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920 Hwy 801NDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 989900057 Tax PIN/EH #: 5862-47-5747 Billed To: Randy Grubb Subdivision Info: Reference Name: Location/Address: 920 NC Highwary 801 N.-27006 Proposed Facility: Business Property Size: 2.90 Acre ATC Number: 4901 **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. 2 System Type:S.T. Manufacturer Tank Date / Tank Size Pump Tank Size N c._ ,� y� System Installed By:,� �J� +�Y 1 i1�11Gf.E.H. Specialist:jW �qa�&Date: DCHD 11/06 (Revised) 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 #: 989900057 Tax PIN/EH M 5862-47-5747 Billed To: Randy Grubb Subdivision Info: Reference Name: Location/Address: 920 NC Highwary 801 N.-27006 Proposed Facility: Business Property Size: 2.90 Acre ATC Number: 4901 Site Type: 211ew ❑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 # People # Seats Square Footage(or Dimensions of Facility) Lot Size t Type of Water Supply: ffCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)Tank Size�U GAL. Pump Tank GAL. Trench Width �� Max. Trench Depth i3 Rock Depth_ Linear FtJ As stated in 15A NCAC 18A.19690 Site Modifications/Conditions/Other:-- aeeepu 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. Q� I ILK \�1Y 0 - � v—'- `; cs Environmental Health Specialist nrHT) 1 1 /M (R fwked) Account #: 989900057 Billed To: Randy Grubb Address: 130 Kent Lane City: Mocksville Reference Name: Proposed Facility: Business Davie County Environmental :Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT P "/EH #: 5862-47-5747 Subdivision Info: Location/Address: 920 NC Highwary 801 N.-27006 Property Size: 2.90 Acre **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: i3141ew ❑Repair ❑Expansion Permit Valid for: 0'5 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type !� oot9 # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply:County/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1969(5) Site Modifications/Permit Conditions: acce ted RystPmc m33fe1so bo Ilae System Type LTAR Initial Repair f"'1JJ S-elfrC_ Environmental Health Specialist SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 provement Permit ❑ Authorization To Construct(ATC)oth ❑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 Billed96.", Contact Person Billing Address Home Phone -,3St1_ 957, S' % City/State/ZIP C_ ? 4 BusinessPhone3Z{r Name on Permit/ATC if Different than Above Mailing Address City/State/Zip YKUVtK1 Y 11Nt'UKIVIA11UN ^ Late Housen acnity corners NOTE: A survey plat or site plan must accompany this application. (Permit is"valid for 60 mo),-f is with site plaj�n�o expiration Owner's Name iJif'� wc :-" l /_ t _� 1_/ 17 Included: ❑ Site Plan ❑Plat(to scale) 1 complete plat.) Owner's Address ➢ ' %i(U City/S ty/Zip Property Address City /Fc/✓c'7 c C_ Lot Size Tax PIN# - q - 574 Subdivision Name(if ,a,p�plicable Seior,}/Lo� Directions To Site: RIAJ / ,0 If the answer to any of the following questions is "yes", supporting documentations ust be attached. Are there any existing wastewater systems on the site? ❑Yes -❑No Does the site contain jurisdictional wetlands? ❑YesZRroo Are there any easements or right-of-ways on the site? ❑Yes�o Is the site subject to approval by another public agency? ❑Yes -050 Will wastewater other than domestic sewage be generated? ❑Yes Flo IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE B Type of Facility/Business/,_,,4c.+��r Orr ` Total Square Footage of Building Ute 0 # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per ay) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:. /Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: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 L;1 f 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 sta�lG the house/facility.110tation, proposed well location and the location of any other amenities. Site Revisit Charge ,Propertyer's or owner's legal representative signature Date(s): - Client Notification Date: Date EHS; Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System O Pavc ,j�M1� d x' , l 13 1111 a. Click Here To Start Over Active Layer. R Else Map Tps PARCELS (Map Tips Available)v Page 1 of 1 Quick Search:(County ID c GIP Map Layers I Results - .......— NC Yily Sol N -- --- l 2 411 {1(,0) 322 l 380 http://maps.co.davie.nc.usIGoMapslmap/Index.cfm?maimnapservice=gomaps&CFID=412... 8/25/2008 ►•` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 989900057 Billed To: Randy Grubb Reference Name: Proposed Facility: Business Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5862-47-5747 Subdivision Info: Location/Address: 920 NC Highwa 801 N.-27 6 Property Size: 2.90 Acre Date Evaluated: — . / O Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH — Texture group Consistence Structure , f 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 i SAPROLITE / CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0. Z SITE CLASSIFICATION: C LONG-TERM ACCEPTANCE RATE: t/ " IN EVALUATION BY. 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 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 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) TTAD T ...+.. #.— ..e..r..„.. +. -11A-141 141 T1%P4T1rT%AC/AG /il Parcel #: C700000055 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View•Prouertv Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: C700000055 Account #:57192000 Owner Information uildin : Tax Codes BXF• PLOUGHBOY INVESTMENT LLC Land: ADVLTAX - COUNTY T Market: 20 HWY 801 NORTH eased: FIREADVLTAX - FIRE TAX Deferred: DVANCE NC 27006 Qualified Improved Property Information Township nd (Units/Type): 2.900 FARMINGTON ddress: 920 N NC HWY 801 Deed Information Local tonin Pate: 06/1997 Book: 00195 Page: 0117 Plat Book: Page: Le al Description PIN HWY 801 5862475747 Property Values uildin : 195,38 BXF• 6,42 Land: 95,07 Market: 2L6"7 eased: 296,87(l Deferred: 3 00195 0117 06 1997 WD Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00173 0462 01 1992 WD Unqualified Improved 12,500 >_ 00162 0371 01 1992 WD Qualified Improved 40,000 3 00195 0117 06 1997 WD Qualified Improved 100,000_ View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 riot, 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/itsneWiew.aspx?prid=1469685 9/8/2016