115 Danner Rd • DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
' Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
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Account #: 990005766 Tax PIN/EH#: F300000100
Billed To: Anne Dawson Subdivision Info:
Address: 208 Howardtown Road Location/Address: 115 Danner Road-27028
1 City: Mocksville
Property Size: 14.99
Reference Name: Janice McDaniel
Propos e4F6994y:T ETss&ffbe 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 sysiem will function satisfactorily for any given period of
time.
System Type:=S.T.Manufacturer Q 1Tank Dat eTank Size
1 Pump Tank Size ./
System Installed By:P-A91A 11A �(�i� E.H.Specialist: G ate: 2®1,1
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GPS Coordinate: r•.- .R 6
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HD 11/06(Revised) It
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
Acenunt M 990005766 Tax PIN'EH#: F300000100
Billed To: Anne Dawson Subdivision Info:
Reference Name: Janice McDaniel LocationiAddress: 115 Danner Road-27028
Proposed Facility: REPAIR Property Size: 14.99
Site Type: ❑New Ktepair ❑Expansion
ATC Number: 5830
**NOTE**This 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 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 Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lot Size CSL Type of Water Supply: [Kounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD)2YO Tank Siz AL.Pump Tank _ GAL.
Trench Width Max.Trench Depth Rock Depth Linear Ft._���
Site Modifications/Conditions/Other: I26,d uC�oil-
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760.
Environmental Health Specialist 04) 1 Date: 0
DCHD 11/06(Revised)
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