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2010 Hwy 64EAccount #: 990005253 Billed To: Shawn Chaffin. Reference Name: Proposed Facility: Residence ATC Number: 4967 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5757-78-1706 Subdivision Info: a,61 D Location/Address: US Highway 64 E-27028 Property Size: 2.73 **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. Manufacturer Tank Date Z 6 "Tank Size.I IO Pump Tank Size�� System Installed By: pI aAG 6�E.H. Specialist:56N V)eo/1l Date: Zl l� DCHD 11/06 (Revised) t 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 #: 990005253 Tax PIN/EH #: 5757-78-1706 Billed To: Shawn Chaffin Subdivision Info: Reference Name: Location/Address: US Highway 64 E-27028 Proposed Facility: Residence Property Size: 2.73 ATC Number: 4967 (p/2��0 � F1'&'t C 4DMILWr6 and YrwLk 1040% 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 2- # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions.of Facility) Lot Size S. Type of Water Supply: ko'unty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)6J2Q_Tank Size[(3)0 GAL. Pump Tank ,/it GAL. Trench Width it LNtlI&J nigkg".&j9(3gpth J 2n Linear Ft. 4M Site Modifications/Conditions/Other: ticcepted Systems may also be 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)751-8760. AVQ 253 ►s' rri�n A `I Environmental Health Specialist. DCHD 11/06 (Revised) n P>Yea I - .� Srcti Is'vrsl� �vm c1 w area -jt Intl sed ' c mus} ►m l n b I96Vi5E� � DAVIE COUNTY ENVIRONMENTAL HEALTH • . n� • P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005253 Tax PIN/EH #: 5757-78-1706 Billed To: Shawn Chaffin Subdivision Info: Reference Name: Location/Address: US Highway 64 E-27028 Proposed Facility: Residence Property Size: 2.73 ATC Number: 4967 Site Type: [! 1`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—2-- People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size�.L_LT� Type of Water Supply: Etounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)7_Tank Size �j O0GAL. Pump Tank �"GAL. Trench Width Max. Tr h n th i� kYepth Ji(IZ -1LinearFt.As stated in re %AG` -1 19 ,Site Modifications/Conditions/Other.accepted Systems may also be e Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telenhone # (336)751-8760. 31S' 4 ll stnL-M Fs MUST u- 6WJkn4r it'� ALML, \ oa-�� a`I RNo � our o� sic. +AREA. 45-rkl Pa LEP'5t W 6W DWNW045 Environmental Health Specialist Date: DCHD 11/06 (Revised) i Davie County Environmental Health •' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005253 Billed To: Shawn Chaffin Address: 131 Daniel Boone Trail City: Mocksville Tax PIN/EH #: 5757-78-1706 Subdivision Info: Location/Address: US Highway 64 E-27028 Property Size: 2.73 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: N New ❑Repair ❑Expansion Permit Valid for: e5 Years ❑No Expiration Residential Specifications: # Bedrooms_ # Bathrooms 2_ # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD):. Type of Water Supply: L(County/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1989(p5 Site Modifications/Permit Conditions: cccepted Systems may atsn he ivcP Site is/ _ oL +y 1 2 � � to r LU T / 4 9 / V3 70f (J — — ALL l/Cn o -n F5 M asfi 6C MttiCa k}T 110 f1WNC-1 OF 5m(, IARC--R� Environmental Health Specialist Date i.p. 11-06 PP I R SITE EVALUATION/IMPROVEMENT PERMIT & ATC 09 Davie County Environmental Health Q Q� P.O. Box 848/210 Hospital Street p Mocksville, NC 27028 ROPE^�o�N� (336)751-8760/ Fax (336)751-8786 plicatior ori rte Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) U oth T e of ication: ❑New 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 �� CL f� t vy Contact Person Billing Address 131 Oun;r J Qotme -\�fi Home Phone 331, - qq X -(,J &P City/State/ZIP _`Mac yt�t2,\\-yy_C a7aag- Business Phone 33& , !t o e o9s$ Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION *Date House/Facility Corners Flaaaed 4'1 -1 - NOTE: "/7 - NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name C a A\ , c C' ke,41, n Phone Number 33 1,, - ft% -3P7� Owner's Address City/State/Zip djoZl< Property Address yAl �, flC oss FrOwl CiQ/�/q f ZE2 fid. Lot Size a.1� �cre5 Tax PIN# 5757-7$- 170k Subdivision Name(if