519 Todd RdDAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Account #: 990005894 Tax*.PIN,EH #: 190000000101
Rifled To: James Cannoy 5ubdivisiori'Info:
Reference Blame: LocationiAddress: 519 Todd Road -27006
Proposed Facility: Residential Repair Pfbperty, Size: 2.98 Acres
ATC Number: 5946
**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 jPYi5
JiAa Tank Date_ Tank Size /
Pump Tank Size / Bedrooms 3
System Installed By: lamsC f Installer#: Date: V21aDIZ
GPS Coordinate:
I f--oj v � 4
I I
IbE- -4s'
Environmental Health Specialist: 4Date: ;w
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
Account #: 990005894 Tax P1N/EN #: 190000000101
Billed To: James Cannoy Subdivision info:
Reference Name: LocalioniAddress: 519 Todd Road -27006
Proposed Facility: Residential Repair prbpA. F9L F: .0YswA6ffair ❑Expansion
** T�,, ** Thi Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
p�T1�ea1Hir eRi-on p9 br to. issuance of any building permii(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 chance.
Residential Specifications: # Bedrooms_ 3 # Bathrooms 4 People Basement❑ Basement plumbing0
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size.. lRC� Type of Water Supply: ❑County/City ZVell OCommunity Well
System Specifications: Design Wastewater Flow (GPD)�Tank Size AL. Pump Tank _GAL.
te
Trench Width Max. Trench Depth Rock epth_AVA Linear Ft. S(301 o�J
Site Modifications/Conditions/Other:
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
DCHD 11/06 (Revised)
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