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170 Webb Way (3) a. _._ ., ....1 z=�., : ,. _ :. , -- -�.,. . .;. ..:;�a., •,.._ . ... , ,..,,- .�-.-;.`a . . .,. ,. . . ._. s�.:�.._ e . . . . �. . . . ' . � � , . , s_ 't , �•t' ., . , a; . . . r . .,-r - ,1'i , . . -''�U7'HORIZATION NO: �������DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's , t�, � , _ �1� P.O. Box 848 Name: k�_ � j • Mocksville,NC 27028 Subdivision Name: Directions to property: L.��� j� , Phone# 33¢-751-8760 Section: Lot: AUTHORIZATION FOR C�,�L�� Wf�lf WASTEWATER Tax Office PIN:# - - ` � � SYSTF,M CONSTRUCTION I �'] Road Name: � . v Zip:� /0��! **NOT'E**This Authonzation 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 Counry Building Inspections Office when applying for uilding Permits. (In compliance with Articl - yof .Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposat Systems) _ ,�... , � 1 � ***NOTICE***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION �...�..-� r. --~'"�� � IS VALID FOR A PERIOD OF FIVE YEARS. ENVIR ` AL Sg�CIA 1 DATE i SUE _ _ 4 ... �t.� '�����.- ., �.,..� .,,,�.•. . . . � ^�-.-_ .. . . � �* ' ., � , -' ' , .. � .. . �, . `^} ✓, . . . . . <. � „F ' ..:; 3 . �er 7 `.,;,'� •;_. r.�'� .......e.-� � ,,, � � 6� :, �; �� . , e, � . �.. ���� ���.x��:,�' � �. � ��d�DAVIE C�OiJNT�HEI�LTH DEPARTIVIENT �"' , �r � TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION _ Permittee's ' � Name:_�,� �►1rti�L �,�4'���.�-' .. Subdivision Name: ' p-�.C Dire,ctions to property: ! ~��, !�' Section: Lot: , IlbIPROVEMENT ' ' ;t i-i, �f,,�� PERMIT Tax Office PIN:# - - I Road Name. 1 v 1"�-{�': i�;�":�- Zip::;r"r<}L. 't: **NOTE**This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATTON FOR WASTEWATER SYSTEM CONSTRUCT'ION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building pernut. (In compliance with Article�l,l of G.5.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) .-�_ �'.. � � ► '. ;' ,�'" � �;�{ � ***NOTICE***THIS PERNIIT LS SUBJECT TO REVOCATION IF STTE � ... ,,,,, r"j i.;�,,�� ,,�,,,,�.,�.,�.,......:. � � � , !'r':�,��,.:�. � PLANS OR TI�INTENDED USE CHANGE.YOUR WASTEWATER T' '`� SYSTEM CONTRACTOR MUST SEE THLS PERMIT BEFORE ENVIRONMEN7'AL`HF.,"A�T'H SPECIALIST�'' DATE�SSUE� �STALLING THE SYS1'EM. � � � � .^ P ' RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPS,,:�" ' #PEOPLE � #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or� „ .�n�`' �;�,)�1,.�� �/....� �.--. LOT SIZE �� � TY E WATER SUPPLY`—��"N�� DESIGN WASTEWATER FLOW(GPD)_�'��✓ NEW STI'E REPAIR SITE ''� r 1 SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH� LINEAR FI'. �� OTHER � J'%I�S� �1r7t��4"� �'��'i'� REQUIRED SITE MODIFICATIONS/CONDITIONS: ( A�� �rT G,�C�S� ��C� L-t►�&.= �+ � ,.�. IMPROVEMENTPERMITLAYOUT �����{ �'� � �� � � { 3_ b i" ` �`':� �����~ � i ''�'1' ' �� . � � � .�� .� � �p�c.�3 'y�ga� . �-'�'.�<`1rJb , " ,- c�.��s;�v� � D 1 ..�`���..s,,.�-, .�.�- .,�-.,. .�—. .�, �'' f�rZ11 r^l --..� `��� , -___� �-� cc.