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4067 Hwy 158 (2)DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001155 Tax PIN/EH #: 5861-08-3220 Billed To: Chad Roten Subdivision Info: Reference Name: Chad Roten Location/Address: U. S. Hwy. 158-27028 Proposed Facility: Residence Property Size: 201.10 x 200.0 Orispon**Nimveent/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CON'T'RACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms3-- #Baths Dishwasher-,]K ishwasher: ]K Garbage Disposal: ❑ Washing Machine A Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial` Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size p& X A0 Type Water Supply Design Wastewater Flow (GPD)n0 Site: New Repair ❑ System Specifications: Tank Size/ QLQ GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench WidthRock Depth Linear Ft I _ _ 1- 12,10 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on, the day of installation. Telephone # is (336)751-8760.**** A)txE q -7sf'- l °SES 4. of �J n Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001155 Tax PIN/EH #: 5861406-3220 Billed To: Chad Roten Subdivision Info: Reference Name: Chad Roten Location/Address: U. S. Hwy. 158-27028 r1VjJV0VU FOU111ty. r%=b1Utl11tX ATC Number: 2480 Size: zui.iu x zuu.0 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: wta• Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. Y� S` oo V oo� Od Septic System Installed By: Environmental Health Specialist's Signature Date-% �(o —e)✓ DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Q En&Ymnmenlal Heys/di SwUhn P.O. Box 868/210 Hospital street MAY 2 2000 Mocksville, NC 27028 (336)751-8760 µt �' .rig►` �� ,.� , �►, * AP CATION Com' SB PROC Z68ED UNLESS ALL X926— Refer to the IRrORM2102I BULLETIN for instructions. 1. to be milled Contact person. (failing Address �Qo 7 U. S �k);z Nam shame l _�3/) 4, City/state/asp (/i /% X) L 700 a wines phone ( 336) ".S,// 2— Z. Maxie on pewit/ATC it Different than Above hailing Address City/stag/sip t. Application Tors G4ite =valuation. 0 Improvement Pandt/ATC 0 Both e. systea to servioen "ouse 0 Mobile Rome 0 easiness 0 Industry 0 Other S. If Residence: i people � i Bedrooms r/3 i Bathrooms Z €i Dish,meber 0 Oarbage Disposal 9'9ashing URabine 0 aasen nt/pluWA&V O frier ntMo plumbing S. if ausine.s/Industry/otbern speoity two i people i sinks i Commodes i showers i urinals i hater Cooler* I! 1'MSiRVICOZ: # Seats Estimated Nater Usage toxons Paz day) 7. Type of water supply: k7—�/Cite 0 Nell 0 Community a. Do you anticipate addition or expansions of the faellity this system Is intended to serve? 0 Ya 13 -NO Uyes, what type? ***IMPORTANT"** CUENTS MWTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBALITTED by the client with THIS APPUCATION. Property Dimensions: ,D/ /l� k 200• U �4 cw rC Tax Office PIN: N .SBI f —D Co 3 -azo Property Address: Road Name %&-1 u5� I.Si� CI1y/Zip MMJ<sc�;JLe nQ7n)9 U In a Subdivision provide Information, as follows: Name: WRITE DIRECTIONS (kom Mocksviile) to PROPERTY: Section: Block: Lot: Date Property Flagged: — O This Is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, if the site plans or intended no change, or if the Information submitted in this application is falsified or changed I, also, understand that I ani responsible for all charges incurred from this applicadou. 