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146 East Robin Drive Lot 6Pemuttee'st` DAVIE COUNTY HEALTH DEPARTMENT Name:, . ,1 C� ± t C ( C4 E-{ � Environmental Health Section C , 1 P.O. Box 848 PROPERTY INFORMATION Directions tproperty: ' T' , Mocksville, NC 27028 Subdivision Name: w( Phone #: 336-751-8760 Section: Lot: of �� t✓!` l� AUTHORIZATION FOR WASTEWATER , t' }J,� ,�ic..:'�i+tf �1J7 SYSTEM CONSTRUCTION Ta Office PIN:# - - f E � J AUTHORIZATION NO: 00M 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/Authonzaiion Number should be presented to the bavie 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) "S i.^ C)t�*NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION °✓l-i�/`j'/�%� `� / IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE ✓ F # BEDROOMS 3 # BATHS L # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REP�IR SITE SYSTEM SPECIFICATIONS: TANK SIZE f TGAL- PUMP TANK OGAL. TRENCH WIDTH 31 11 ROCK DEPTH ( LINEAR FT. OTHER ! r\ a q u j ,e 3 17 t o A) 6U P^P tt Lc=..11 r. Y1 REQUIRED SITE MODIFICATIONS/CONDITIONS: i IMPROVEMENT PERMIT LAYOUT �r r I a`i- 11t r-- 7 01f b,r1057 I t o r u g .tiac del �` va W q� ! r ell q4 101 VIAtt, 76 �k 3 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 IA I SYSTEM INSTALLED BY. C'LtJ x'1 d .01"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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02102 (Revised) d % + // 16; Permittee s'r DAVIE COUNTY DEPARTMENT N Environmental IHealth PROPERTY INFORMATION G ' P.O. Box 848 e-- Dlrectiolis;t� property:, * '' Mocksville, NC 27028 Subdivision Name. Phone #. 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Ta ,Office PIN :# - - S 7 , SYSTEM CONSTRUCTION 00281 S _ AUTHORIZATION NO: � Road Name: Zip: **NOTE** This Authorization for Wastewater System Constniction 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 Sy t�errls) OgNOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION V IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 3# BATHS +' # OCCUPANTS GARBAGE DISPOSAL: Yes or No v COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No (� f LOT SIZE TYPE WATER SUPPLY r DESIGN WASTEWATER FLOW (GPD) 3 � © NEW SITE REPAIR SITE' / SYSTEM SPECIFICATIONS: TANK SIZE � � t GAL! / "%%GAL. TRENCH WIDTH PUMP TANK ✓ ROCK DEPTH l � LINEAR FT. OTHER J �- � t e J A, 5 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT VI(JI pie b -P#✓ C r0il 00 a d d V?a erg 14 0" ltt. (Lo 1651 . `may V 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. 74 I �/ OPERATION PERMIT SYSTEM INSTALLED BY.. ` Oi C U� S ' I ' _ /�� •_ JA J. / e 6 d' 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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised)1 �� �rl` `� it Permittee'sDAVIE COUNTY HEALTH DEPARTMENT Name: ieg 0 010 Directions toproperty: 14V t AUTHORIZATION NO: 00247 A Environmental Health Section P.O. Box 848 Mocksville, NC 27028 Phone #: 336-751-8760 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION PROPERTY INFORMATION Subdivision Name:x bC8 I —e Section: Lot: - 61 Ta/xyOffice��P--IN:# - Road Name: ��'��� J- Zip: -2 -7ef47�; **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) ***N07"ICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME (1,4Ul'e 1�%N�()UQ PHONE NUMBER ?Y)b;A)' uADDRESSy (0 �: �IUC�� SUBDIVISION NAME 00 ee- LOT # (!/ DIRECTIONS TO SITEaX/7 w fo/ ru DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY Se, NUMBER BEDROOMS 3 _NUMBER PEOPLE SERVED TYPE WATER SUPPLY Well SPECIFY PROBLEM OCCURRING //Ves 57011 DATE REQUESTED MIA" INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that 1 understand I am responsible for all charges incurred from this application. SIGNATURE O/F� OWNER OR AUTHORIZED AGENT, Rev. 1ry9 ...-�'�Ci�� iC-- f I ✓` C'e� 1. ' I -1 't% GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page I of I Click Here To Start Over Quick Search: (County ID c - Active Layer. RUse.,VTips ap GIS 0 Ij tai 0 .0p PARCELS (Map Tips Available) ciao Lavers I Results I Lr 4 Pj . �l'2t 181 ft http://maps.co.davie.nc.usIGoMapslmapllndex.cfm?maim-napservice=gomaps&CFID=4129... 5/9/2008 6i -A, Or I I `" 9gO DAVIE tANTY,HE LTH DE ART TENT 11 SEPTIC TANK PERMIT Date j_--2.2 —23 Okmer/Occupant To: <nw% 5 , / " C , Address z d Address Building Contractor /L/Z Address (�fAtnm o ks '"al. D a Manufacturer's Name Address r '4o. of lines Width ,.3 bin. Total length JSO ft. No. sq. ft.Sd %/,5 Type of filter material st Total tons used ,3 D Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400 Two-bedroom house 800 600 Three-bedroom house 900 900 I No one shall install a septic tank in Davie County without a permit from the Health Offic or his agent. Date of Final Approval Signed:. Sanitarian I hereby certify that the above septic tank has been installed according to specificatior Signed ��t/ i `�I SeTank ContractorContractor Note: Make sketch of disposal system on back of sheet and mail to Davie County Health Center, Box 57, Mocksville, North Carolina 27028. C c- T4 .f t �e9 Ala, /10 p.c Lay' . 5 �c � DAVIE ANTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date Nmer/Occupant _ To: ,Q �/ Address f ��� /� Address /� l sZ Building Cantractor' Address <'%tntnohs Cal. 0 a Manufacturer's Name Address °do, of lines Width ,, .bin. Total length ft. No. seg. ft. Type of filter material Total tons used 3 Minimum REquirements: House Trailer Tank cap. 800 Sq.. ft, line 400 Two-bedroom house 800 600 Three-bedroom house 900 900 •y Y No one shall install a septic tank in Davie County without a permit from the Fealth Offic or his agent. Date of Final Approval Signed: . Sanitarian , I hereby certify that the above septic tank has been installed according to specif i cation Signed: ✓ lt'�.�-�Y Septic Tank Contractor Note: Make sketch of disposal system on back of sheet and mail to Davie County Health Center, Box 57, Mocksville, North Carolina 27028, 6 GoMaps GIS Page I of 6 sxt �A" i r V AA i'l i r r w a r � ! 1.' r4!Q�-ar P 0 312 ft e' r http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=17813&CFTOKEN=49736857 5/28/2008