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232 Rhynehardt Rd . . . . . , . , ,,. . , , , . • , z a : , - , . . ..: ,_,. . , ... . >,.., ; , .. . . . � . .. , � ... � , '. ...:'9 fi'�..,. *. . .: ': � . . ��f....����"\ � ..�.. te � . � / �� ' �Permittee's a ,;�: AVIE COUNTY HEALTH DEPARTMENT , Na�:��//� ��1 � t1 i�� ��«<� Environmental Health Section PROPERTY INFORMATION �1��1 P.o. BoX sag � Direc6ons to property:J �� � � � �"' Mocksville,NC 27028 Subdivision Name: ( a,� �:G: ( � � � G.r Phone#:336-751-8760 Section: Lot: � ,� , AUTHORIZATION FOR . y; � ���. ,� �n (r tc� �:. r� �. 7 �-- 0� �� WASTEWATER Tax Office PIN:# ��'�' � � ��j�' SYSTF.M CONSTRUCTION ' AUTHORIZATION NO: D O���� t� Road�am�h y�'� �c,�c.` Zi � �G )� P�-,c, **NOTE**This Autharization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Fom�/Authorization Number should be presented to the Davie Counry Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) C_,,.,,F�j�� ,//'�� /�_� _�***NOTICE***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION � � ��''}% IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEA�TH SPEC(ALIST DATE ISSUED � RESIDENTIAL SPECIFICATION:BUILDING TYPE �' w m#BEDROOMS� #BATHS � #OCCUPANTS I GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILTfY TYPE #PEOPLE #PEOPLFJSHIFI' #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE /� � r��PE WATER SUPPLY �� DESIGN WASTEWATER FLOW(GPD) 3 G D NEW SITE REPAIR SITE v SYSTEM SPECIFICATIONS: TANK SIZE '� 0 d GAL. PUMP TANK�GAL. TRENCH WIDTH -�' G / ROCK DEPTH 3 � /LINEAR FT.� OTHER � �rl�✓� ✓1 '� � -o .�vt c� Q �r � �. F• � c. � ,� �� r"� r'S 1 j I, h i1�� ,�r ,.i REQUIRED'SITE MOUIFICATIO S/C�NDITIONS:� ��5�� �{ '� � ° / �s S/!� /'P ; C ------�^7 .r— IMPROVEMENT PERMiT LAYOUT ^ �-- � h.p ���r e� 12 e� -tv�doi `1 US ��G � ' �-P� G t�- - �� � �S � � � � `��StQ�� I ^'` �' t I p. `�C/ �./n x � �*,l�n� �.nj� . � I .` � .��'ftj^/�✓`1 ! �� — - � , � t]� i ` '�`, y� s � � �' 'y.U`?tl y . , :h �, p WM+t � � �° „�. , �� �'�` �� �� � � ���� \� .� . _ � � � \ � ' � ` - �� �_� � — " ,.-P— — —� "_-- --- _ -- I ��- �r , _ �_ -- ---_-� _ - ��/� � �Q L ,�N rs � ' __._ ,.. . A �/'G�"�� -� �:-t'4'� � � D G / •�N � v�u� h -�'� ', /� . , � CoV`'I,�� U �a � � y FOR FINAL INSPEGTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT �� � SYS'j�f,IJVJ��A`�L.ED Y: �C�(/�� O_C 1 - uw'�� 1 � �"� ¢�1 �� I �- � ��y� �'�` � �� � , -n � , � � � � � E 3 � -----�, � I � c �� AUTHORIZATION NO. �/�/ OPE TION PERMIT BY: � DATE: � � ••THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WTTH ARTICLE 11 OF G.S.CHAP'fER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BL1T SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTO$ILY FOR ANY GIVEN PERIOD OF TIME. �o���.�> �r�-��5i� __ �v�,����� .. , S --_ _'7a,_� . 'afs i.-. � ,. ' ' _ F -..�:.,:-_, ,.. , .� _ .�� . c h . . �t .��v` . �� ••f y`;s�� r.•:,i.�', z�.:,: . ... � _ .i�s,,.,,;.: � V r ��t aa "��� ..- . _ . . . . p i �` e 's ;' - DAVIE COUNTY HEALTH DEPARTMENT � � � / 1 �m���.� J � ` '<i ' ' �' �'f C'.r� Environmental Health Section PROPERTY INFORMATION 2'���0 ,r. �• � ,f � :� + ' � ! - ' ' "''' P.O. Box 848 � • Direcdons to pmperty: �') �- �--,. � �""' 1�'Iocksville,NC 27028 Subdivision Name: '. � Phone#:336-751-8760 •-' f_:t -�', C' � ,���r --f L.