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6510 Hwy 801SAccount #: 990005011 Billed To: Jeffrey Crisco Reference Name: Proposed Facility: Residence ATC Number: 4820 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 #: 5756-15-7988 Subdivision Info: Location/Address: NC Highway 801 S-27028 Property Size: 14.75 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. �c gLVI System Type: S.T. Manufacturer a OfL Tank Date Tank Size y Pump Tank Size System Installed By: -Pr/l. ��d��� E.H. Specialist: Date: • r •� DAVIE COUNTY ENVIRONMENTAL HEALTH Pd� P.O. Box 848/210,Hospital Street Mocksville, NC 27028 J (336)751-8760 Fax #(336)751=8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005011 Tax PIN/EH #: 5756-15-7988 Billed To: Jeffrey Crisco Subdivision Info: Reference Name: Location/Address:, NC Highway 801 S-27028 Proposed Facility: Residence Property Size: 14.75 Acres -� ATC Number: 4820 Site Type: 5 ew ❑Repair ❑Expansion **NOTE** This Authorization to Constrict (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- Tans, plat or the intended use chame. -0 '1 1 . A _ r{ ,a%40 ,v i-,� 5 10em c -e Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non:Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size �� % `> 4cPs5 Type of Water Supply: ❑County/City RAlell ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) 01� I Tank Size/, 660GAL. Pump Tank GAL. Trench Width 3 (o Max. Trench Depth 3G Rock Depth Linear Ft. c( As stated in 15A NCAC 18A.1959(3 Site Modifications/Conditions/Other: nrrept-d 1,R)g:tf�mg mnv nign be urE Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day oVnstallation. Telephone # (336)751-8760. At `h � xb f4vironmental Health Speciali T)Mn /04 (T?PiAca(l) �O r9 a Davie County Environmental Health P.O. Box848%210 Hospital Street Mocksville, NC 27028 .(336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005011 Tax PIN/EH #: 5756-15-7988 Billed To: Jeffrey Crisco Subdivision Info: Address: 400 Cherry Hill Road Location/Address: NC Highway 801 S-27028 City: Mocksville Property Size: 14.75 Acres Reference Name: Proposed Facility: Residence **NOTE* *This Improvement Permit DOES NOT. authorize the construction of a wastewater system. An Authorization To Construct a was 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: f6New ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats nn Square Footage(or Dimensions of Facility)_/ 2 Design Flow(GPD): Type of Water Supply: ❑County/City C?'(Vell ❑Community Well As stated in 15PA NCAC 18A.1969(3) Site Modifications/PermitConditions: accepted Systems may elso be u:;td Environmental Health i,_n4 1 \ , \ � 1� � jF � Date c% _._.APPLICATION FOS; Applicatiop~ JAvaluation/Ilnp Type of Ap ' c 'ion: ❑New.Sysf in E{F�t EVALUATIONAMPROVEMENT PERMIT & ATC County Environmental Health . Box 848/210 Hospital Street Mocksville, NC 27028 1)751-8760/ Fax (336)751-8786 P -Authorization To Construct(ATC) Both System ❑ Expansion/Modification of Existing System or Facility ***IMPOR ANT*** THISAPPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMA OhLI&TlZbVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed''e-W(cu $Ce+ Cti5C0 Contact Person ae.Op w SCO Billing Address 1-100 Che&__ W II led Home Phone q IQ 73 (c'7 City/State/ZIP MDC Ui [f��l. C. a-7Oaa Business Phone 99 S - to(v(vo2 Name on Permit/ATC if Different than Above Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: VrSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Namet4cmt S. Cf i SCO Phone Number 9 9S -(Pia boa Owner's Address t -I 0 i I KA City/State/Zip /11QWUilICJ4.C. 0.'7o= Property Address 6510 HWG. 01 S. City �6CKSUi(IQ Lot Size Tax PIN# Subdivision Name(if applicably _ - S66tion/Lot# To i -_z KI 0 IV 411 S T If the answer to any of the following 4neVions is "ye&", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes EKO Does the site contain jurisdictional wetlands?, , ' ❑Yes o Are there any easements or right=of--ways on the site? ❑Yes o Is the site subject to approval by another public agency? ❑Yes o Will wastewater other than domestic sewage be generated? ❑Yes o IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes UNo Basement Plumbing: ,'❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business `" Ary BW ldbiTotal Square Footage of Building 5)a. # People # Sinks I # Commodes I 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: ❑ County/City Water H'New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes VlNo . 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 staking the house/facility location, proposed well location and the location of any other amenities. P ^ o 's or owner's legal representative signature Datt _L��— Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given ❑Yes ❑No Account # ko) bl� Revised 11/06 Invoice # I .!;! R t �� �� ��� C� �o �C- �°�'�PS o� �o� VPi • APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department �7 • pg� Environmental Health Section D V ` P.O. Box 848 Mocksville, NC 27028 OCT 2 1997 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ! ` Contact Person el /VI - Mailing Address o Home Phone City/State/Zip Business Phone -&! — 0/— 3 3� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ ]_Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/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 [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? 