594 Sheffield Rd DAVIE COUNTY ENVIRONMENTAL HEALTH
4 '.- _ ; P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680 '
` ' ` ' REPAIIt OPERATION PERMIT
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� Sillcd Ta: Wade Stroud • Su�ic�ivisior� infa:
�, ; R�fer�r�ce Na��e: REPAIR PERMIT Loca#ioniAddr�ss: . 594 Sheffield Rd.-27028
� �; 'Propc�s�c9 Fa�i€ity: Residential Repair , , Proper#.y�iz�: ., 0.75 Acres - : ;, ,
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��� 'I7�j�uance of this Operation Permit shall indicate the system described on the ATC has been installed
�T�n comp iance witri 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
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^ System Type: .i S.T.Manufacturer Q �VI Tank Date � Tank Size�
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System Installed By� • ` E.H.Specialist: � ate: ���Z
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DCHD 11/06(Revised) -
DAVIE COUNTY ENVIRONMENTAL HEALTH
• � . ►�. P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �
, Acc�►��t �: 990005798 ' T�x PI�€%EH#: G20000004503
Biilcd To: Wade Stroud Sufadivi�ior� Infu:
Referer�ce Rfanie: REPAIR PERMIT LacationiAddr�ss:: 'S94 Sheffield Rd.-27028
PropasQd Fa�i€ity: Residential Repair = :� ., : ` - Prop����e;;`>p����ir OExpansion ' ' .
f1Tc 5$[00
��f�I�6A�'�i�r.�E'hi�fhorization to Construct(ATC)MUST.BE ISSUED,by the Davie County Environmental
Health Section prior to.issuance of any building permit(s),(in compliance wifh Article 11 of G.S.Chapter 130A
Wastewafer Systems,Section.1900 Sewage Treatrnent 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 change.
Residential Specifications: #Bedrooms 3 #Bathrooms #People Basement� Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats •
Square Footage(or Dimensions of Facility)� ' �
Lot Size .���_ Type of Water Supply: �ounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD)��(�Tank SizeEn',�� P AL.Pump Tank �GAL.
Trench Width�_ Max.Trench Depth�(oi� Rock Depth�� Linear Ft.��` "
Site Modifications/Conditions/Other: o�S�jb ,t�Gt(,�tOr�
Contact the Davie County Environmental He�lth Section for final inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. �
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Environmental Health Specialist � Date: �"
• DCHD 11/06(Revised)