5381 Hwy 601NAccount #:
990000995 .
Billed To:
Shannon Pratt
Reference Name:
Shannon Pratt
Proposed Facility:
Residence
ATC Number:
2345
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #:
5814-70-9446
Subdivision Info:
53V
Location/Address:
U.S. Hwy 601 K-27028
Property Size:
1.632 Acre
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 Tr tment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE ION I ALID FOR A PERIOD OF FIVE YEARS.
—:::>Environmental Health Specialist's Signatur • Date: bo
�7
QIr Peflvd 3 e odrcom5
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.
�I M
Septic System Installed By:
Environmental Health Specialist's Signature :
DCHD 05/99 (Revised)
Dp
50' x3x.i z„
Date: 7Aq IM
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
,ter-11--oa
,7= 70
Tax PIN/EH #: 5814-70-9446
1 Subdivision Info: �
(_ Location/Address: U.S. Hwy 601 N -27028
r� Property Size: 1.632 Acre
**N��E'i�i simprove�ment/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 CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type0 104S-115 L11-1#People #Bedrooms _ #Baths '2—
Dishwasher: Or"
Garbage Disposal: ❑ Washing Machine: 12� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size to ��ype Water Supply ` Design Wastewater Flow (GPD) Site: New Er Repair ❑
System Specifications: Tank Size IC)M GAL. Pump Tank GAL. Trench Width -'$;' Rock Depth Linear Ft.�l
Other: 2 NOP . Lis -mu- LaAj2s 910-C• t^',''`)•
��, sa
Required Site Modifications/Conditions: liJSTINIL p,J CATtp,)2, KOEP � FgDzmn � 0��
V �-ry In �.c MDR uab
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 K 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.****
l)
N
1= aOlzi-
HOL)se
�Po.t2
Health Specialist's Signature:
DCHD 05/99 (Revised)
N1
A2oP. I- taa
Date:
'7 00
Account #:
990000995
Billed To:
Shannon Pratt
Reference Name:
Shannon Pratt
Proposed Facility:
Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
,ter-11--oa
,7= 70
Tax PIN/EH #: 5814-70-9446
1 Subdivision Info: �
(_ Location/Address: U.S. Hwy 601 N -27028
r� Property Size: 1.632 Acre
**N��E'i�i simprove�ment/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 CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type0 104S-115 L11-1#People #Bedrooms _ #Baths '2—
Dishwasher: Or"
Garbage Disposal: ❑ Washing Machine: 12� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size to ��ype Water Supply ` Design Wastewater Flow (GPD) Site: New Er Repair ❑
System Specifications: Tank Size IC)M GAL. Pump Tank GAL. Trench Width -'$;' Rock Depth Linear Ft.�l
Other: 2 NOP . Lis -mu- LaAj2s 910-C• t^',''`)•
��, sa
Required Site Modifications/Conditions: liJSTINIL p,J CATtp,)2, KOEP � FgDzmn � 0��
V �-ry In �.c MDR uab
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 K 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.****
l)
N
1= aOlzi-
HOL)se
�Po.t2
Health Specialist's Signature:
DCHD 05/99 (Revised)
N1
A2oP. I- taa
Date:
'7 00
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &Davie County Health Department
Environmenta/Hea/t6 Section
P.O. Box 848/210 Hospital StreetELMMocksville, NC 27028
(336)751-8760
***IIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDAED. Refer Qto t�the�}►INFORMATION BULLETIN for �instructions.
3 Namr to be Billed s�7 R O/V ` R STT f n Contact Person /� 4 A & ry DN p '� gr -t
Mailing Address ut 1c3 0 WeST 9AA 1 �� 11R Home Phone l x � 9I -01(F"l
City/State/ZIP vr�� V+ Pc,�s; (U(- Z'7ZAo� Business Phone C33(, Z$2," V"
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: dSite Evaluation improvement Permit/ATC R ---Both
s. system to service: /�( House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S. If Residence: # People # Bedrooms 3 # Bathrooms Z
Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7.. Type of water supply: ❑ County/City X Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes $KNo
If yes; what tyre?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: /. % 3 -2 Ac -
Tax Office PIN: #
Property Address: Road Name US &01 rJ
a7o.Z8'
City/Zip Lilac (!tt,[_c; el-ic.S`
If In a Subdivision provide information, as follows:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
.♦ • r 1 _
dF YACkS 0 CaUvu'T Y ►SND
OAIT Coueiry , L4ST L67 a�1
Cit✓ fit` gc'-i-ts•v4 BPSc� HiY�c .