2M PROPERTY INFORMATION REQUIRED: *** IMPORTANT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: `ZI XCAa-fv WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #_ -G 7 Property Address: Road Dame 25- Off e City/Zip f.C� %2 L' a 7,4 2'q ' If in Subdivision provide information, as follows: Name: Section: Lot # ' 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 property located in Davie County and owned by Y7• h�Qit�cei+� to conduct all testing procedures as necessary to determine the site suitability. DATES i SIGNATURE r Revised DCHD (06-96) THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN: 2 JI ��. SR P� ' `� 1� 'l �j yiLV ✓1 µ�y�,, k $ Y � I.. S ��. lY S�` Z +• Nm �. R � , r; Y 1 ya �r ...� �•!Y n�t`� � ��' "� �:. � .� .�� t a+ 6. ,CY) s T etj iV1}G, i �"'''�t ?5�q• �:y R• t. ;�;'� ..: �. Ci k. � .a }Y a+ �y�.�F+� } .* v �5� ,! .ty R ir'a �� ;fir A• ;�! r .. +` i ,�� ��'�ylr fix,,.. . +yJ" k' }�'h" „z�j �. , �;r-�`•�""`A, ±tom � � � •,�` 1� a, e r ' a + v ±.r q�'"`•` i' ^"y�7a 4 :✓ ,i-:-vt.' �"'°' •N , p 0 •r bsS N lsl N CO M O� N wiF ,.fib 9 eotj X. co � • N � Ar F � .. J ... P� � � � �'3 a Y M �� i. �,� ,� a•: 96£ OSI- , 0b (=,d OZ-6UI Q t � � 05112 I OD <- N or 31 rig i }'• �. ql� 4F +� Xy ��"�7'�'i� _ � `i'� * � Vy I Fyy` k. dlrry L,? x , Pi M sX 3 GD,. dSt +R-'112 `�°�•...� ►S f6l S- '7 7�5 9' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED (o PROPOSED FACILITY PROPERTY SIZE 141,C� SUBDIVISION ROAD NAME LLI,Q)q ROL Water Supply: - " On -Site Well Community Public Evaluation By: Auger Boring. - Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % v 2 HORIZON I DEPTH Texture groupL GL Consistence; S S 4-1 Structure 1< L2--,)Z— Mineralogy ; ,' / HORIZON II DEPTH Texture group Consistence a ; Structure MineralogyI:1 HORIZON III DEPTH -qXZ Texture group5.01 G t Consistence F : g 45 P: 5 f-y,l Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE a . O SITE CLASSIFICATION: la EVALUATION LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: �_vi� [ a t' 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 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 (01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMNON MEMNON HMEMNONi ,MEMNON MOMiiiMEMNONMEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■s■■Mese===■e■■■■■■t■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County Health Department and Home Health Agency Environmentaf Heafth Section P.O. BOX 848 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 Jeffrey Scott Crisco 400 Cherry Hill Rd. Hocksville, NC 27028 October 7, 1997 Re: Site Evaluation U.S. Hwy. 801S. Tax PIN: 45756-15-7988 a Dear Client(s): As requested, a representative"from this office visited the i aforementioned site on October 6, 1997. Based upon the information �. provided on the application for sitej,evaluation and after the evaluation was completed, the site was found to:be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. t ly :t `j Jef Beauchamp, R.S. Environmental Health Specialist JB/wd Enclosure(s) i i r GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page 1 of 1 t Click Here To Start Over Quick Search:(County ID c +/ Active Layer. F14-0Use.Map Tps GIs Ij IPARCELS (Map Tips Available) - I Map Layers I Results http://maps.co.davic.nc.usIGoMapslmap/Index.cfm?mainmapservice=gomaps&CFID=412... 1/28/2008 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System a� Click Here To Start Over iOy Active Layer. Use Map Tips Olult-1 *-�O` 1;1F,9PARCELS (Map Tips Available} Page 1 of 1 Quick Search:(County ID c GIS Map Layers I Results http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=412... 1/28/2008 APPL�WVAiF�bWA"N Billed To: Jeffrey Crisco Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Tax PIN/EH #: 57-92MY INFORMATION Subdivision Info:' Location/Address: NC Highway 801 S-27028 _ Property Size: 14.75 Acres Date Evaluated: < Water Supply: On -Site Well 'Community Evaluation By: Auger Boring Pit Public Cut .FACTORS 1 2 3 4 5 6 7 Landscape position 4— slope % slope HORIZON I DEPTH Texture groupG' Consistence Structure IL Mineralogy HORIZON H DEPTH Texture groupr 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 5 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ` LONG-TERM ACCEPTANCE RATE: d 7-5 REMARKS: ,et:— EVALUATION BY: I" ,A OTHER(S) PRESENT. / y LEGEND sc�rc� 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 CONSI4TEN 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 tes 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) <S LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/0.5 (Re.vi.-;M1 Parcel #: L60000000906 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search i View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: L60000000906 Account #: 19086530 Owner Information Building: Tax Codes BXF• RISCO JEFFREY SCOTT Land: ADVLTAX - COUNTY T Market: 00 CHERRY HILL ROAD ssessed: FIREADVLTAX - FIRE TAX Deferred: OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 14.830 AC JERUSALEM [Address: 6510 S NC HWY 801 Deed Information Local Zoning Date: 10/1997 Book: 00198 Page: 0031 Plat Book: age: Le al Description PIN 14.825 AC HWY 801 5756157988 Property Values Building: BXF• 2,1201 Land: 112 22 Market: 114 34 ssessed: 7 27 Deferred: 107 07 Sales Information No. Book Pape Month Year Instrument Qual/UnQual Improved Price 1 00198 0031 10 1997 WD Qualified Vacant 74 000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oPY CDavi e 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 verif=ication 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=1472116 8/24/2016