174 Knight Ln '� DAVIE COUNTY ENVIRONMENTAL HEALTH
� .
` ' �^�''"' P.O.Box 848/210 Hospital Street
� ' i Mocksville,NC 27028
• (336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
,�ccr��a�t #�: 990002433 : . . '�ax F�i�I.��H#: G800000014
�ifl�;d TQ: Triple Real Estate Investment . Sufat�ivisiar� lr�fo: .. .
Refer�r�ce �lanie: REPAIR PERMIT �. . :.LocaiioniAddr�ss: .174�knight Lane-27006 �
Propossc� F'�ciiity: Residential Repair. : . ': �:' •: P�o��r#y Siz�: .,4:96 Acres . �
a�TC Nurnber: 5890 .,
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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.
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System Type: � � S.T.Manufacturer Tank Date �' Tank Size t � o 0 0
Pump Tank Size Bedrooms �.
System Installed By:_�o,�i�e�al'n-�5 Inspector#: � Date: 3�3 �" � a.
GPS Coordinate:
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' Environmental Health Specialist: Date: � - 3d ��
DCHD 11/06(Revised) .
l DAVIE COUNTY ENVIRONMENTAL HEALTH
� - • P.O.Box 848/210 Hospital Street
. � • • -, ,,;s•,
. .• Mocksville,NC 27028
(336)753-6780/Fax# (336)753-1680
REPAIR IMPROVEMENT PERMIT
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Acct��ar�t �: 990002433 �"ax�1EVf�N�: G800000014 -
Billc�TQ: Triple Real Estate Investment SuE�t�i�i�ior� lnf�:
Refer�r�ce Nan��: REPAIR PERMIT LocaiioniAddress: 174�cnight Lane-27006
Pro�c�s�d ��s;ility: Residential Repair Prc���r#y Size'. 4.96 Acres
Site Type:Repair�Expansion()
�TC Nu�tb�r: 5890 .
**NOTE** This IP/Authorization 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 IP/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 change. ,
Residential Specifications: #Bedrooms�_#Bathrooms___�__#People ( Basement0 Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
. Square Footage(or Dimensions ofFacility) � ,
Lot Size �.��t�, Type of Water Supply: ❑County/City ❑Well ❑Community Well
. ,.
System Specifications: Desigri Wastewater Flow(GPD) �� Tank Size p � � GAL.Pump Tarilc�GAL.
Trench Width�_ Max. Trench Depth 3(�j� Rock Depth�_ Linear Ft.1��°fa
Site Modifications/Conditions/Other: • �Q�U7b/1
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 753-6780.
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DCHD 11/06(Revised) � � I�I lZ
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