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3248 Hwy 601N' f- DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street — - Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 Account #: 990005454 Billed To: Brianna Barrett Address: 3248 US HWY 601 N City: Mocksville Reference Name: Proposed Facility: Residence -WOV OPERATION PERMIT Tax PIN/EH #: 5821-03-2353 Subdivision Info: Location/Address: US Hwy 601 N-27028 Property Size: 2 Acres a **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��T,,,4 Tank Date Tank Size Pump Tank Size System Installed By:, N/1 Specialis � fi e: O 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 #: 990005454 Tax P€NfEH #: 5821-03-2353 Billed To: Brianna Barrett Subdivision Info: Reference Name: Location/Address: US Hwy 601 N-27028 Proposed Facility: Residence Property Size: 2 Acres ATC Number: 5067 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 # Bathrooms2i2 # People Basement❑ Basementplumbing ❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size_ Type of Water Supply: ❑County/City &,Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 6 Tank Size 1beO GAL. Pump Tank/u4 GAL. Trench Width Max. Trench Depth o k Depth A&W Linear Ft UO s stated in 15A NCAc; 1 r+. �4) Site Modifications/Conditions/Other: accepted Systems may also be US0 Contact the Davie County Environmental Health Section for final inspection of this system between Environmental Health Specialist DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Streit Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005454 Tax PIN/EH #: 5821-03-2353 Billed To: Brianna Barrett Subdivision Info: Address: 3248 US HWY 601 N Location/Address: US Hwy 601 N-27028 City: Mocksville Property Size: 2 Acresfo it 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 Permitis subject to revocation if site plans, plat or the intended use change. Permit Type: New ❑Repair ❑Expansion Permit Valid for: 05 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathroomsi # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type- # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): Site Modifications/Permit Conditions: Site Plan Type of Water Supply: ❑County/City fl.Well ❑CommunityWell Environmental Health Specialist i.p. 11.06 Date�,`5[� f-G� r SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health MQR 61� P.O. Box 848/210 Hospital Street �V Mocksville, NC 27028 2�,�I jr7 �NVIROKMENjP-NENJ" (336)753-6780/ Fax (336)753-1680 J ppV1E CAUMY A lic ite Evalu4 ion/lmprovement Permit ❑ Authorization To Construct (ATC) e oth Type of Application: ❑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. A PPT .TCANT INFt1R M A TTC1N Name — t ' Contact Person �• ,, t�� Pr Address ;� Gf5 ,o ' IV Home Phone Z .'i`%�Z City/State/ZIP MP c ' V', 1e_ N(., 27-C 2 Business Phone 322- ;5 "7 2 - Name Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION *Date House/Facility Corners Flagged 3'/G'/G' NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit ' valid for 60 months with site plan, no expiration with complete plat.) Owner's Name r-+ &A r'1 CL_ Barr g, Phone Number Oft ti2L__ Owner's Addresses Z elg C« /-%wy to 01 Al City/State/Zip C CA � :IZe C y Property Address City Lot Size „? ,q i �� S Tax PIN# -2 3 Subdivision Name(if applicable) Section/Lot# Directions To Site: 1,;,0JA/ A q c X t/ m iJe_s p e, ,%+ m -wg c7r, A', - k. If the answer to any of the following questions is "Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes X No Does the site contain jurisdictional wetlands? Yes kNo Are there any easements or right-of-ways on the site? gYes No Is the site subject to approval by another public agency? Yeses( No Will wastewater other than domestic sewage.be generated? Yes �LNo IF RESIDENCE FILL OUT THE BOX BELOW # People 3 # Bedrooms 3 # Bathrooms �2 /2_ Garden Tub/Whirlpool 0Yes ❑No Basement: ❑Yes pNo Basement Plumbing: ❑Yes JKNo 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: AConventional ❑Accepted ❑Innovative ❑Alternative ❑Other, Water Supply Type: ❑ County/City Water XNew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No 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 loca ' and aggi or staking the house/facility location, proposed well location and the location of any other amenities. f Site Revisit Charge Property ow er's or owner's legal representative signature Date(s): 14-,10/0 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # Invoi e APPLICANT INFORMATION Account #: 990005454 Billed To: Brianna Barrett Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5821-03-2353 Subdivision Info: Location/Address: US Hwy 601 N-27 8 Property Size: 2 Acres Date Evaluated: �- C! On -Site Well v Community Auger Boring ✓�! Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape Rosition Slope % c UJ HORIZON I DEPTH p_ Texture group C _L L Consistence ,,2 Structure 61, Mineralogy . l HORIZON H 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 23 EVALUATION BY: y�%1` A � I01411 a LONG-TERM ACCEPTANCE RATE: • 3 OTHER(S) PRESENT: 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 1�l21St 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) TTAR - T.nna-term grrPntanri- rata - anlhinu/ft7 rr� ncinc m__ :__.3N rrrr-rrr.... ■■■■■■11■■■■■■■■■■■e■■■■iiiiiiiiiiliiiii■ee■■■■■■i�■■■■■■■■ ■■■■■ell■■■■eee■■e■■e■■■e■■■■■■e■1�1■■■■■■■■■■■■■u■e■■■■■■ ■■■■■ell■■■■■■■■/■■/■■//■■/■■■■e■■e■■■e■■e■e■■e■>I�■e■■e■■■ ■se■■epi■■■■■■■■■ee■■■■a■■■■■e■e■ee■eee■e■■■■■■■Ir■e■■e■■■ ■■■■■■■■■■■■■■■■■■Ile■e■■■e■■■■■e■e■■■■■■■■■■■■ ■■■■■fir\■■■■■■■■■■ill■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■I��YI■■■■e■■■■■ell■■■■■■■■■■■■■■/■■■■■■■■■■■■ ■ ommumil MENNEN wommomEMPEEM MENNENNONE ■■■■■■■Ile■■e■■e■■e■■■■■■■■■?� r',■■■■■■■■■■■■■f'�/■ -------------------------------- ■■■■■■■■■II■■'�■■■■■■■■■�■�■■■■■■■ ■■e■■■ ■■■■■■■■■I/■0■■�/!�'�: ii■■■iii.:.=.:����■■■■■ ■■■ ■ ■ ■ ■ a ■ 110\■■e■■■■■■■ 10\a■■■■■■■■■■ 1■1Ie■■■■■U■■ In ■■■■■■ ■■ Ir■■■■■■■■■e■■ Ir■■t■■■e■■■■■ I■■■■■■■■■■■■■ Ire■■■■■■■■■■■ ■■■■■■■■■■ ■■■e■e■■e■ ■■■■■■■■■■ ■e■■■■■■■■ ■ ■■■ u7 r m c TANNER JORDAN LOlI1li D.B. 815 , PG. 327 �SEED.B. 766, PG. 619 FOR E) t- -------- -- ---- O O n f r S .lad' 'elan —^ � ^tv No h I:amllaa L. Tutterow, Registered Land Surveyor. Number L-2527 I, Grody follow as indicated by an X: certify to one or more of the That this is a plat of a survey that creates o subdivision an f land within on area of a county of land; municipality that has ordinance that rsgof a parcels is located in such a b. That this Plat is of o survey ,:nic�unregulatedality that is unregulated at to an portion of s cr..:tY ur r.+ ordinance that regulates Parcels of land; c. That this plat is of a survey of on existing parcel or porcels of land,of another category, such as the d. That this plot la of a survey recombination of existing parcels, acourt—ordered survey. or other exception to the definition of a subdivisions such e. That the information available to this surveyor is best of rt+Y that 1 am unable to maks a determination h d. Dhow. profesi not bility to isions contained in o. throuq SLS 5 Signat or Registration Number DW[G13 D.B. I. G I and and Bac from in that thi that thi 47-30 126 , PG. 295 - that this plat was drawn an actual survey made description jecarded in D.B. 126 , PG. 295 EXISTING GRAVEL DRIVE CAR 10 SEAL1 I L -252740 11k Plat DWIGHT F. R D.B. 471 , • ` Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 '� ". (336)753-6780 / Fax (336)753-1680. WELL PERMIT Account #: 990005454 Billed To: Brianna Barrett Address: 3248 US HWY 601 N City: Mocksville Tax PIN/EH #: 5821 -03 -2353 -Well Subdivision Info: Location/Address: US Hwy 601 N-27028 Property Size: 2 Ac Reference Name: Randy Foster Proposed Facility: Residence-Well0O5lo Actions of the employees of the Davie County EH Section shall in no way be taken as *a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any fact/circumstances upon which this permit was issued. Permit Type: New Repair ❑ Abandonment ❑ Proposed Well Diagram Certificate of Completion Diagram Comments: j-/ loo Driller: C9 , Certification #: �n p. • tL o Grout Inspected: Well Head Inspected:. sf27fZ!i`l c0 n GPS Coordinates: EHS: rrAl GUCGf Date: gl(b'116 EHS: Date: W.P. 7-08 Parcel #: E300000101 Page 1 of 1 o��t� Davie County, NC - Basic Estate Search 00uti'�� Davie County Web Site 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 #:E300000101 Account #:26368000 Owner Information Tax Codes 39 20 0000 FOSTER GEORGE RANDALL& FOSTER DANA ]ONES 115 ADVLTAX - COUNTY T 2069 240 US HIGHWAY 601 NORTH 6104 FIREADVLTAX - FIRE TAX 61 04 MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 1.070 AC CLARKSVILLE ddress: 3248 N US HWY 601 Deed Information Local Zoning Pate: 02/2001 Book: 00360 Page: 0328 Plat Book: Page: Legal Description PIN 1.1AC HWY 601 LOT 6 E G ]ONES 5821032353 Pro a Values Buildin 39 20 0000 BXF: 115 Land: 2069 Market: 6104 ssessed: 61 04 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00360 0328 02 2001 WD Qualified Improved 45,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 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.daviecountyne.gov/itsnet/View.aspx?prid=1465956 8/9/2016