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4207 Hwy 601N11, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section =. P. O. Boz 848/210 Hospital Street - Mocksville, NC 27028 (336)751-8760_- IMPROVEMENT/OPERATION PERMIT Account #: 990002559 Tax PIN/EH #: 5822-05-2628 Billed To: fficha-eLDrennen Subdivision Info: Reference Name: Location/Address: USHighway 601 N-27028 Proposed Facility: Residence Property Size: see map ATC -Number: . 3367 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOK 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 ((IN,, STALLING SYSTEM. Residential Specification: Building Type I -j0 QS V #People _ #Bedrooms `"f #Baths • 5 Dishwasher: Garbage Disposal: 121"" Washing Machine: Ero'- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot. Size %5+ �' S>I pe Water Supply Design Wastewater Flow (GPD)4b Site: New Repair ❑ System Specif cations: Tank Size 10%OGAL. Pump Tank GAL. Trench Width 3a' Rock Depth 12�� Linear, Ft - ocher: �1 i! �1tJ ZOx STA LI - L-� f Required Site Modifications/Conditions: Of4 x F�. 5f © V 1<C�r'OLL V IMPROVEMENT/Of ERATION PERMIT, LA YOUT - D FLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative County Health Department for final inspection of this system between 8:30 a. n. to 9:30 a.m. or 1:00 p. . to 1:30 p.m. on the day o ation. Telephone # is (336)751-8760.**** 0�� � Un1ES�. 6qqVW 570/ -•To J Lisp E LA, r Q PM -'r I'(- ' t LdtSeD 3 j1 0 3 Environmental Hea h .pecial wv! cc--- — I t- w- - -, 05/99 (Revised) s Signaturd- C�ml �2� Pte- CWTAC 1tS oG��C% Pa4aP- TD pt= Sop n� r010j4P • OL DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002559 Billed To: Michael Drennen Reference Name: Proposed Facility: Residence ATC Number: 3367 Tax PIN/EH #: 5822-05-2628 Subdivision Info: Location/Address: USHighway 601 N-27028 Property Size: see map 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 .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA C IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur 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. �• 30 -dz Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) "Isti-r �j NO t' � 14 IOFlt,�2 17 f'4�k�-LS �� C-4nvvb, L -5q wp.-�-Ti7��A 9-5 Date: i "7A 7 Z IL APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department EnWronmenfa/ Health. 5& on G P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 , ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T ��\( INFORMATION IS PROVIDED. ``Refer to 't/he INFORMATION BULLETIN for instruc 1. Name to be Billed \ C e.1 r e� 1 �+ l ' �+� Contact Person by / / Mailing Address . V. �bD( J L4 hh) ��77 rr�� Home Phone (v'j City/state/ZIP �i /Ile , w.I,_. a-)l!i R Business PhQl/ / 0' O- 6 71 y 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Vsite Evaluation 0 Improvement Permit/ATC 0 Both a. System to Service: 41 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. if Residence: #People _ #Bedrooms4 #Bathrooms IL '/Dishwasher V6.bage Disposal U4"hing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/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 0 Community e. Do you anticipate additions orexpansions of the facility this system is intended to serve? ❑ Yes WINO If yes, what type?l ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBM12TED by the client ,with THIS APPLICATION. Property Dimensions: 0MCO X 332) X 51A 333-- oO� Tax Office PIN: # Property Address: Road NameW�Y �� 1 • , � City/Zip �,� �� ���E'. �j,� � ���g If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: (Pat1r> 3f� , C9 /40 Date Property Flagged: 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 to conduct all testing procedures as necessary to determine the site suitability. DATE L.4 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE P de all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Dat s): Client Notification Date: ✓�a3�� 51- �� �� ----- t' EHS: r Account No. " Invoice No. z t t✓ 16 9 43,2. 