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3810 Hwy 601NDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR OPERATION PERMIT Account #:-,990005838 Tax PIND30000006501 Billed To Kenneth and Kathy Ferebee Subdivision info: Reference Name: LocalioniAddress: 3810 US Hwy 601 N-27028 Proposed Facility: Residential Pool PropertySize: 5.93 Acres ATC Number6gOo **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 Tank Date Tank Size Pump Tank Size / �B�e/droomse/ j Q System Installed By: Br%QA I�ndDector#: Date: ` Z GPS Coordinate: Environmental Health Specialist: DCHD 11/06 (Revised) Date: V, 2 DAVIE COUNTY ENVIRONMENTAL HEALTH ` P.O. Box 84" ) Hospital Street Moe,- NC 27028 (336)753.1 "ax # (336)753-1680 AU')rHORIZATION FC fEWATER SYSTEM CONSTRUCTION Account #: 990005838 Tax PIN ',EH #: D30000006501 Billed To: Kenneth and Kathy Ferebee Subdivision Info: - Reference Nanie:LocationiAddress: 3810 US Hwy 601 N-27028 . Proposed Facility: Residential Pool Property -Size 5.93 Arres Grrj Site Type: ONew Repair ❑Expansion f%T4myffi4prAuthorization to Construct (ATC) MUST BFISSUED 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 chance. Residential Specifications: # Bedrooms _ # Bathrooms # Peopled BasementO Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Sizer Type of Water Supply: I County/City DWell OCommunity Well System Specifications: Design Wastewater Flow (GPD) =Tank Sized L. Pump Tank GAL. It (J Trench Width 3 - Max. Trench Depth�� Rock Depth Linear Ft2O � 29� Site Modifications/Conditions/Other: m0 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. f 73.���G. c011 Nom' r` 14 4 FJ r mx Environmental Health Specialist Date: 7j DCHD 11106 (Revised) ounty Health `Department EG mental Health Section MAR !rnvi P.O. Box 848 210 Hospital Street pYt Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON -SIT +W,ATER CERTIFI Fax: (336) - 753-1680 P (Check On Replacement .Remodeling Reconnection Name: r Phone Number 7 Z, (Home) Mailing Address: 3 �l0 of A) 3 - ?S�/ - �'9 411 (Work) IUC D28 Email Address: Tomf "eL9 A) 4gyi'e . k t 2, ne- Lt -5 Detailed Directions To Site: 10 ( y r11--, — bl'." e- 61:5:t _�9606666�s-QI Property Address:C3 Please Fill In The Following Information /About The EXISTING Facility: Name System Installed Under: Vr'h A 9�t) � ��� Type Of Facility: h (u- -Q-_ Date System Installed (Month/Date/Year): ry / '/7 (p Number Of Bedrooms:__S,�Number Of People:_ Is The Facility Currently Vacant? Yes No If Yes, For How Long?. Any Known Problems? Yes No I Yes, Explain: Please Fill In The Followidg Information About The NEW Facility: Type Of Facility: /'(�(}1 aC�f}/VS"% �� Number Of Bedrooms: Number of People Pool Size: A 'G a Size: Other: Requested By: Date Requested: C nn o fi. rnl For Environmental Health Office Use Only Approved Disapproved �] &�Mfi '5`700 Environmental Health Specialist, Date: *The signing of this form by the Environmental Health S'tAff 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 #: � a 3P Invoice i n 42, Davie County Health Department , 18 t , Environmental Health Section . , P.O..: Box 848 210 Hospital Street O U't Courier # : 09=4p-06 Mocksville,yNC 27028 1911 Phone: (336) - 753 - 6780. ON -SIT �1STEWATER CERTIFI 3� 0 Fax: (336) — 753-1680 (Check On Replacement Remodeling Reconnection Name: r e Llff, Phone Number /p/— % a. (Home) + 3�rQss�rWork)MailinAddre i�.2� Email Address: re.ti� k.� d�U�`P . k I: , ne,- U-5 Detailed Directions To Site: /n D I AJ,, 1-(, — 6vl p Inn I (\11 ,nrl s+ L. 1 �er U 1 P Property.Address:sml Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Ka h 4 P J 6 ECC b a e_' Type Of Facility:: a(t_S-Q_. Date System Installed (Month/Date/Year�r - Number Of Bedrooms:�_N;e/rf P ple '__. . Is �'he Facility Currently Vacant? Yeso es, How Long Any Known Problems ? Yes No I Yes, Explain: .. Please Fill In The Follows tInfor naiion About:;The�.Tacility: o :...Type Of Facility:_j X . N,..S1�C�i`� , -, . 