229 Dogwood Lane Lot 115-119DAVIE COUNTY ENVIRONMENTAL HEALTH
' P.O: Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Account #: 990005831 Tax PIN!EH #: H5150B0015
Billed To: Gary Boger Subdivision Info. Woodland Lot # 115-119
Deference Narne: LocationiAddress: 229 Dogwood Lane -27028
Proposed Facility: Residential Repair P(opert.y Size: - 1.16 Acres
ATC Number: 5884
**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 TypeS.T. Manufacturer I Tank Date e -"--Tank Size
Pump Tank Size"Aate:__
System Installed By: 2a� Qr 0�� E.H. Specialist: 1I�2NZ
GPS Coordinate:
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR tMPROVEMENT PERMIT
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990005831
Billed To:
Gary Boger
Reference Name:
Proposed Facility:
Residential Repair
ATC Number: 5884
Tax PINfEH #: H5150B0015
Subdivision info: Woodland Lot # 115-119
'LocationiAddress: 229 Dogwood Lane -27028
Pt6perty•Size:" 1:16 Acres
Site Type: Repair W Expansion ( )
**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 2 # People Z Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
. Square Footage(or Dimensions of Facility)
Lot Size 0J_ Type of Water Supply: gCounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) AD Tank SizeAd,GAL. Pump Tank -' GAL.
Trench Width Max. Trench Depth Rock Depth Linear Ft. S0
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)753-6780.
11/06 (Revised)
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