Name:
•t
--'Section: Block: Lot: Date Property Flagged: —?'�' ° d
This Is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed I, also, understand that I am responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described proper ty !"atea an Da—Ae Ccun ; aad Owned by
to conduct all testing procedures as necessary to determine the site suitability.
'la -6 o SIGNATURE =:2 —496-��
ARE MAY BE USFOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property line and dimensio , structures, setbacks, and septic locations).
VV
Date(s):
Client Notification Date:
Account No. !�
Revised DCHD (07/99) -�� Invoice No.
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PROPERTY OF
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LOT NO. MAP OF NO. �t_
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FARM BOOK _ PAGE _--S$ __-00040101W COUNTY, N. C. �+
SCALE: 1 INCH= FEET
jos No
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PROPERTY OF
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LOT NO. MAP OF NO. �t_
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FARM BOOK _ PAGE _--S$ __-00040101W COUNTY, N. C. �+
SCALE: 1 INCH= FEET
jos No
f�I,NRRN /NOTQ POINT • SUPPLY CO.—WINOTOM-SAL5W (,149t01
APPLICANT INFORMATION
Account #: 990000995
Billed To: Shannon Pratt
Reference Name: ',,Shannon Pratt
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 581470-9446
Subdivision Info:
Location/Address: U.S. Hwy 601 N.-27028
Property Size: 1.632 Acre Date Evaluated:
Water Supply: On -Site Well v/ Community_
Evaluation By: -Auger Boring J Pit
Public
Cut
FACTORS
1
2
3
4 5 6 7
Landscape position
4-
L-
L
Slope %
lilz
x7
HORIZON I DEPTH
O-
Texture group
5 CA.,
&C -L-
L
$ : C L-,
Consistence
Fr 55
S
(--r S? �j
Structure
c2
Mineralogy
HORIZON II DEPTH
$ - Zip
S •
-e - 2D
• I�
Texture group:
C_
C -
Consistence
S
' S P
Structure
k
Sg k
Mineralogy
HORIZON III DEPTH ' .' :
Zip - Lk
2 0
Zo - 3
2s0 - ata
Texture'group
: C
: G
i C a
: Ca
Consistence
F'
Structure
Qv14
Mineralogy'
t ' 1
HORIZON IV DEPTH
f
Texture group,
O
Consistence .
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S -S
5 -
LONG -TERM ACCEPTANCE RATE
3
0 3
SITE CLASSIFICATION: Y5 EVALUATION BY:y� �
LONG-TERM ACCEPTANCE RATE: Q • OTHER(S) PRESENT:
,.REMARKS:tN�aCluw 30 -3►I"
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
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)
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Parcel #: B30000000101
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: B30000000101
Account #:82515383
Owner Information
137,9201
Tax Codes
62
PRATT SHANNON LEE & PRATT JACQUELINE NICOLE
14,4001
ADVLTAX - COUNTY T
152,9401
5381 US HIGHWAY 601 NORTH
152,94g
FIREADVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Property Information
Townshi
Land (Units/Type): 1.000 LT
CLARKSVILLE
ddress: 5381 N US HWY 601
Deed Information
Local Zonin
Date: 09/2014 Book: 00969 Page: 0207
Plat Book: age:
Legal Description
PIN
1.632 AC OFF HWY 601 N
5814708446
Property Values
Building:
137,9201
BXF:
62
Land:
14,4001
Market:
152,9401
ssessed•
152,94g
[Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00332 0054 04 2000 FD Unqualified Improved 0
00843 0328 11 2010 NW Unqualified Improved 0
3 00969 0207 09 2014 WD Qualifled Improved 140,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnetfView.aspx?prid=1184250 8/23/2016