� c��� � �A� C�E _ **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF'��I����,3��, BETWEEN 8:30-9:30 A.M.OR 1:00-130 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)C��7�6�.rJ 1—�7E� OPERATION PERMIT `�`'�,� SYSTEM INSTALLED BY: V�'���- �A�--�7 ,,` : � . -� ��� . S �i . AUTHORIZATION NO. � �"w OPERATION PERMIT B . DATE: � **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH SCRIBED ABOVE HA EN 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 OR TIME. DCHD OS/96(Revised) ,� ,..:'� ; DAVIE COUNTY HEALTH DEPARTMENT � ...2-����c� ' Environmental Health Section �l ��'v . ' ,. , P.O.Boz 848/210 Hospital Street . ` Mocksville,NC 27028 (336)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990000923 Tax PIN/EH#: 5872-12-2923 Billed To: Wayne Webb Subdivision Info: Reference Name: Wayne Webb Location/Address: Webb Way-27006 Proposed Facility: Business Property Size: 24.5 Acres **NU"1�.-"*"t�iis��i�ipr�Ver�ent/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 #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: FacilityType���.�'�:X.-#People 'Z #People/Shift #Seats Industrial Waste: ❑ Lot Size •��-'�--�'Type Water Supply��Y�Design Wastewater Flow(GPD) �O Site: New�Repair❑ System Specifications: Tank Size����GAL. Pump Tank GAL. Trench Width�� Rock Depth��� Linear Ft. lf�� Other: � �-15t�..1 l�i��I t�� �O� Required Site Modifications/Conditions: ,J " �P�7. `t��C�1 3t�'�oh•• 2��� ��-S ��� L ')�C IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 830 a.m.to 9:30 a.m. or 1:00 p.m. to 1:30 p.m.on the day of in�stallation. Telephone# is(336)751-87G0.**** p2c�A, ���^ o��J�� ?�.' FQt.�Y�SC�-1 b��+� �"7a` x:3�'x,�n'� `fo �.JT��O.S,+-�T' �z,v �� �-•,tv�L`X-,i���'"�1 0� �nVrv�,T ��,�J� [�p'�, �7�� S'�S^i`���-���, --�c 3�� �.-�TE1 ����i: - �►�y�L-�Sil�-�p`�-�= I�Lp T 1�� ,_ F°.�'� ' �����-�" s�Ac.�: -oFPQD�. ;o u,�� �r � _ F„� �,�� ��;�,� �To �.�/ � ���- `� ��m-='� 1Z.�G �� C�D��� / �1�1�.5� �vJA'� l �.;�_ S�S.�i-=,,,�— Environmental Health Specialist's Signature: Date: ! �'9 � � DCHD OS/99(Revised) � ' . DAVIE COiTNTY HEALTH DEPARTMENT � , - ` Environmental Heaith Section P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 Account #: 990000923 Tax PIN/EH#: 5872-12-2923 Billed To: Wayne Webb Subdivision Info: Reference Name: Wayne Webb Location/Address: Webb Way-27006 Proposed Facility: Business Property Size: 24.5 Acres ' ATC Number: 2313 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 I 1 of G.S.Chapter 130A, Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW T N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: / CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on ImprovemendOperation Permit 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. ..— � �.,-r.�C.H 1��-/a�.J ,U�� r-(z,�„�; � 1 J ST�I�G� �T T1�'`u oF � �5�^,;;.�:ri a� �.�-'`.`��� - To 3�:: Z'o 4b��t7�' U �' s�,;a � �1 S ��S rt►ti.- AT 3 c.� ' ►1r �;, r� � �o�� �`, X�,,k� b:, r Septic System Installed By: i>1�nJ!�1 L ��IC�L� _ Environmental Health Specialist's Signature : Date: � � ' __ � . , DCI-ID OS/99(Revised) _ �,, � . DAVIE COUNTY HEALTH DEPARTMENT � 2-��=o G ' . • • � Environmental Health Section ��-�c - . . P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 ' IMPROVEMENT/OPERATION PERMIT Account #: 990000923 Tax PIN/EH#: 5872-12-2923 Billed To: Wayne Webb Subdivision Info: _----�� Reference Name: Wayne Webb Location/Addres � Webb Way-27006 Proposed Facility: Business Property Size: 24. c **N�*'Trii��i�ipr�Z�hent/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). TTiIS 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 #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: FacilityType���:F��#People 2 #People/Shift #Seats Industrial Waste: ❑ Lot Size •5�-�-�'Type Water Supplyl��'i''�Design Wastewater Flow(GPD) '� O Site: New�Repair❑ System Specifications: Tank Size����GAL. Pump Tank GAL. Trench Width�� Rock Depth��� Linear Ft. �7�� Other: � �-1st(z,l ��]�0� �O� / Required Site Modifications/Conditions: ,J �Q.