! 7
ADDRESS 2�o P���b►-u�x s�h • �SUBDIVISION NAME
��d��n�3 A� ��7,��r�• LOT #
DIRECTIONS TO SITE I � � Y
��n�r ts�d� i�- �? Iq2 p�ne b�ol� sc� (L�
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �t NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY ��.D • SPECIFY PROBLEM OCCURRING �SUr �Yl
� W II - b u
DATE REQUESTED R'� S� I� INFORMATION TAKEN BY ��I�
This ia to certify that the information provided is corceet to the best of my knowledge,and that I understand I am responsible for all charges incurred}rom this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rsv.,rya �,j O�f�'ll C 1 ��
-{-l'
. GoMAPS - Davie County NC Public Access
� - � _ ;
I � � WATERSHED_STRUCTURES
� --� f
� i'� WATER_Bd01ES
� ���yLi� fI' �I � COUNTY_BOUNDAftY
j ��� �/{ STRE�TS
���- / �' � - ,y.,x�"' F2AtLFtOAD CEfJTEF2LINE
- � i` t +
1 '� � +� � PARCELS
Ii'� i:�-�� f
i� ;�'� -` CfTY_LIMITS
`,
— iJ, � BER6FUDA RUN
i� - .. ______-- ,J.' f
��� ~�i � COOLEEMEE
��i
� y�i '�' f I' � DAVIE COUNTY
r---� . � � '��' j'�� �
i I�—� hSOCKSViLLE
'Iti ___ �' ~�
ti, � N`� ----�___ - � - I nccountics
�� "_-- �,�
' � � �� � �- I DAVIE
� t� �,
, � ti ;.�.
, k y, ,=' I�--
-- 5 d' �f :[� ,�' : � . <all offier values>
----_('IPJEBRC _,,_��_ ._ __ �y y� � `ti ,,''i�' �_I
Q K S CH C Q L'i?D -----�- iI F� �` �' / I
�-L 1 \ .''� �___
- _ __-- //f �.C= / - .
�~_--- r�__-��__- .. �,�� . .
1 �- ~`-.r;' f:
. _� -1--- ` ��,1�, f f`�ti-
.-- � .� �-----
'�`'.
.,`* 'J� t_��
:C'�'`� ��_
.,` '�',,. -
,.,k1 f�' -�,`3 F- rf,, ` �� ��
.;.,'l` '�-J �', ,',�Y!� ,,;,� '�.� Wednesday,August 8 2012
, � .,\ ,'ll �ti� ,
I `� ���� './, _ � \ � �
�'� `\ \ '.` i: � )
OOltitl� .`., ,' .�f- iti� '`,�� '....,` ,y — � � ,' !1
�fi
***WARNING: THIS IS NOT A SURVEY!***
This map is prepared for the inventory of real property found within this jurisdiction,and is compiled from recorded li � �
deeds,plats,and other public records and data.Users of this map are hereby notified that the aforementioned public o
primary information sources should be consulted for verification of the information contained on this map.The �,, v
County and mapping company assume no legal responsibility for the information contained on this map. : �„ �� �,
`\� �
_ ( �.1 �
�_ �
