1339 Hwy 801NAccount #: 990000673
` Billed To: Jerry Kapp
Reference Name:
Proposed Facility: Barn
ATC Number: 5072
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Strl;�t — -
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
OPERATION PERMIT
11,.
Tax PiN1EH #: 5852-98-3345
Subdivision Info:
LocationiAddress: NC Highwary 801 N.-27006
Property Size: 1.75 Acres
**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 `SMOOTTank Date Tank Size o' G
Pump Tank Size
�
System Installed By: ,104 ' ` 141"�I E.H. Specialist: Date:/7(
7�- I/ -3&001. oc9a uJ 090 3T0
DCHD 11/06 (Revised)
` DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990000673
Billed To: Jerry Kapp
Reference Name:
Proposed Facility: Barn
ATC Number: 5072
Tax P€ir€IEH #: 5852-98-3345
Subdivision Info:
LocationiAddress: NC Highwary 801 N.-27006
Properly Size: 1.75 Acres
Site Type: Q-,ew ❑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 Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type &y(4 # People # Seats
Square Footage(or Dimensions of Facility) &o
Lot Size
75 Type of Water Supply: Rf ounty/City ❑ Well ❑ Community Well
System Specifications: Design Wastewater Flow (GPD) IC90 Tank Size GAL. Pump Tank 4eZGAL.
Trench Width 3lo tr Max. Trench Depth G "'Rock Depth � � � Linear Ft. f (Q r
Site Modifications/Conditions/Other: -Li ce —Yr U A,
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)7514760.
S� � rc
ekel.
1 ��01✓�ir
Fu I U ! -P
#C);1A. P
Environmental Health Specialist_ rj//!s� Date:
DCHD 11/06 (Revised)
Davie County Environmental Health
P.O. Box 848/210 Hospital Strut
Mocksville, NC 27028
(336)753-6780/Fax(336)753-1680
IMPROVEMENT PERMIT
Account #: 990000673
Billed To: Jerry Kapp
Address: 153 Cornwallis Dr.
City: Mocksville
Reference Name:
Proposed Facility: Barn
Tax PIN/EH #:
585
Subdivision Info:
Location/Address:
NCJdWkW 801 N.-27006
Property Size:
1.75 Aft&rts
**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: ONew ❑Repair ❑Expansion Permit Valid for: PIS Years ❑No Expiration
Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type a ✓✓1 # People # Seats
Square Footage(or Dimensions of Facility) .DC9 0
Design Flow(GPD): o� Type of Water Supply: QCounty/City ❑Well ❑CommunityWell
Site Modifications/Permit Conditions: AS statedin 15A NCAC 18A.1989(5)
accept", OybLUIlis may also bc; usnd
System Type LTAR
Initial -r-1 (a 011_7
Repair f ed
Site Plan -7 7
H1 �
epeaIc 1
a4
/33
Environmental Health Specialist yt�1_'�% Date'_
i.p. 11-06
03/18/2010 09:09 FAZ
. ,
APPLICATION FOR SITE EVALUATIONAMPROV -MENT PERMIT &
Davie County Environmental Hea th
P.O. Box 848/210 Hospital Street
Mockavllle, NC 27028
(336)753-6780/ Fax (336)751.8786
ApI lica lon For. Site Evaluation/Improvement Permit fa Authorization To �ification
nstruct(ATC) o
T o Applicatio : Aew System ORepair to Existing System OExponsiun/M of Existing Syst
* l PORTA " THIS APPLICATION CANN0T6EPR0CBSSED UNLESS 4LLOF THE RL•QUIRED
1 FO tMATIONJIS PROVIDED. Refer to the INFORMATION BULLETIN for filittructions.
be
L.
tGL1Y
t PermitU TC if Dgerent than
Address
intact
Home ne_ 9yJ-y/5v
tsiness P ne_
TY IN ORMATION *Date House/Facilit niers Fla ed=:..
survey p at or site plan must accompany this application. Included: n S Plan OPlat(to scale)
crmit is i slid months wigFite plan, no expiration with complete pla t)
Lot i 1. era f Qtax PIN# - .�
Sub ivi ion Name (if applicable) Sec
Dirc tic isToSite f-ya ixls W. Pld
A.
If th ani wer to any f i e following questions Is "yes", supporting document
re there afiv existing wastewater systems on the site? Utes
Does the J.biect
o contain jurisdictional wetlands? ❑Yes
Are therey easements or right-of-ways on the site? UYes
Is the site to approval by another public agency? Oyes
illwastder other than domestic sewage be generated? ❑Yes
IF AESIDENCE FILL OUT THE BOX BELOW
# P+plf Bedrooms # Bathrooms _
Bas me t: ❑Yes No Basement Plumbing: ❑Yes ❑No
IF NOW -RESIDENCE FILL OUT THE BOX BELOW
s
Q001
) ��uU
MAR 7 8 2010
ENVIRONMENTAL N
cilia OAS VI_�UNT}�(TH
Garden Tub/Whirlpool ❑Yes ONo
Typ c Facility/B siness UHRi✓ Total Square Footage ofBu ding /32 v 1 # People /
# Si ks / # Commodes / # Showers
rinals -O-
Esti at Water sage (gallons per day) 1 O O (Attach documentatio
of similar facility water consumption)
FO D RVICEONLY: # Seats - o -
Typ system requea d: OConventional OAccepted 0hmovative OAltemative
then
Wa St pply Type: ®'County/City Water O New Wcll ❑Existing Wel
n Community Well
Do u a nticipate k ditions; or expansiow of the facility this system is intended to us
N,
10 Yes II
Ifyis, what ?
This s tc certify tha the information provided on this application is true and correct
be best of my knowledge. I understand
that ny ermit(s) oi ATC(s) issued hereafter are subject to suspension or revocation i
he site is altered, the intended use
than es, r if the rmation submitted in this application is falsified or changed I h r
eby grant right of entry to the Authorized
Rep ter tiv f Davie Cou Health Department to conduct necessary inspcctic r
s to determine compliance with applicable
laws nd s. 1 etstand I am responsible for the proper identification and lab
ing of property lines and comers and
lots n nd in s the se/facility location, proposed wall location and
he location of any other amenities.
Pro y ner's or er' al representative signature
Site Revisit Charge
te(s):
/v1cr
I ant Notification Datc:
Signiv n nYes 0 0 Account# 0&73
Revi d 1/06 Invoice#
03/18/2010 09:10
FEun-rr
C19Is1I" 1
Opp
Q 003
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000673 Tax PIN/EH #: 5852-98-3345
Billed To: Jerry Kapp Subdivision Info:
Reference Name: Location/Address: NC Highwary 801 N.-27006
Proposed Facility: Barn Property Size: 1.75 Acres Date Evaluated:
Water Supply:
Evaluation By:
On -Site Well
Community
Auger Boring Pit
Public r__
Cut
. FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
C qss
Consistence
r $
Structure
Mineralogy
HORIZON II DEPTH
/—V -
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
MineralogyR
HORIZON IV DEPTHLr
V
Texture group'
Consistence
LX
Structure
Mineralogy
SOIL WETNESS
'—'-
RESTRICTIVE HORIZON
-�
SAPROLITE
CLASSIFICATION
S
LONG-TERM ACCEPTANCE RATE
, 1 ?5
SITE CLASSIFICATION: ) �" EVALUATION BY. _&&,ell
��?—r.Q
LONG-TERM ACCEPTANCE RATE:y / OTHER(S) PRESENT. 1 �
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
3
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky I
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 s
Horizon depth - In inches ,/ !
Depth of fill - In inches t
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable) \ n
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less `Q1
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
TTAR - T.nna-term arrPntanrP rATP - oaUAau/ft) Tll-TTrl ncInc m__.:__��
Parcel #: C60000007602 Page 1 of 1
oA4r�
Davie County, NC - Basic Estate Search ZoU ,1-,P
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Parcel #: C60000007602 Account #:82514806
Owner Information
Tax Codes
ADVLTAX - COUNTY T
- FIRE TAX
PP JERRY W & KAPP FAYE B
1620 FARMINGTON RD :1FIREADVLTAX
MOCKSVILLE NC 27028
BXF•
Property Information A
Township
nd (Units/Type): 1.750 AC
ddress:
FARMINGTON
4600
ssessed:
4600
Deed Information
Local tonin
Pate: 08/2009 Book: 00804 Page: 0193
Plat Book: 0010 Page: 103
Legal Description
PIN
[TRACT B 1.7504 AC HWY 801
5852983345
Property Values
uildin
0011
BXF•
16 26
nd:
29 74
arket:
4600
ssessed:
4600
eferred•
Sales Information
No. Book Page
Month Year Instrument
Qual/UnQual
Improved Price
1 00804 0193
08 2009 WD
Unqualified
Vacant 0
View Property Record
for this Parcel View Map
for this Parcel View
Tax Bill Information
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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=1414959 9/8/2016