1, hereby, give consent to the Authorized Representative of the Davie County Health Deeat to enter upon above described property located in Davie County and owned by -- eop y to conduct all testing procedures as necessary to determine the site suitsbWty. DATE Sz--©� SIGNATURE) THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include sH of the following: Existing and proposed property Una and dimensions, structures, setbacks, and septic locations). Site Revisit Charge j Revised DCIM Client NotiBestion Date: ERS: Account No,. Invoice No. 7� kssM (r.85A) 8929 m 6 MsC NVI 1836 7T, 160 i N V 073 O i 1234 on (. r This map is for PERC TEST 511 and BUILDING PERMIT purposes only. The Davie County Tax Administrator's Office :XED ON assumes no liability for any information contained on this ma 5861.12 2031 EnB 0974 COUNTY -ID: E600000079 ,15 n62 May 01, 2000 10:24 AM 9832 Parcel Identification Number No 158 5861-06-3220 f ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001155 Tax PIN/EH #: 5861-06-3220 Billed To: Chad Roten Subdivision Info: Reference Name: Chad Roten Location/Address: U. S. Hwy. 158-27028 Proposed Facility: Residence Property Size: 201.10 x 200.0 Date Evaluated: Water Supply: On -Site Well Community- Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure /� C Mineralogy" HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: //�� EVALUATION BY:� L LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS -Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace . FP - Flood plain H.- Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky ` VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■Nee■Nee■■■■es■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■e■■■■■■■■■■■■■■■■■coca■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■E■■■■■■■e■■■■■ ■■M■■■■E■M■■■■■ MMM■■■■■■■■■■e■ ■■■■■■M■■■■■■■■ M■E■EM■■■■■■ME■ ■■■MM■■■■■■■■■■ ■EMM■MM■EMEMM■■ ■■■■M■■■■■■■E■■ M■MEMM■MEN■■M■■ ■■■■■M■■■■■■M■■ ■■MEM■M■■■■MM■■ ■■■M■■■■■■■■■■M ■■■■■M■MMM■M■M■ ■■■■M■■■■■■■■e■ ■M■■■■■■■■E■■■■ ■■■M■■M■■■■M■■■ SOME ■■■■1.�m■■■■■■■■■EM■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■s■■■■■■■■■:■■■■■■iii■■■■■■■■■■■■■■n■■■■■■■■■s■■■■■ ■■■■s■■■eery■■s■a■s■■■s■s■■�■■■■■■■■■�■■■■■■■■■■■■■s■ iWiMMEMMEHIMMEMEN MEMNON MENEMEMEMNONSEMMES ■■■■■■■■■■��■■■■■■■■■■■■■■i�■■■Nee■■■■■s■■■■■■■■■■■■e ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■s■■■■■■■■■a■e■■■■■■■■■■■■■■■■■■■■■sea■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ No ■■■■■■■■■■■■■E■i ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ 3` I ENVIRONMENTAL. HEALTH SECTION P. 0. Box 848/270 Hospital Street Co:irler #06-40-06 Mocksville, NC 27028 336)761.8760: ,.Phone #:: . , .. - .... _ . ............. ... � . n✓,... .xe... _ ........::3.15.">wa........x..� ...- x ...... .. .. May 12, 2000 Chad Roten 4067 U.S. Hwy. 158 Mocksville, NC 27028 Re: Site Evaluation/U.S. Hwy. 158 Tax Office PIN: # 5861-06-3220 Dear Client: As requested, a representative from this office visited the aforementioned site on May 11, 2000. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, J&"trt. g�4aA. Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/mp Enclosure(s) Parcel #: E6OOOOOO79 Davie "County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:E600000079 Account #:62516000 Owner Information Building: Tax Codes BXF• ROTEN JERRY FRANK & ROTEN NANCY L Land: ADVLTAX - COUNTY TA Market: 067 US HIGHWAY 158 ssessed• FIREADVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 2.580 FARMINGTON [Address: 4067 US HWY 158 Deed Information Local tonin Date: 05/1976 Book: 00098 Page: 0581 Plat Book: Page: Lecial Description PIN 58 AC HWY 158 62516000 Property Values Building: 91,1201 BXF• 19,0401 Land: 40,9101 Market: 151 07 ssessed• 151,07CI Deferred: 01 Sales Information No Sales Data found. View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP.7r� ®rik-11-4 Davie County Web Site All Information on this site is prepared for the inventory of real property found within Davie County. All data Is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the Information. All information contained herein was created for the Davie County's internal use. Davie County, Its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or Implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnettView.aspx?prid=1458677 6/8/2016