Loading...
192 Westridge Road Lot 44AUTfdORIZATION NO: '7DAVIE COUNTY HEALTH DEPAR6WTM--E-NT Environmental Health Section PROPERTY INFORMATION Permittee's P.O. Box 848 ,1 �' k Mocksville, NC 27028 �'l (l..t (jC Name: �` �}_ -.�1 "L ' Subdivision Name: Phone # 336-751-8760 Directions to property: Section: Lot: H AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION Road Name: t= �,"t F t r [;�� 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 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 L� IS VALID FOR PERIOD OF FIVE YEARS. ENVI�NI�Nj LTHSPECIdLIST DAT tSS ED r ' [""r "',- —F, s--,•� - '"•.`�-t``''om-.`°..r".r'.,wr�-�''--•vim•. ,-,r"''"1'r R' 1iq �'�, . � � ,�� ;. �—�" Cep' - k::1c �•;f� F Q„ .S L�' r•DAVIE COUNTY HEALTH DEPA1tTMENT -� s17574 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ,Q 1 ernirttee's _ � Subdivisi, on Name:; ttions.r Section= Lot: -property: r .IMPROVE ENT pT Tax Office PIN:# j a Road Name: F!� 9�Cw Zip:' . **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An - AUTHORIZATION AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the ; +' construction/mstallation of a system or the issuance,of a building permit. (In cwmp• •liar ,with Article 14 of G.S. Chapter 130A, Wastewater Systems,'Section .1900 Sewage, Treatment and Disposal Systems) t ***NOTICE*** TIII.S'PERMIT IS SUBJECT' TO REVOCATION TF SrPE AIS PLANS OR THE INTENDED. USE CHANGE. YOUR WASTEWATER' . TH SPECUtiIST. SYSTEM CONTRACTOR MUST SEE. THLS PERMIT BEFORE INSTALLING THE SYSTEM ,' ,, , � . , ; • � _ {• �. . , ' . (. ,, tib; RESIDENTIAL SPECIFICATION: BUILDING TYPE k" # BEDROOMS _ # BATHS # OCCUPANTS GARBAGE DISPOSAgVes)or No COMMERCIAL SPECIFICATION: FACILITY. TYPE : _#. PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No wI i*� . NEW SITE REPAIR SITE! * LOT SIZE TYPE WATER SUPPLly• DESIGN.WASTEWATI RFLOW (GPD) SYSTEM SPECIFICATIONS: TANK SIZE GAL: ' PUMP TANK GAL. TRENCH WIDTH" ` ROCK DEPTH �� LINEAR FT. OTHER _ _ ) WPa &)T t o-1 REQUIRED SITE MODIFICATIONS/CONDITIONS: 1r1)=17Akl 01.1 C-0-noXZ. wRovEmEk PERMIT LAYOUT *APMVED EFFLUEt+IT FILTER* *RISER (BY IF 6g * BELOW FINISHED 6R9DE* **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) 6348760. ><xxkxXIRMX- OPERATION PERMIT SYSTEM INSTALLED BY: i-- " o 1 �I i r DAVIE COUNTY HEALTH DEPARTMENT r ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee's Name:: �..;. :.."f Subdivision Name:; j 4 , ; , Directions ro property: Section Lnt # IMPROVEMENT PERMIT Tax Office PIN:# Road Name: t Zip: . w **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 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTALREALTH SPECIALIST DAT�ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE,_ INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE ' >," i, # BEDROOMS # BATHS 2,. # OCCUPANTS GARBAGE DISPOSAL(Ye`s•or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLYr ; i) TY DESIGN WASTEWATER FLOW (GPD)' �'� NEW SITE REPAIR SITE 1 SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 4 ROCK DEPTH 2W' LINEAR FT. OTHER I f'�i ZI i, r. )7 o� v REQUIRED SITE MODIFICATIONS/CONDITIONS: PERMIT LAYOUT 'tnPPROVE:D EFFLUENT FILTER* *P.ISER(S),-IF 611 DE -101.1 FINIU'ri I) GRADE lti i 'tJ 1 L **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. xxxxxxxxx OPERATION PERMIT r AUTHORIZATION NO. �� OPERATION PERMIT BY: DATE: % OCA **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE YSTEM 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 05196 (Revised) . A �. 6r).%, C0CXr -r AG DAVIE COUNTY HEALTH DEPARTMENT er (Septic Tank) Improvements Permit and Certificate of Completion a.-- c.c cT a►— (Ground Absorption Sewage Disposal System - a.s. Chapter 130 -Article 13C) OWNER OR CONTRACTOR_ t yµ� z ttri•��- �• �h��i "f"DATE PERMIT r t N° 1497 LOCATION LA./",,i , ;,cam - .� �. S.R. NO. SUBDIVISION NAME L,i. "; �, . , _ LOT NO. 4A dl SECTION OR BLOCK NO. SS NITRIFICATION FIELD sq. ft. House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 800 Gal. 400 NO. BEDROOMS NO. BATHROOMS Gal. _ Z GARBAGE DISPOSAL UNIT YES ❑ NO 0 - AUTO. DISHWASHER YES 0 NO ❑ AUTO. WASH. MACHINE YES 0 NO ❑ SITE SUITABLE YES ❑ ,NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. DEPTH OF STONE IN LINES: I 1 1. .J . •1 . - WATER SUPPLY: _Individual ❑ Public (g' IMPROVEMENTS PERMIT BY 0-\(ctt6 INSTALLED BY CERTIFICATE OF COMPLETION ByDate (8/16/73) *Construction mus comply with all o er applicable State and local regulations LOT AREA t\0%,Le 90 -rdo-A 1-j / �7S I DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completionw- (Ground Absorption Sewage Disposal System .S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR4` F �n �i� i �•,; �•; , �h l:ri ,. 'wj'DATE ._. �.: - j' i PERMIT N° 14 9'7 LOCATION i._i� ,:`t' , ., , �.�_, ,�1, • - S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ( MOBILE HOME ❑ BUSINESS ❑ NO. BEDROOMS NO. BATHROOMS .? GARBAGE DISPOSAL UNIT YES ❑ NO AUTO. DISHWASHER YES © NO ❑ AUTO. WASH. MACHINE YES Ci NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. INSTALLED BY C. CERTIFICATE OF COMPLETION ByKof Date (8/16/73) *Construction must comply with all o er applicable State and local regulations LOT AREA nil S�. / I'.//4 fi[.. ........ `..• f '7 7S � �i G" Q � -7 DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27023 (7 04) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME� (��� (��. DATE ISSUED ADDRESS PERMIT NO. Explanation of charge i-�.••.. b.ca►s= - ,,_ AMOUNT DUE6, t4 SANITARIAN �+ PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.