applicable) Section/Lot# Directions To Site: G u V--_ i�. �,1lk 1 h-0,.nn+ r.3am7 (1nr hQ4-z4 i( PIA. .4, q�+ azro SS answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yeso Does the site contain jurisdictional wetlands? ❑Yes1110 Are there any easements or right-of-ways on the site? ❑Yes Is the site subject to approval by another public agency? ❑Yeso Will wastewater other than domestic sewaize be Qenerated? ❑Yes IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bat ooms �o Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes o Basement Plumbing: ❑Yes Vo 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: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: I County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? VN 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 unde'r'stand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. 0dA&,Q Site Revisit Charge Property owner's or owne s egal representative signature -ly-D Date Date(s): Client Notification Date: EHS: Sign given ❑Yes ❑No Account # JQ,6�14 Revised 11/06 Invoice # �Go1VIA .S - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System r; Click Here To Start Over Quick Search: (County ID or Owner Ni `'� 0er. y ❑ use Nap T ActiveLa ips r�. �a� 14" 0 .01 PARCELS (Map Tips Available) Addre http://maps.co.davie.nc.usIGoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=412... 4/17/2009 APPLICANT IN ON Billed To: Shawn Chaffin Reference Name: Proposed Facility: Residence DAVIE COUNTY. HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation -75-7_19, 1706 Tax PIN/EH #: 5757-IQBBRTY INFORMATION Subdivision Info: Location/Address: US Hgihway 64 E-27028 Property Size: 2.73 Date Evaluated: - Z $ - d Water Supply: On -Site Well Community Evaluation By: Auger Boring ✓ Pit Public Cut FACTORS 1 2 .3 4 5 6 7 Landscape position L (. Slope % HORIZON I DEPTH U , -y Texture groupG . G Consistence Structure v Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S $ PS LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: p5 LONG-TERM ACCEPTANCE RATE: �2S REMARKS: EVALUATION BY: BY1T lL(11 v aril al�I OTHER(S) PRESENT: 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 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) T TAR - T .nna_term arrPntanrP rate - aalldav/ft7 nr to none -I -L7 ■■■■■■■■■■■■■■■■■■■■■et■■■■■■■■■■■■■■■■■■wet■■■■■t■■■■■t■■■■■■t■■■■et■■■■et■■■■■■■■ ■■■■■e■■■■■■■■■■■■■e■■■■■tt■■■■■■■et■■■■■■■■■e■■■■■■■■t■t■■■■te■et■■■■t■tt■tt■■■t■t■ ■■■e■■■■■■■■■■■■■■tette■t■■■■■■■■■tt■est■■■■■■■e■■■■■■■■■■■■■t■■■e■■■■■t■■■■■■■■■■t■ ■■■apt■■■■e■■■�i■■■■■■■■■■■■■��■■■■■■■■■■■■■■■■■t■s■■■■■■■■■■■■■■■■■■■■■e■■■■s■■■■■■ MEOWS MEMNONNone" iMEMEMNiiiiii MEMNONMEMNON�iiMENNENiiiiii MEMNON�ii ■■■■■n■��us■■■■■■■■■■■■■■e■■■e■u■■■■■■■■■■ee■■e■■■■■■■■■■■t■■tett■■e■t■■■t■t■■■■■t■ti ■■■■■■It■�■.t■■■■lira■t■■■■■t!�i�■■t■■■■■■t■■■■■■■■■■■■■■t■■tt■t■t■■■■■■■■■■■■■■■t■■tttl ■■■■■■■�■■■viii■■■■■■■■■■t■■■■■■■■■■■■■■■■■■■■■■■■■■s■■eset■■t■■■■■■■■■■e■■■■■■■■■■■i ■■■■■■■■►�■■■ut■■tt■■■■e■■e■■■e■■■■■■■■■■■■■■■■■eee■■■■■e■te■■■■■■■■■■■■■■■s■e■■et■■■i ■■■■■■■■■■■■■■e■■■t■■e■■■■■■■■■tt■■■■■t■■ ■■■■t■■■■■■■■ecce■■■■■■■■■t■■■■ee■■■■■■■■i ■■■■■e■■■■■■■■■e■■■■■■■■■■■■c■■■■■■■■■■■t�ii■■■■■■et■tttt■■■■t■■■■■■t■■t■■■■t■■■t■t■■i ■■e■■■■■■■■■■■■■eeeee■■■■■■■■■■■■■s■■■e■t■tt■■■■■■ ■ Parcel #: J600000074 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #:3600000074 Account #:82529155 Owner Information ufldin Tax Codes BXF• HAFFIN CANDIS ANN CARTER nd: ADVLTAX - COUNTY T Market• 010 US HWY 64 EAST ssessed• FIREADVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 2.600 AC FULTON ddress: 2010 E US HWY 64 Deed Information Local Zoning Date: 01/2008 Book: 00742 Page: 1073 Plat Book: 0009 Page: 261 Le al Description PIN LOT 1 2.731AC CARTER T SD 5757781706 Property Values ufldin 44,67 BXF• 1,23 nd: 32,26 Market• 78 16 ssessed• 78,16 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00195 0126 06 1997 WD Unqualified Vacant 0 2 00742 1073 01 2008 WD Unqualified Vacant 0 3 00131 0349 05 1986 WD Qualified Vacant 29,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oxlz: 0o U ��• 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=1460817 6/23/2016