�7 `l�.Cr�1C.r1 `go'T`ol� ?�j� ���n� �C� IMPROVEMENT/OPERATiON PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 f4 BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of in�tallation. Telephone#is(336)751-87G0.**** PQc�P. t_�a�^ � _ o��,2�. �� FP�caa �� -�o` ��'�-t��� `To �,�T�s-+a�`�' uZc� �� �...�b,X,,i��'41 oF rv�Vw�,T �i�'J� yp'�.7,' 5,��'r`-�.�^-Z`�-�, ...T� �;' ��-N �.���� -�►��-T Si;?��=• I�L� �T 1.-sT� �-oPAQ�w. �o ca�� �r F��' ,��t�J�--� S�AC�� p�c t� To �.-�/� �3�.TG�- � C�3 r� ~FIu.. +,�1 �2���5 Qwn�l I Z'` nF C���' .-- - �,�. S�jS�-=�- Environmental Health Specialist's Signature: Date: 2� a� DCHD OS/99(Revised) . ' . r+ , . . � • • � � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section P.O.Boa 848/210 Hospital Street • Mceksville,NC 27028 (33G)751-87G0 Account #: 990�00923 Tax PIN/EH#: 5872-12-2923 Billed To: Wayne Webb Subdivision Info: Reference Name: Wayne Webb Location/Address: Webb Way-27006 Proposed Facility: Business Property Size: 24.5 Acres ATC Number. 2313 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLJST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 WASTEW T N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation Permit 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. � .� ?� �Q-�,—f��H 1�'�1 iJ ,U c�T' 2-O+J � 1 J ST�Ia.G� a i TI�``� OF �..�S�'�`r'1 a� ;': C�'��i'� - Tn 3� To 4FS��� �1 s . � � A S ��'s r�- s�T 3c� ' � � Co'�i---�, x.�„k�b,, _ ; Septic System Installed By: ��.J n�I l.= �=11(�Ti' Environmental Health Specialist's Signature: Date: ' 0� i t , DCHD OS/99(Revised) � .._.� � * ' ,. APPUCATION FOR SITE EVAL�lAT10N/IMPROVEMEM PEAMR&ATC D LK � � O � � . . . Davle County Health Department . • " • Envr►ronmenta/Hea/Lfi Sedfon . r.o. eox 8�8/210 Hospital BtxNt DEG 2 9 1999 . �oak.viii., Nc z�oze � . (336)751-8760 ENVIRON�1E��TAL HEALTH • DAVIE COUNTY ***I1�ORTAIIT*** T�IS ]�PBLICATION ��NO? ffi pROG'�BS�D UNL�$8 11LL TAa REQUTAaD I21�'O�D1T20N t8 pA0N2DED. R�fsr to th� Ild�'ORt�IT=0�1 BOLLSTIN !or iastruat.ioas. s. lt.�. to r,. aa.li.e 1.1 l�Y 1t/�� ����_ co�t.oe p.r.«► `.cJ�9�`/��' x�.i� �.,. j � tf� /✓w� 8�/ A� ao�. r�. �3G—4�y-3 �a y C1t7/Ytat�/i2D //�� G�t"S l//.��L �/�. Z,O 2� Dwia��� phoa� _ y 7 p �Z� Z f .r_r. �. 1taa� os� P�sait/UTC i! Di!l�srnt th�► 1►bon 1fa111aQ ]lddsy�• City/ttab/iip a. !►ppliaation ror: 0 Sit� =valuatioa 0 Improv�m�at 8�rmit/1►TC I�oth �. sYsc.s to s•s�so.� 0 Hous• 0 Mobile Hom� �usia�ss O =ndustsy 0 Oth�r a. _! tt�sidu►a�: t peopl� f Sedrooma � Bithrooms �_ O Di�hMu�r O OasbaQ� Dirpo�al O lhabinQ ICtohla� p �aswt►t/Dltsibiaq 0 suwnt/No pluabiaq s. :: awitu..�zadurtsy/otb.r� sp.oisy syp. G�/�f�G C f II�vpl. _� � siak. �_ / Coa�aod�� _�_ f 8ho�r� f tlriaal• i ltabr Cool�r� I! lOdDSS�RVICS: � 8�ats $atimat�d Nat�r D�aq� (oaiioa. r.r asy) 7. Typ� o! wabr �uppiy: � Couaty/City � 1P�11 ❑ Community e. Do yoa snHcipste addiHow or e�raneiont of t6e fa�illty Wb rystem Is intended to urveT g'Yes 0 No Uyea,what type? w,�/Cl o7`i�r - �si�i,�,,a�- �u.