162 Westview Ave � : .� ���i �, ,v
DAVIE COUNTY ENVIRONMENTAL HEALTH J j`� Q �� .��\
P.O.Box 848/210 Hospital Street ��-\� �\�
Mocksville,NC 27028 �(�'
(336)753-6780/Fax#(336)753-1680 �
REPAIR OPERATION PERMIT
Accr�u�t �: 990005865 � '�ax F�I�€r'EH#: M4130A0016
Billc;d T�: Albert Whipkey �u�atii�i:iort lr�fo: �
Re€er�r�ce Rlanie: REPAIR PERMIT LocaiianrAd+�r�s�: 162 Westview Avenue-27'p1'� i'
f�ro�c�s�;c9 F��:ility: Residential Repair P�n�er�.y S�ix�: 0.97 Acre
e��TC Nu�b�r: 5917
**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.
�'/
System Type: � S.T.Manufacturer 01'f?�f��,� Tank Date � Tank Size -''
Pump Tank Size Bedrooms �- ��
,''.. ' , P r"-+...!, � ��;Z�,
System Installed By ��.:E��".' � ,1,�` 'r.� L��`�Tnspector#: Date: .�,�`,r.-=-'�j;�?
GPS Coordinate:
. f � M1 r ,.
_�r, r2'
�`) �
. ��
�L��
����
�
4 � ' �� �
� �
�'
� �
a�y �
Environmental Health Specialist: .�C � � Date: � � ,�
�� � � V/
DCHD 11/06(Revised) C D �
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 CONSTRIJCTION �
�cct�u�t #: 990005865 "��x �'f�€:�N#: M4130A0016
BiE�et�To: Albert Whipkey Suiat�i�si�iar� ln��:
�e:f�r�r�ce P���ie:: REPAIR PERMIT � Lacaiionrr�dc�r�ss: 162 Westview Avenue-27104
f�ro�c�sgi9 F��i€ity: Residential Repair' • P�o��rf.y S�iz�: 0:97 Acre
Site Type: ONew �IZepair ❑Expansion
��'T*�*'NCTI'���3This A�uthorization 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 change.
Residential Specifications: #Bedrooms 2 #Bathrooms�_#People Z Basement0 Basement plumbingu
Non-Residential Specifications: Facility Type # People #Seats �
Square Footage(or Dimensions ofFacility) '
Lot Size�_ Type of Water Supply: ❑County/City ❑Well ❑Community Well
System Specificatiqns: Design Wastewater Flow(GPD)�Tank SizeP � )��iAL.Pump Tank �GAL.
� v
Trench Width�� Max. Trench Depth3��� Rock Depth� Linear Ft.���l
Site Modifications/Conditions/Other: 1���
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.
� _
� �
� � I�,��-
. � I 4
l
� / �. �.- - .� .
_�� h� �
( vU_r,��! � .1
�1����.)
�� �
�
�
I -
l�y� �-
_ �
Environmental Health Specialist V � Date: a ���
DCHD 1]/06 (Revised)
_ �iU U,0're��g 1 Z7