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2881 Hwy 601NI . � 1 " DAVIE COUNTY HEALTH DEPARTMENT -- ` Environmental Health Section U P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003752 Billed To: Chris Culler Reference Name: Tax PIN/EH #: 5820-08-8849 Subdivision Info: Location/Address: 2881 Highway 601 N-27028 ATC Number: 4221 As stated In 15A NCAC 18A.1969(5) accepted Systems may also be use 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 .1,900 Sewage Ty6atment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON IS ALID PERIOD OF FIVE YEARS. Environmental Health Specialist's Signator • Date: 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. A�X/4- • s� Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Account #: Billed To: Reference Name: Proposed Facility 990003752 Chris Culler Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5820-08-8849 2881 Highway 601 N-27028 33.6 acres **NOT N risbImprovement/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 Type 1AWSC– (eA"�"a) #People _ 2 #Bedrooms #Baths 2— Dishwasher: Dishwasher: 0 Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift ''#'1Seats Industrial Waste: ❑ Lot Size 3.� Q Type Water Supply Design Wastewater Flow (GPD) �`IQ Site: New [�' Repair ❑ System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width _70Rock Depth l2" Linear Ft. ;?G01 As stated In 15A NCAC 18A.1969(5) Other: -?—'D►S,t7 r-z� - accepted Systems may also (be usi~d Required Site Modifications/Conditions: INST&LL. fhJ C-Ew T11 ge V_, -)►,-p 5' IMPROVEMENT/OPERATION PERMIT LAYOUT - APPR( FINISHED GRADE. ****NOTICE: Contact a representative of system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on Environmental Health Specialist's DCHD 05/99 (Revised) E� EFFLUENT FILTER RISLR(S) IF"6 " BELOW : Davie County Health Department for final inspection of this -day of installation. Telephone # is (336)751-8760.**** 125 Fa-�) >Y- M)cTa,--71A1 —1>�4 3(10•1 Date: nJ APPLICATION FOR SITE EVALUATION/lA1PROVUIENT PER I • \�o. Davie County Health Department Environmental Health Section SEP 2 1 2005 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751•-8760 IgN M,0.91TALiii7,111.3 DAVIEtXll IM ***IFIPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORI•I:ATION IS PROVIDED. Refer to the INFO10TATION BULLETIN for instructions. 1. Name to be Billed GhQr/s l �(�( C I Contact Person ch ri-S or !�D re 11C Mailing Address o? OI NIC��/ (00 l I (� I Home Phone :33 &31 City/S tato/ZZP ImOe a Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/Stat/Zip_. i"11 4 -0 3. �/ Application For: 1krSitc, Evaluation tiimprovement Permit/ATC ❑ Both C/4,3 ,;v S'%=. 31 Pi - A. System to Service: 011oune ❑ Mobile Home ❑ Business ❑ Indua try' ❑ Other S. Typo system requested: W-16onvontional ❑ conventional modified ❑ innovative pacCepted G. If naaidenco: It People _ 9 Bedrooms It Bathrooms ❑Dishwasher ❑Garbage Disposal Mashing Machine Wasement/Plumbing ❑Basement/Ho Plumbing 7. If Business/Industry /Other: verify type It People S Sinks I Commodes 9 Showers tt Urinals It Water Coolers IF FOODSERVICE: 0 Seats Estimated Water Usage (gallons per day) 0. Typo of water supply: El—County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility tills systenl is intended to serve? ❑ Yes M<0 If ycs, ivllat type? ***I/1IP0.R7ANT*** CLILNTS,4IUSTCO4f11LETETIIE REQUIRED PROPERTY INFORMATION REQUESTED I117LOR'. Either a PLAT or SITE PLAN MUST RESUAM17TF.D by the client with TIIIS APPLICATION. Property Dimensions: 33,& WRITE DIRECTIONS (from Moclaviile) to PROPER11%, Tax Officc PIN: Property Address: Road Name a Sg j 14wY &01_n _ i�cj a C (SSS -PmM IQS G ax— Ci I ty/zlp x-City/Zip 1`Yine k 0i ilQ 6C aloz% _ on I.P4+ If in a Subdivision provide information, as follows: Nalne: Section: Block Lot: Date home corners flagged: o?� 6 s This Is to certify that the information provided is correct to the best of my knowledge. I understand that any perlllit(s) issued hereafter arc subject to suspension Qr revocation, if the site plans or intended use change, or if the inforlllalion submitted ill tllis application is falsified or changed. I, also, widerstaml thatl ain responsiblefor all charges incurreilfrom this applicat/un. I, hereby, give consent to the Autlldrized Representative of the Dav' Cou�n 'llra D )artment to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE "/' U7 f ' Q dJ SIGNA'I'URL 540,4 f,.,—n tyye &L TIIIS AREA MAYBE USED I OR DIZAIVING YOUR SI•TE PLAN (Include all of tic following: Existing and proposed property lines and dilnensiolls, structures, setbacks, and septic locations). �y bin•S �5 c .