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2509 Hwy 601N0 DAVIE COUNTY ENVIRONMENTAL HEALTH _ P.O. Box 848/210 Hospital Street w ' Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990001657 Tax PIN/EH #: 5820-34-9774 Billed To: Keith Latham Subdivision Info: Reference Name: Location/Address: 2509 US Highway 601 N-27028 Proposed Facility: Residence Property Size: 9.93 Acres ATC Number: 4612 **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. Manufacturerrl:.a- / Tank Date 3 a Tank Size I- , D OCA Pump Tank Size i System Installed By:�� -ri.�... ,-�c � 5 E.H. Specialist: fi _Date: NY DCHD 11/06 (Revised) ooh neo � . `i6 P ,41 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990001657 Billed To: Keith Latham Reference Name: Proposed Facility: Residence ATC Number: 4612 Tax PIN/EH #: 5820-34-9774 Subdivision Info: Location/Address: 2509 US Highway 601 N-27028 Property Size: 9.93 Acres Site Type: ❑New ❑Repair ❑Expansion **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_ !_ # Bathrooms # People_q Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size '? 3aee-4-- 5 Type of Water Supply: P1County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 3 &G Tank Sized GAL. Pump Tank OA GAL. Trench Width 3 4 "Max.,Trench Depth 3 6 � t Rock Depth ( 1 " Zinear Ft. q34 As stated in 15A NCAC 3.SA.:1GG9(5 Site Modifications/Conditions/Other: nceepted SyQte;ns my a also his used 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)751-8760T. Ai Fl N Environmental Health DCHD 11/06 (Revised) 11 b 1 __ tl SK Hr V01 s 4 _A y,o G✓"S� I COL 0. $C Date:` Q 7 i l� A Ew" co"T E EVALUATION/IMPROVEMENT PERMIT & ATC 7 vie County Environmental Health g' P.O. Box 848/210 Hospital Street �; d Mocksville, NC 27028&vA A -1C (336)751-8760/ Fax (336)751-8786 `; AppAcaUoe+M117`Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) oth Type of Application: jiew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed 4)�L % 7,a •n- Contact Person f ti �' �► Billing Address A Sg / u_S 12,4.4c, 4V 601 Home Phone yq,2- 2 S �'c�// 9z// -?d City/State/ZIP lnoc« S u, iI -e- tip. 2?02 F Business Phone Name on Permit/ATC if Different than Above Mailing Address gSa- t u< /-1.6 4 uA-1 (ao/ tet/ City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is vali4 for 60 months with site plan, no expiration with complete plat.) Owner's Name %,44a.r- Phone Number 3,3 9�/f: db" / Owner's Address of ,r/ City/State/Zip !yl,0c,e_s 2 70?- Property vaProperty Addressp , e R loot ti City /w cr- SLotSize 19,q3 4 cy5 Tax IN# 6 3 D00000,60 58ZO 2V977y Subdivision Name(if applicable) Section/Lot# Directions To Site: &0t x w -h. 7V 5-Oq ell If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Dyes Leo Does the site contain jurisdictional wetlands? ❑Yes PN -o Are there any easements or right-of-ways on the site? Dyes DKO Is the site subject to approval by another public agency? ❑Yes l� o Will wastewater other than domestic sewa¢e be Qenerated? Dyes ❑No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms_ # Bathrooms 2 %- Garden Tub/Whirlpool ❑Yes ,110 Basement: ❑Yes o Basement Plumbing: ❑Yes Ao IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑C,pfiventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: County/City Water ❑ New Well 1. ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �10 If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staki ng the house/facility location, proposed well location and the location of any other amenities. .�a�y« Site Revisit Charge Property owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given Dyes ❑No Account # 5� Revised 11/06 Invoice # �tn0�) CRAIG G. FJEBELKORj,4 E10 DB 189 PG 211 TAX MAP G3 -3A PARCEL 7101 BENT MP -14 /v ,, (99 '4 - El El� CHRISTOPHER S. MEADWELL AND WIFE ANGELA LL DBL N. MEADWE 595 P 289 TAX MAP G3-3 PARCEL 51 TRACT -,----I 35318.1 SQ: FT. - �p��%/c� 0.81 ACRES ORTION OF DB 186 PC 616 /// PS 634 70 07 41 NN9) CR p 9" '0v BEVERLY B. WALKER DB .164 PC 712 PS TAX MAP G3 PARCEL .48 EIP TRACT 2 lb 439450 DB 3V 9186 P 6.93 ACRG ES 18 OF DB 186 PC 61 PORTION OF DB 311 PC 2 49 Z --AEIP Pq BETTY JO LAYMON WILL BOOK 2002EO286 TAX MAP G3 PARCEL 7203 EIP IPS P P RO E -HUTCHENS DB 96 P-AG_E 140 TA AP G3\P ARCEL 48 BRUCE B/BED DB 176- PAGE J TRACT 3 EIP TAX XAP G3 P. 74305.7 SQ. FT 1.71 ACRES IE3[V/ � L�i rob r El .0s pG (WE),HE I i m 00, T i Z _ 7 5808 .95Aar 774 �. CC NOW 500 V lS(y.JJYMao;..... 