��/l/�rG N-�?- T T�/s o,��- **''IMPORTANT"**CLIEiVT3 MtIS7'CIDMPLETETHE REQUIRID PROPERTY INFO1tMATION REQUESTED BELOW. Eit6er s PLAT or S1TE PLAN MiJ�ST BfiSUBMIT7ED b the elleot �vit6 TUI3 APPLlCATION. Pcoperty Dimenaloua: �� � /��s W1tITE DIRECf[ONS(trom Ma{caville)to PItOPERTY: ,�� /� ss�z-��-�9-� Tai 081ce PIN: # `���� �n G �T�—' � i�� � Property AddKss: Ra�d Name � ���e� �� CIty/Zip ,� N� � -.,� `/ �� � a�066 It in a Subdivteioa pcavtde IntormaHon,aa foilowe: Name: SecHoat Blceks Lot: D�te Property Fls�edt �.'2 'Z�—� � Thie is to cerRiFy that t6e IntormsHoa prwided is corr�ct M the best oi my Icaa�vitdga I andershnd thtt�ny pecmit(�) issaed hereafter Are eabjeet to swpeneion or revoc�Non,if t6e elte piane or Intended nse c6snee,or i!t6e informaHon eabmitted in t6V applicaHon Is falaitied or chan�ed. I,also,and�rstand diat I ant ruponslble jor a/l cia�gcs lncumd jront tl�ts appllcadon. I,hereby,�ive eonaent to t6e Ant6orized Repreaenbttve of tLe Ihvie Coaaty HadW Department to eater npou above deac�ibed property loc�ted in Davie Coanty and mrned by to condoct ail teating procedara Ae nceeaaary to detecmine t6e dte sat bWty. DATE �� ��� SIGNATURE THIS AREA MAY BE USED FOR DRAW�iG YOUR S1TE PLAN(Inclade all of t6e follmving: Ezlattag snd proposed property pna aad dtmenatona, etractarea, eetbacka, aad aptic IoatNoni). Site Revblt C6ar$e Date(�): Cltent NoHHaiHon Date: EHS: Account Na �'2� �� Revi�ed DCHD(07/99) Involce Na q , . . �.._- . o e . : . , . . � _ ,_.. ... . ..._ ...�,._....- . . . . . _ - . _ . .: . . .�� . � . "� . �.>.... � . ,_��r_ � � :�.�� � ' � . . - .`_L 1-. :,j:i!.�1\�+� .. • Yj'�-`�,•'l.�z'F,._�=.i'�;1;5�."•9�',l�+., p ;�'• - � , , �� n '�` -�,?,�',+``i,�.k`t.Z.';Z• . ti�:.'�r.:.::;, .:: :� �. I � .. I+� � . . "t. .f'1:.+..,a.�};.btl.'.�,-So,��.,��i. . • ��p8 1� � vic�'i.l�'i.Rt"awr� � . . 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' . � � • DAVIE COUNTY HEALTH DEPART`MENT • ' � Environmental Health Section ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000923 Tax PIN/EH#: 5872-12-2923 Billed To: Wayne Webb Subdivision Info: Reference Name: Wayne Webb Location/Address: Webb Way-27006 Proposed Facility: Business Property Size: 24.5 Acres Date Evaluated: Z 7 0� zJYf� Water Supply: On-Site Well Community Public '�"� Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition L �— L �- Slo e% Z7o 2 o Z o 2�� Z 20 HORIZON I DEPTH - D ��to O - D- Texture rou � ��L-�- „ �',�L � y� Consistence Stcvcture Mineralo ;' HORIZON II DEPTH -�!i-1 �F � . � Texture rou ,I� QcX,k pJSf Qvc�U,JSf GL Consistence �� 'd5 O oJ� � SS Structure J� Mineralo HORIZON III DEPTH ..2p Texture rou G Consistence • Structure Mineralo HORIZON IV DEPTH 'Zo-Z Texture rou Consistence � Structure Mineralo � ; SOIL WETNESS 3� 3 � o RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION t1� c�S � LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �S `7��G -Td S�AI`���A�,/Z�� EVALUATION BY: �`�� �� LONG-TERM ACCEPTANCE RATE: �'2 OTHER(S)PRESENT: �4Y.J� ��3 �2 I7) REMARKS: h� �l--L ��C+?��2d �{Z'7�.�-�- �R.��-� � �t�,....J4Tt4 S��[.- L��dtnk�Ss r.•� �S`T��'.,_. 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' '• J. / �� . .i_r��4�51''!• a., , � • , � � � ^ ' + ;�.r� y�s .�.�-.����+ . t� ..,: "r,r.tct �'. . , � ' � . . � .- \`�0��- •• L � r'k''��,.,a` j ��a� �'+!