- t, r _ . Section: Lot: � , ., � 7 AUTHORIZATION FOR r-;�;,� , �� � �,''�•r:y;;�; I�`•��k-�" ' {_ �; � } V�,� �L R'ASTEWATER ?r.`' ` _ �1,;(r ( " Tax Office PIN:# -r SYSTEM CONSTI�UCTION � oaz��� � 3 � �`� , ,.� � �,w.�- � � �� �� AUTHORIZATION NO: A Road Name: f� ��� Zip:� *NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permit�.This Fomi/Authorization Number should be presented to the Davie County Buiiding[nspections Office when app]ying for Building Permits. (In compliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) L..�_.,,.,.,=;���//�� � --�' ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ��� �'✓"�-''�i�� /� � � `C� IS VALID FOR A PERIOD OF FIVE YEARS., ENVIRONMENTAL HEALTH SPEC(ALIST DATE ISSUED `� •'``" ta , ' i ' RESIDENfIAL SPECIFICATION:BUILDING TYPE �"v�#BEllROOMS � #BATHS #OCCUPANTS � GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or No LOT SiZE C � Y'r TYPE WATER SUPPLY �� DESIGN WASTEWATER FLOW(GPD)_� NEW SITE REPAIR SITE v � ✓� � �, � / SYSTEM SPECIFICATIONS: TANK SIZE 1_GAL. PUMP TANK�GAL. TRENCH WIDTH ��� ROCK DEPTH 7 �' LINEAR FT. l '� 1+ � �' /� � - - 07'HER ��^�<✓1 � "� 1�. 1 �v��� G � �� � F -' r.L.. t' `l r'� r� ��,J� U•� ��� ,n REQUIRED`31TE MODI CATIONS/CONDIT[ONS:� �`�5 r�l� i ,'� i•t c � 6's S/ (� lf ' C _ p , , C ..-- IMPROVEMENT PERMIT LAYOUT �'� ��� r�. ��,,,�-1 � �� f 7 �.�ici 1 US c�, �, � � f���. � ,g 1 � _ �(� _ � � _ �- � , 5 � � � ..� . . � t� 1 I ` _ _ � , - .h; 1 , ' . � pw�,+� � � , ` � �. �,� _, � — - . . � , � `�_ �. � ,� , ` `-c` � � � _ .�-----� � �,. _ �_ ,�� _� ---� _ _ ���� ) y6 L '�r5 � o - ; � ,� �-�� � ��� — -- .! — C �'rr��� . � 1 L v� � �,�� GN��I � -�f , /� �� � , < < G �'"I'�y L� � o � c 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. OPERATION PERMIT � �- _� YS'�{I,IfVa�A°�.LED Y: � G^lil i O ` ` `` �J1N��� t s� ` \ � -� � � �� � U� �� �1 J� ,, . n �� � � �"�- ��y ��1 �� , � � � .,,,1 .. � � � � � � ` � � � 1 �� � � � 3 � � ' � —�. � – � -� I�-- . _ . I � s � 'J �� AUTHORIZATION NO. � G/ OPERATION PERMIT BY: ' DATE: ✓ � � `� •*THE ISSUANCE OF THIS OPERATlON PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE ` WTfH 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. . � �o���,�� �'l��1 �lr/f� :. .__.:..=_ _._:_ _�.:: � .�v,�(��y � - n : �2 us �wr/ 1s�1 a�v��ve� Z �Q�/�wy��r,�he-x� " ` DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION y�u�� ,(7�"' APPLICATION FOR IMPROVEMENT PERMIT-(REPAIR) NAME � �- PHONE NUMBER ��(� �� ��37ZCo ADDRESS �J7i • — SUBDIVISION NAME l`Z d (pO✓C� LOT # DIRECTIONS TO SITE �� �I/ �(�/�/✓ �I w �d� <(.�r�l! 1 Zl o b �v f�Gv�1 �ol �h�n/����� 2G� �n/ /? - , / �DATE SYSTEM INSTALLED � S� S NAME SYSTEM INSTALLED UNDER ��/� �d�N� �I' TYPE FACILITY vw� �" NUMBER BEDROOMS � NUMBER PEOPLE SERVED I /� / , TYPE WATER SUPPLY GGV) SPECIFY PROBLEM OCCURRING I` G/}1/eS 5' o �C� u �r �u� i9G'%it/ urn �l� W,�s - d DATE REQUESTED ���q-(�� INFORMATION TAKEN BY �IGe. This ia to certty that the informa6on provided is oorrect to the best of my knowledge,and that I understand I am nsponsible for all eharges incuned from thia application. SIGNATURE OF OWNER OR AUTHORIZED AGENT �.,�3 / 0 i! Q i�iss �D► �Z 0