�• o Ps I'•,l cl] • >1'J 5 Sign given Account No. 3? S Z -04 Revised llCIII) (05/03 S � Il voicc No. t� APPLICANT INFORMA Account #: 990003752 Billed To: Chris Culler Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5820-08-8849 Subdivision Info: Location/Address: 2881 Highway 601 - 7028 Property Size: 33.6 acres Date Evaluated: On -Site Well Community Auger Boring ,/_ Pit Public Cut SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: _ LEGEND T,a-ndscape 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 )41St 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 Sri ,r 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 testes .. _ 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 05105 (Revised) Landscapeposition HORIZON I DEPTH Texture group Consistence HORIZON H DEPTH Texture ir-0-11—P Consistence - Mineralogy Texture group Consistence HORIZON IV DEPTH Texture group Consistence Mineralogy-®�®®® SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: _ LEGEND T,a-ndscape 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 )41St 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 Sri ,r 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 testes .. _ 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 05105 (Revised) ■■■■■e■■■■■■■■■■■■t■■■■t■■tet■■■aa■■s■■■■■■t■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Uiiiii ... MEMEiiiiNNEN MENNEN EMMONSoiiiisMEMNONMENNEN ■■■■■■■■■■■■■■■■■i�■■■Biu■■c�■■■■-o■■■■■■■■e■■■s■■■■■■■■■■■■■■■■■s■ ■■■■■■■ts■■■■■■■■■■■■■■■tai■■■■t■■►�■■■■■■■■■■■■t■t■■■■■e■t■■■■t■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■n■■■■■■pit■■■■■■■■t■■■■■■■■■■■■■■■■■■■■t■■ ■■■■■■■■■■■■■■■■■■■■■■■■■�I�!f■■IL"SII■E11'I■■■■■■■■■■■■■■■■■■■■■■■■t■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■�■rpt■�■■■r�■■■■■■■■■t■■■■■■■■■■■■■■■■■■■■ ■■■t■■t■■■■■■■■■■•tip■tee■■■■r■■■�■■■■■■t■■■■■t■■■■t■■■■■■■ttt■■■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box.848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 September 26, 2005 Chris Culler 2881 US HWY 601N Mocksville, NC 27028 Re: Site Evaluation - 33.6 Acre Tract/HWY 601N Tax PIN#: 5820088849 Dear Client(s): As requested, a representative from this office visited the above site September 26, 2005 to perform a site evaluation. Based on the information provided on the Application for Site 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. House location, size and other design criteria may necessitate the use of an alternative or innovative system. System design will be determined at the time an Improvement Permit/Authorization to Construct is applied for and issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. LSincerel Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s) ~INDEXED ON 5811 s 9162 0013 0837 1995 (18.45A) 4558 (r56) 9.59A 7612 (1067) (24.83A) 2031 601 s AA, 3 a 'j DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWACERTIFICATION FOR DWELLING (Check One) REPLACEMENT REMODELING ❑ RECONNECTION ❑ Name:--/!/ �''fIPhone Number: ! �'�/ a '� (Home) Mailing Address /��'�a Lam% (Work) Detailed Directions To Site: Property Address:Zjr- r„� Please Fill In The Following Informations About The Existing Dwelling. Name System Installed Under: �` � dullelt T Dwellin : � Y Type g Date System Installed(Month/Day/Year): 2 G � 2, 7 Number Of Bedrooms--4(Number Of People: Is The Dwelling Currently Vacant? Yes ❑ Nod'' If Yes, For How Long? Any Known Problems? Yes ❑ NoA If Yes, Explain: Please Fill In The Following Information About The New Dwelling: Type Of Dwelling: .B.Lim ergfBedTamrr�;: Number Of People: )(equested By:_� (Signature) For Environmental Health Office Use Only Approved Disapproved ❑ Environmental Health Requested: --� �-� "y 'Me signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ Date: Paid By: Received By: Account #: Invoice #: '707 Parcel #: F30000007807 Davie,County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search (Q View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: F30000007807 Account #:8302966 Owner Information uildin Tax Codes BXF: ALTON MICHAEL T & DALTON STACEE S nd: ADVLTAX - COUNTY T arket: 881 US HIGHWAY 601 NORTH ssessed: FIREADVLTAX -FIRE TAX eferred• OCKSVILLE NC 27028 Unqualified Improved Property Information 3 00945 0934 Township Land (Units/Type): 13.040 AC Unqualified CLARKSVILLE Address: 2881 N US HWY 601 4 00946 0903 12 Deed Information Qualified Local tonin Date: 12/2013 Book: 00946 Page: 0903 Plat Book: 11 Page: 268 Le al Description PIN 13.040AC OFF HWY 601 5820181762 Property Values uildin 193,28 01 BXF: 40,57 nd: 105,72 arket: 339,57 ssessed: 339,57 eferred• 2013 QC Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00517 0833 30 2003 WD Unqualified Vacant 0 2 00939 1007 10 2013 QC Unqualified Improved 0 3 00945 0934 12 2013 WD Unqualified Vacant 0 4 00946 0903 12 2013 WD Qualified Improved 300,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Searchl Page 1 of 1 o��rF wrj--11� 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=1458397 8/9/2016