1 �� I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001657 Tax PIN/EH #: 5820-34-9774 Billed To: Keith Latham Subdivision, Info:., Reference Name: Location/Address: 2509 US Highway 601 N-27028 Proposed Facility: Residence Property Size: 9.93 Acres Date Evaluated: '" { J s ` e Water Supply: On -Site Well Community Public �I Evaluation By: Auger Boring 11 ! Pit Cut - FACTORS 1 2 3 4 5 6 7 ,''.Landsca eposition L L Slope 1' . HORIZON IDEPTH c l Texture groupG c . Consistence i Structure Mineralogy :l - =HORIZON II DEPTH Texture group Consistence �.. «Structure ,',,Mineralogy HORIZON III DEPTH Texture group Consistence -Structure Mineralogy} Y HORIZON IV DEPTH Texture group Consistence Structure Mineralogya. SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ? SITE CLASSIFICATION: I-��t a 4 (� c� EVALUATION BY:� " �l ✓ Irl /7J %lS LONG-TERM ACCEPTANCE RATE: �7 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 'NS - Non sticky ` SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic i S � , ,r SC - Single grain M Massive, CR -.Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL -. Platy PR - Prismatic Mine ar lo�v ., , 1:1, 2:1, Mixed Nair 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 05105 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMNONNEEMEW■iMENNEN iiiiiiMEMNONs:iiiisisii► ■■■■■■■■ Nlar:1■■■■■fYL■■■■\PAOEM ■■■■NI■■■ ■■■■■■■■■■■■■■■■■■■■■■i■■■s■■■■■■■■■nn■■W■■■■■■■■■■■■■■■■■■■■■ems■■■ ■■■■■■■■■■■a■■■■■■■■■■■■■■■■■■■r■�■■■■■iia■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■��■■■■■■■■'�J■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County Environmental Health P.O. Boa' 848/210 Hospital Street Mocksville, NC 27028 (336)751=8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990001657 Tax PIN/EH #: 5820-34-9774 Billed To: Keith Latham. Subdivision Info: Address: 2521 US Highway 601 N Location/Address: 2509 US Highway 601 N-27028 City: Mocksville Property Size: 9.93 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ❑New ❑Repair ❑Expansion Permit Valid for: 05 Years ❑No Expiration Residential Specifications: # Bedrooms 3 # Bathrooms 15- # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 3 (e O Type of Water Supply: 06ounty/City ❑Well ❑Community Well I,t. 5taUA i,, 15A NCslc Site Modifications/Permit Conditions: atccoDted Systems may alpp be u96a Environmental Health i.p.11-06 Date- -3 — 5F — 63 ? Parcel #: G300000050 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View'Propertv Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: G300000050 Account #: 82527640 Owner Information BXF: Tax Codes Land: LATHAM KEITH H & LATHAM LINDA L Market: ADVLTAX - COUNTY T 0 509 US HIGHWAY 601 NORTH Deferred: FIREADVLTAX - FIRE TAX Unqualified MOCKSVILLE NC 27028 0 00703 0258 Property Information 2007 WD Township Land (Units/Type): 9.930 AC 0 CLARKSVILLE [Address: 2509 N US HWY 601 1993 WD Qualified Deed Information 0 Local tonin ate: 03/2007 Book: 00703 Page: 0258 1994 WD Qualified Plat Book: 0009 Page: 076 12,500 Le al Description PIN rl-RACT 2 KEITH LATHAM S D 5820441603 Propertv Values Building: 93,45 BXF: 7101 Land: 81d33 Market: 175ssessed: 0 175 Deferred: 1996 Sales Information Vo. Book Pape Month Year Instrument Qual/UnQual Improved Price 00186 0618 04 1996 WD Unqualified Improved 0 00186 0620 04 1996 Unqualified Improved 0 00703 0258 03 2007 WD Unqualified Improved 0 00170 0158 09 1993 WD Qualified Improved 0 00174 0609 06 1994 WD Qualified Vacant 12,500 View property Record for this Parcel View Map for this Parcel View Tax BIII Information Page 1 of 1 gplf� 00, 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/itsnet/View.aspx?prid=1463325 8/23/2016