`�f�/SS)C'k '•�l� , 1 � '_ .�. . . , . . � . +-tiO�V . � ' . - . - '��KT��,,.fi� .w� . . - ' - . ' . . � . ...�..y.• ' . � ,.�.:. • ftUTxortlzA7'�Oiv 1vo: �� `t�' � O�DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section PROPERTY INFOItP�1ATION Permit�ee's /�� / �� i � P.O. Box 848 .Name:�F1�'►�:. �V� • Mocksville, NC 27028 Subdivision Name: �('� _�� Phone# 33¢-751-8760 Section: Lot: Directions to property: AUTHORIZATION FOK !�`jL.� w�1) WASTEWATER Tax Office PIN:# - - _ T SYSTF.M CONSTRUCTION v Road Name: �/�/C��� � U Zip:�� /0 G�t! **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Counry Environmental Health Section prior to issuance of any Building Pernlits.This Fonn/Authorization Numbcr should be presented to the Davie County Building Inspections Office when applyino fo�uilding Permits. (In compliance with Artid yof G, Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposnl Systen�s) %' / 1 / i / .. ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION i �`.� — � �, - � IS VALID FOR A PERIOD OF FIVE YEAI2S. � ENVIR �N AL/ S��C(A I'�'u DATE I SUE ; � ' I . _..._.__..._.__.�___.�,__...�._�.....�.._...- ......��.._____-� _, ._�...:....�,W.__._.._ _ _�....�d.:�_�:..,w_:_._�.,�._..��,_._..�..._...._._._�._._.._—�_.__._..__.�_._ ...__... _....., RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No. � /r��,(In(� COMMERCIAL SPECIFICATION: FACILITY TYPE��. #PEOPLE � #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or`�1o_� � J� �5 ,-�� -- ,-�--� ; LOT SIZE "" ' � TYPE WATER SUPPLY����� DESIGN WASTEWATER FLOW(GPD)�� NEW SITE REPAIR SITE f� � , 1 � SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH�y''• LINEAR FT. �n OTHER � t����3) ��-T1 Q y ��'/� i j REQUIRED STfE MODIFICATIONS/CONDITIONS: � nr'"T ��t ��� L I n�k� � � IMPROVEMENT PERMIT LAYOUT *HP� � # # � i i ' �'ti I � ��� I , 0 i .��uy i�Q°�'� j ��,`1rJfo " ,._ - _'c��x�s�.,��� p .� � � � (�rz 4 ��) �"�"._, ,.,.- ___,. ..-... ..._._. .Q . `"'Z 1 CC�1-r o�f� ` � s 1 1 i ; �A�.-� C9� ' _ '*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF � ��t�Yc�'�k�x � BETWEEN 8:30-9:30 A.M.OR I:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)���6p:T51-87 ' i OPERATION PERMIT SYSTEM INSTALLED BY: �'��L- �A��%� i I � ,` � � -� ��� � � _ AUTHORIZATION NO. 1 �"'� OPERATION PERMIT B . DATE: I •*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH S SCRIBED ABOVE HA EN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPfER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC'fORILY FOR ANY GIVEN PERIOD OF,TIME. � DCHD OS/96(Revised) � ; . —~ � I l�Gt= � — ��� d� �! �-�--e� ' (.`J e�� � �-. , �. = , : . • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �- �2 � APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) � 3 ' NAME �� H�1�. �n�'�l� PHONE NUMBER "1� X -7�J Z� �'I I���S �-��YQ � ADDRESS U'O1 � �x3t,(�-S SUBDIVISION NAME � LOT # �' DIRECTIONS TO SITE � � � DATE SYSTEM INSTALLED G� NAME SYSTEM INSTALLED UNDER S /�►�'�� � TYPE FACILITY �`���� NUMBER BEDROOMS NUMBER PEOPLE SERVED � TYPE WATER SUPPLY �.t�t�.J"�Y SPECIFY PROBLEM OCCURRING �AC�C.S CJ�P C,J� ('� (1 ���� � DATE REG�UESTED 1� Z� � _INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsibie for ail charges incurred}rom this appiication. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.t/93 ,