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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 $KNo If yes; what tyre? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: /. % 3 -2 Ac - Tax Office PIN: # Property Address: Road Name US &01 rJ a7o.Z8' City/Zip Lilac (!tt,[_c; el-ic.S` If In a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: .♦ • r 1 _ dF YACkS 0 CaUvu'T Y ►SND OAIT Coueiry , L4ST L67 a�1 Cit✓ fit` gc'-i-ts•v4 BPSc� HiY�c . Name: •t --'Section: Block: Lot: Date Property Flagged: —?'�' ° d This Is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described proper ty !"atea an Da—Ae Ccun ; aad Owned by to conduct all testing procedures as necessary to determine the site suitability. 'la -6 o SIGNATURE =:2 —496-�� ARE MAY BE USFOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property line and dimensio , structures, setbacks, and septic locations). VV Date(s): Client Notification Date: Account No. !� Revised DCHD (07/99) -�� Invoice No. q.� I c" r 5 2�e 2I'00"E c,' 7 .SD'.r rAto loft oT �. T DP V) G f�` �� oR L EL. i�t..s1 94 6 7 _ I `% ` 7'ax �-e7 3 AP MV3- luJ uli Im L.b. 81 'P S70 J x`4140. A PROPERTY OF )111) IV ID �f'p.a r 7 -;. %11j...: /r';' fi < r Jot>�( LOT NO. MAP OF NO. �t_ L't Eeo 4 � FARM BOOK _ PAGE _--S$ __-00040101W COUNTY, N. C. �+ SCALE: 1 INCH= FEET jos No f�I,NRRN /NOTQ POINT • SUPPLY CO.—WINOTOM-SAL5W (,149t01 L STa« rt iba � f /a•`�>'�a he /3sT a 2a< .� wY c/� ,� 4. V\ v - 1319 N QgvID LEE �QF T O BRUCE .0 QiegTT �xv/ .IU RR' i+. ��� It Ta l.1 3 AG �. G 32, AC 4, � u r r 5 2�e 2I'00"E c,' 7 .SD'.r rAto loft oT �. T DP V) G f�` �� oR L EL. i�t..s1 94 6 7 _ I `% ` 7'ax �-e7 3 AP MV3- luJ uli Im L.b. 81 'P S70 J x`4140. A PROPERTY OF )111) IV ID �f'p.a r 7 -;. %11j...: /r';' fi < r Jot>�( LOT NO. MAP OF NO. �t_ L't Eeo 4 � 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■E■■■■M■■■■■■■e■■■M■O■■■■■■■■■■M■■■■■■Me■Mae■■■■■■■■■■■■■■■■■■■■ ■■■■■A■■eeeeee■oee�eee��e�����■�����A��A��e�w����■�■�■■���■�■■■■■■■■■■�����■0■■ ■■■■i�■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■�■■■■■■■■i■■�■■■■tee■■■■■■■r�::�........ u■■M■■■E■■■■■■■■■■■■■■■■■■■■■■■■■■■es■■■■■■■■■■■■■■■■■■■■■■■■■■■■MMEM■■■E■■■■ ■■■■■■■■M■■■■■■■M■■M■■■■■■MEMO e■■■■■■■■■G■.1�■■■■■■■■■■■Me■■■■e■■■■■■■■■■■■■■■■■■■■ ■■■e■■■■■■■■M■■■■■■■■■■■e■■■■e■■■ecce■■■r,.■■■��■■■■■■■■■■■E■c�:M■■s■�■O■■■■■■■■s■Ori■■■ ■■■■■■■■■■■■■■■Mee■■■■■■■E■e■■■■■■■■■■�-.■■■■■■.■M■■■■■■■■■■■■■■■■■■�■■■■■■■eee■■e■ee■ ■■■■■■■■■■■MM■■■NEMEM ■■MM■e■■■■■■■M■■■■■■■■■■Me■■■■■■i1■►a■■■■a■■e■■■■��■■■■■■■■■■■■■f!�■■■i■Ci■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■►■■■■■■■■■■■e■e�■e■i■■■■■■■■■■■Ori M MEMNON NEEMEMMEEMEM t iEMEMSEMENNEN MEMNON onsiiiti=MENNEN= iMEMNON MEMO ■M■■■■■■EM■M■■■■■■Me■■e■■■■■e■e■■O■■■■■■■■■e■■�.■■■■■■■c■■■■■■■■:i■e■■■■■■■.Ori■■ ■�■■■■■■■■■■■■■■■■■■■■■■■■■■�►;�■�■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■Mrs.■►�■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■■ ■■■■ ■ ■■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■Mee■■■■■ ■■■■M■■■■■ ■■■■■E■e■■ ■■■■■■■■■■ ■■■MEMO■■■ ■■■M■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■167■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MOs■■■■■■ ���■■■■IML'J�.'iM�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■E■■ ■E■■ Parcel #: B30000000101 Davie County, NC - Basic Estate Search i Basic Search Real Estate Search Tax Bill Search Sales Search 0 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 « Return to Basic Search Page 1 of 1 C, 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