'Nvmber'Of Bedrooms: -nit:. Number of People a� Pool Size: Gaya e Size x Othe t ` _ _., Requested By:t -~ (1nature) ti ;. For Environ, ntal�ealth Offibr UseOnly Approved ^ Disapproved , Comments: iO if , (C_ } -6 'Yt` i plc! ` l T ` , _ . 1 Z, 1;' '�� Environmental Health Specialist/� r/ e(�` / fie r2C C" *The signing of this form by the Environmental Healtfil•Staff is'in,jo way intended; a�o�r should be; taken as a guarantee' (extended or limited) that the on-sitew�stewate n'system yvi11 function pro perly(foTy given period. of.time. \ t., ,r, . fes%: o- /-,-, Payment: Cash Check Money Order # Amount:$" '! pate: c -' '! C i t. f' } Paid By: � � r , ;Received, y Account #: Invoice #: DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name ks SCA Fee - D e -cam Date p Location �ro us �-rw�r�oc �1 Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family - Garbage Disposal YES Q NO[] Specifications for System: IboO�e TawtL Auto Dish Washer YES Q NO ❑ I)- box WO )e3 X IF n4l— Auto Wash Machine YES Q NO ❑ Type Water Supply 'This permit Void if sewage system described below. is not installed within 36 months from date of issue. Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed byx_ta[�llvt� l� ` 4W -W, -, . L t/ De� }{Date Certificate of Completion Date 10-t I — �d 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. h l i Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed byx_ta[�llvt� l� ` 4W -W, -, . L t/ De� }{Date Certificate of Completion Date 10-t I — �d 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. Davie County Health Department 1110P8 j� Environmental Health Section P.O. Box 848 , C� S„ 210 Hospital Street Courier # : 09-40-06 1911 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753.1680 (Check One) Replacement Remodeling Reconnection - Name: f 1- UQAC-C yr 4 -LL -'7- ?()'j'L. Phone Number 3 3� 9 51 / l0(Q� (Home) Mailing Address: l u qoi' -d 373' �,,(WWork) Email Address: rnoe)( P©0� e1M�,ir1 ilK► yyj-•/L' Detailed Directions To Property Address: q 4ZID &01 NQ(L' W Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Type Of Facility: Ej751J6-^' U— Date System Installed (Montb/Date/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes da If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: P 0 r -- Please Fill In The Following Information About The NEW Facility: -7 Type Of Facility: R 17$ • -- ,Z Number Of Bedrooms: ?.Number of People ` Pool Size: 1 Requested By: (Signature) Other: Date Requested: For Enviroirmental Health Office Use Only proved Disapproved Comments: / v l a Fri VC, i v) / ��Q Q l'(� 'I""ti1 5'0 �d,'C Environmental Health Specialist. Date: 1^9 —/ ff— *The 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: CashChec Money Order # —L -C-1 Amount:$, Paid By: Received By:_ Account #: J�3 Invoice 4 .. .� .,•wa.. �v.Gia:� T I a'c"p µ't :•',��..•.,� _.. .�. -4;r. . � DAVIE' COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *�O: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c a Sewage Treatment and Disposal Rules (10 NCAC 1 O .1934-.1968) Permit Number NamekA_^^4A1 _ xre b e e. Date �l a.. Location _ RIn 1,1 S k1AI(LI it Subdivision Name Lot No Sec. or Block No Lot Size t, House Mobile Home — Business Speculation No. Bedrooms No. Baths z No. in Family 2 - Garbage Garbage Disposal YES p NO QSpecifications for System: 10001 a �Giwt� Auto Dish Washer` YES Q NO E)�U ZO )(3 Y 18" �o Auto Wash Machine YES p NO f-1 Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. Final Installation Diagram: System Installed by ' rkr _c f. _be bot d Certificate of Completion `�'i ^ Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT y Davie County Health Department Environmental Health Section P. O. Box 665 'Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 6 ,5/y3 R:5�3 1. Permit Requested B Business Phone o 2. Address 3. Property Owner if Different ttdn Above Arldrasc -- -- -- — 4. Permit To: a) InstallyAlter Repair b) Privy Conventional Other Type Ground Absorption c) Sub -Division r- Sec. Lot No. '- 5. System used to serve what type facility: House --'Mobile Home Business IndustryOther b) Number of people Z' 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms 3 Bath Rooms Z- Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: PublicPrivate Community b) Has the water supply system been approved? Yes -±:::f No 9. a) Property Dimensions b a4.,sa, b) Land area designated to building site c) Sewage Disposal Contractor, 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What tvnta9 This is to certify that the information is correct to the best of m knowledge. Dat wne Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: (gv I N -' `� 6ks� w .��-, o... 2 _ `� r.••�c,.. S �`r..a�— S c1 . ;r DCHD (6.82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 _ SOIL/SITE EVALUATION Name ������P Date Address Lot Size a Cc FACTr1R.R AREA 1 AREA 2 AREA 3 ARFA 4 Topography/ Landscape Position S S PS U PS U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) �P S PS S PS U U U U 1) Soil Structure (12-36 in.) Clayey Soils S PS S PS S PS U U 1) Soil Depth (inches) PS PS S PS S PS U U ) Soil Drainage: Internal PS S PS S PS U S PS U External S S �$ its S PS U S PS U �) Restrictive Horizons Available Space <:::S0 PS PS S PS S PS U U U U 1) Other (Specify) S PS S PS S PS S PS U U U U 1) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by _ SITE DIAGRAM DCHD (6-82) ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990005838 Billed To: Kenneth and Kathy Ferebee Reference Name: Proposed Facility: Residential Pool Property Size: PROPERTY INFORMATION Tax PIN/EH #: D30000006501 Subdivision Info: Location/Address: 3810 US Hwy 601 N-27028 5.93 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 Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy 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: EVALUATION BY: _ LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND La_ridscape 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 Torg - 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 CONS STEN a uht 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 NQt� 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 - gaUday/fU DCHD 05105 (Revised) Parcel #: D30000006501 Davie County, NC - Basic Estate Search 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 #: D30000006501 Account #:25284000 Owner Information BXF: Tax Codes Land: FEREBEE KENNETH LEE& FEREBEE KATHERINE M Market: ADVLTAX - COUNTY T ssessed: 810 US HIGHWAY 601 NORTH eferred• FIREADVLTAX - FIRE TAX MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 5.330 AC CLARKSVILLE ddress: 3810 N US HWY 601 Deed Information Local Zonin ate: 02/1986 Book: 00130 Page: 0200 lat Book: Pa e: Legal Description PIN 5.93 AC HWY 601 5822009689 Property Values uildin 186,66 BXF: 45,31 Land: 53,09 Market: 285 06 ssessed: 285 06 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00130 0200 02 1986 WD Unqualified Vacant 1 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search M Page l of 1 o�'t� 00 U �-n 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 . h4://maps.daviecountync.gov/itsnet/View.aspx?prid=1459203 8/10/2016