371 Foster Rdi
Account #: 990005791
Billed To: Andy McLaughin
Reference Blame: REPAIR PERMIT
Proposed Facility: Residental Repair
GPS Coordinate:
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Tax PIN/EH #: L2000000201
Subdivision Info:
Locatlon!Address: 371 Foster Road -27028
Propefty Size: 1:058 Acres
* * cognTN1* * Tl}o gtuance of this Operation Permit shall indicate the system described on the ATC has been installed
ATCimp lance wit 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.
System Type: S.T. ManufactureTank Date .! Tank Size
Pump Tank Size_ ,, r
System Installed ByVGPAq m W ay'Zig s E.H. Specialist: ate:_ `
\\I�?"
DCHD 11/06 (Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mock'sville, NC 27028
(336)753-6780 / Fax # (336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005791 1 Tax PIN,EH #: L2000000201
Billed To: Andy McLaughin Subdivision Info:
Reference Name: REPAIR PERMIT LocationlAddress: 371 Foster Road -27028
Proposed Facility: Residental Repair PfopE � : ❑*X8[Wpr ❑Expansion
AT c;
f,TCNWffibt ff'hi$6"4horization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to.issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use chanee.
Residential Specifications: # Bedrooms # Bathrooms / # People 2 Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: MCounty/City ❑ Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) Tank Sizeo„_AL. Pump Tank /GAL.
Trench Width c Max. Trench Depth 36„ Rock Depth49/d Linear Ft.�j
Site Modifi ations/Conditions/Other: �� °0 &t(A
Contact the Davie County Environmental Heilth Section 'ns ection of this system between
8:30— 9:30a.m. on the day of installation. Telephone ,(336)751-8760.
a
wN,
Environmental Health Specialist Date:
0
DCHD 11/06 (Revised)