Loading...
108 Elm Street Lot 23-25Permittee's DAVIE COUNTY HEALTH DEPARTMENT Name: �- = ►.� ALL_&,a Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property:7' Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 AUTHORIZATION FOR Si"Gr'1`� WASTEWATER SYSTEM CONSTRUCTION AUTHORIZATION NO: 002760 A Section: Lot: Tax Office PIN:# r> Road Name: !��`r'? t-, 1 Zip: **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 Form/Authorization Number should be presented to the bavie County Building Inspections Office when applying for Building Permits. (ln"corn pliance with. Article 11 yf 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. f ENVIROI*1MENT L1lEALTH SPECIALIST` DA ISSUED RESIDENTIAL' SPECIFICATION: BUILDING TYPE Nvy_; # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPL , JIJN tit DESIGN WASTEWATER FLOW (GPD) Z—&1;0 NEW SITE REPAIR SITE ✓ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT `IT rN loo D y �.--�- �f P too A1,a- FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: ��� 1 'Vy �• 1.�.-l•'. TtiCu ►��:� p -fix n.,J'� �.ft,.rt�t; ��. , ti/���+�: ,,� �;/•;.nSli ::Y�� AUTHORIZATION NO. Z,!7UC OPERATION PERMIT BY: DATE: a / "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYST CRIB OV HAS BEEN INSTALLED k 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 02102 (Revised) )y'er�nittee's� �� A DAVIE COUNTY HEALTH DEPARTMENT "~ %Tame: ANLL :;;, Environmental Health Section PROPERTY INFORMATION Directions to property: - -, Jpj P.O. Box 848 Mocksville, NC 27028 Subdivision Name: t ltz ,i '1<-A, Phone #: 336-751-8760 ;; w Section: Lot: AUTHORIZATION FOR r WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION AUTHORIZATION NO: 0027 fS 0 A Road Name: �" ` � � Zip: t� **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 Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In Compliance with Article I 1 of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) A ,.r /% s ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. j ENVIRONMENTAL HEALTH -SPECIALIST', DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE t 1"'_G# BEDROOMS -) # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY JWA1 Y y� DESIGN WASTEWATER FLOW (GPD) ` NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: II FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: t_. r L "W AUTHORIZATION NO. t., L) OPERATION PERMIT BY: DATE: r "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH SYSTEM CRIB 1OV HAS B N INSTALLED I 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 02/02 (Revised) - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:. Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage_Tre'atm�ent and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number, NameJ�t� r h .�_:\ ► Date _� to 1 Location i SrK' SubdivisionName I t V f i 9 1 Ll it IA u J, cti_ , c Lot No. Sar. nr Rlnnk Nn Lot Size �� .House. Mobile! -Home — Business Speculation No. .Bedrooms __! No. Baths No. in Family _ :` ter- DAVIE COUNTY HEALTH DEPARTMENT ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name Date - Location Subdivision Name Lot No. Sec. or Block No Lot Size — House Mobile Home — Business __ Speculation No. Bedrooms -- No. Baths --- No. in Family Garbage Disposal YES E] NO ❑ Specifications for System: Auto Dish Washer YES E] NO ❑ Auto Wash Machine YES ❑ NO F-1 Type Water Supply — __— "This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by '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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: b,; �A System Installed by 'P - the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: .Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Name Location Permit Number Date ---- Subdivision Name Lot No. Sec. or Block No. Lot Size House `�Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family-- Garbage amily _Garbage Disposal YES p NO E]' Specifications for System: -- Auto Dish Washer YES Ey NO p Auto Wash Machine YES 0 NO E] Type Water Supply __— *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by - ` - ` ` ' ^ V_ *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: �,c System Installed by t------ `--- - Certificate of Completion. r Date. *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time.