Loading...
128 Haywood Dr Lot 2 AUTHORIZATI 14 NO: 14 2 9. DAVIE COUNTY HEALTH DEPARTMENT ti'1 i .s• Environmental Health Section PROPERTY INFORMATION Permittee'sP.O.Box 848 Name: ff60 '1 Mocksville,NC.27028 Subdivision Name: � Phone#:704-634-8760 Idn Directions to property: 1/l�` 1f Section: Lot: j AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION �► rY f I iY !� Road Name: p: **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 Fonn/Authorization Number should be presented to the Davie County 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) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPttIALIST DATE ISSUED c -, ,f�tiva J�.'"4.r" �K,,.iji ifpw•Rt'`yv } � Y.,,�5 � � ! .}.. �': .i� .. i.. .F,.:.r. „... . . ' :. i;-4 NA qc000y 0 DAVIE COUNTY HEALTH DEPARTMENT 4i TM��� ' rnIPROVEMENT AND OPERATION PERMITS PROPERTY it ON Perm�tte�'`sl Name: f I ' �+' Subdivision Name C1�� �•1,��s:��jY+s Directions to property: f �/� ' t" �' Section: C�, Lot: / IlVIPROVEMENT r` J�' ;`i.4t dj'r ` PERMIT Tax Office PIN:# ,r y; y Road Name: Zips ©�(o **NOTE**This Improvement Permit Dbp NOT authorize the constriction or installation 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) ***NOTICE***:THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ✓ �" }.�, , ; ,, .. ,:� 'i-PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE . ENVIRONMENTAL HEALTH SP$C IST DATE ISSUED INSTALLING THE SYSTEM. ` RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS= #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFI #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY (1/0 DESIGN WASTEWATER FLOW(GPD).eO NEW SITE - REPAIR SITE .' SYSTEM SPECIFICATIONS: TANK SIZF,/S�t3 GAL. PUMP TANK J� aGAL. TRENCH WIDTH ROCK DEPTH LINEAR FTs OTHER REQUIRED SITE MODIFICATIONS/CONDMONS: IMPRO P AYOUT �Vol 8�l q� "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM P BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. OPERATION t✓0 ✓]� SYSTEM INSTALLED BY: -� O A Clip► I L I j .wo t r AUTHORIZATION NO.- -�`—'—OPERATION PERMIT BY: 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 NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) 'k. �,rVr Y..);:.-: "[ .,"t:: -"` f. . .... a s .. �4f♦fr :i. -�.:�"' .. . - .^ .. .. ., .,,,_.. o, 14251 DAVIE COUNTY HEALTH DEPARTMENT „� p IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Per nitieC,•V,. Name: D �? .1 Subdivision Name: 1/0e/ Directions to property:* 1}°Ft' � � +"'�' Section: r } Lot: ¢ / EUPROVEMENT PERMIT Tax Office PIN:# Road Name: al"Ilv7d 91006 **NOTE**This Improvement Permit DOES NOT authorize the construction or installation 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) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ; >> c` `'' PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS_ --!r-7#OCCUPANTS<GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY F r1 DESIGN WASTEWATER FLOW NEW SITE (GPD), ; T_ REPAII�SITI: SYSTEM SPECIFICATIONS: TANK SIZE,�GAL. PUMP TANK –�GAL. TRENCH WIDTH l ,ROCK DEPTH /--? LINEAR FT,9�y OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: .y IMPROVEME P LAYOUT ^ a 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 THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. OPERA NTmgrr SYSTEM INSTALLED BY: L 14m, b� y Y3 yn s a2Gv ,. 1 r - t 91-1 ' AUTHORIZATION NO. l lT OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A i GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. '. DCHD 05/96(Revised) z