211 Haywood Dr Lot 2 {;.r- •Y pr+r.i?+.Lt..i +Tr'�
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` DAME-.('CUNTY AEALTH DEPARTMENT `
m, %
IMPROVEMENT; AND OPERATION PERMITS PROPERTY INFORMATION ”
' Permittee's 4
Name:` t
Subdivision Name: r>,
Directions to property: W /1r S ,. Section: Lot:
Il17PROVEMENT
i{ r f'. .<: !�^�" h PERMIT T.. fHce PIN:# -
Roaame ). Zip:
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a s ater 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 I I of G.S.Chapter130A.Wastewater Systems,Section'.1900 Sewage Treatment and Disposal Systems)
***NOTICE***.THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
`— -6 SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRONMENTAL HEALTH SPECIALIST' DATE ISSUED INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE_ #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSALrYes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE 'j #PEOPLE #PEOPLE/SHIFT. #SEATS INDUSTRIAL:WASTE:Yes or No,'
S LOT SIZE TYPE WATER SUPPLY l D DESIGN WASTEWATER FLOW(GPD)—' ��[t NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK i'GAL. TRENCH WIDTH ROCK DEPTH 1 a LINEAR FT. a l
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
3v, e
(3a '
**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 (336)751-8760..
OPERATION PERMIT �C d IL Tr u►��,,`.
SYSTEM INSTALLED BY:
AUTHORIZATION NO. 7 q g OPERATION PERMIT BY: DATE:
*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT E 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 FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised)
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DAME OUNTY HEALTH DEPARTMENT
=, IMPRO'VEMENT AND OPERATION PERMITS PROPERTY INFORMATION
=Permittee's
Name: ''� 1. '/ � �`.: ,} Subdivision Name:
per"
Directions to property: •% ��' 't :,i�rt�';t Section: 1 Lot:
r ! IMPROVEMENT --
t PERMIT
Tffice PIN-
IX- -
(Road Umle: 1, r , ', ' Zip:
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a�eptic-a Mstem.or-my-waste acv`ter system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
constructionfimstaIlation 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
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 #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPEEI #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY r DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH NEAR FT.
'1
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT (3,� .c 'S
1 3,)
t
ao
i
G1v;•t,. .-r,l�
41 ,
**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 (336)751-8760.
y
OPERATION PERMIT
f
SYSTEM INSTALLED BY: r
J,�
AUTHORIZATION NO.
7"( 9 OPERATION PERMIT BY: '� DATE:
�_
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT L SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
DCHD 05/96(Revised)