0, P . . I�ert S. POOi 4, P9': ?Q¢ 08°?4'49'T .740.26' -•-► - Stone pile N .4nastas a Py, 440 y S 09°4531 "W !. —•--�. Brencn ........ -"'"•� fie line. N 85°41'02"W 1 pondx 1 %. �Rebor tmn p/n + �� found bund wi� K 1 Do J ... e to Aq 07. 29.446- Acres.4 ib 6q� 41.7 . �6PIS 06 bld5 s , Please to Initial Charlie -Barney, A • � � D.B. 801, P9: 288 r. Zoned: RIA Zoned: R20 N 02°11'48"E___ear Rebor 66.00, R shod found N 89005'49"E N 87.48'12"W aw:knp 224.34' foto/ . 176.39' total_ S 05°38'24"W S 05°41'40"W S 05°41'06"W 1 Rebar t 102.63' 378.924' 190.01' f and -- -- -- - ---- Raw U.S. Hfgh -•---------- •-- - ---- -- RIOW 60Right— ton - T S 23°42'29"E found J &03' I, ' FACTORS DAVIE COUNTY HEALTH DEPARTMENT -' 3 -Environmental Health Section 5 ' Landscape position Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002559 Tax PIN/EH #: 5822-05-2628 Billed To: Michael Drennen Subdivision Info: .a Reference Name: - Cv Location/Address: USHighway 601 N-4,7028 Proposed Facility: Residence Property Size: see map Date Evaluated: ///070-3 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut (�SP -SConsistence rS 5 FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % _ L'. Ci vv .a HORIZON I DEPTH - Cv 0-(9 — - - Q-7 Texture group S; CL i CL- 'C -L L GL (�SP -SConsistence rS 5 r P FrS5S Structure `iblc s/ /r /c Mineralogy HORIZON II DEPTH Lv - 1 In - Texture group G - ;C_ 5, Consistence'. CIO Al SV Structure sc- Mineralogy HORIZON III DEPTH I CQ 10- Texture groupE Y G t Consistence Structure @5i< A5e (. I� . 3 Mineralo x &7 ` / ; .1 7 HORIZON IV DEPTH Texture group Consistence Structure Miheralogy SOILWETNESS 20 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5- -S 4 LONG-TERM ACCEPTANCE RATE O . - O 'LJ 27., ' (� SITE CL. �/ EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 0• Z� OTHER/(S) PRESENT: REMARKS:' A.nu,tA yS- PLS, �Y,-7o j Z,4'+ L GEND 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 05/99 (Revised) NOON■s■■s■■■■■■■■■■■EEi ■■■■■■■NNM■E■■■■■■■■MEI ■sea■■■■■■■■��■■■■■■e■■i ■■■EN■Me■E■■��s■■■■■■NEI ■■■■IL1J■■■■■ISI■■■■11.■�:�■I ■■s■e■■■■■■■ore■■■■■■■■ ■■■■■■■■■■■■■\l\NOON■■■ ■■■■■■■■■■■■■■■V�\NOON■ ■O■■ NONE MEMO ■■e■ ■MN■ ■■■■ SEEN ■E■■ NONE ■ i i i ei ME ME NOON■■■e■■■■■■■■■■■■■MEN■■■■■■sa ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■NOON■■■■■■■■s■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■NEON■■■■�■■ ire■�r.,�■■■�_•■■■e■■e■ee■■e■e■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■NOON■■■®■N■■EM■■N■MEE■■■■EEE■E■ v■■■■■■■■■■■■■■■■■■■■■■■■■■ENE■■ 7i]ONM[!l7Ltd'IL0NOON■■p■■■■■■■■e■■e■■■■■■■e■■ --------------- ■■■■■■■■■�■■■■■■■■■■■■■■■s■■■■■■■■■eee■■ ■■■■■■■■■■■■■NOON■YL'■®■R�T��LJ■■■■■N■■■■■■■ ■■■■■�i■IG■i■■■■/ll�����iviiii:a�iiiiiii■■■■■■ NOON■■■ss■e■■I■■■■■■■■■■d■■■e■■■■■■■M■■ ■■■eee■■■■■■■■■I■��■■■■■■■■■■■■■s■■■��■■■ ■■■Eae■■■■■E■E■I■■E■■N■■■■■■■■■ENE■■■■M■■ ■■■■■■■■eee■■■■■■■■■■s■■■■■■■■■■■■■�icz�:■ ■ii■■ilii■NE■i■■■:e■■EM■■■■■■s■■e■■E■■■■ �s■■■■■■■■■■N■■■■■■■■■■■■■■MO■E■MEEN■MON i■EN■E■■■■ENEE■EEEEN■N■■EOM■EEE■■■E■M■■■ ■■N■■■■E■■■■■■■■■■■NEE■■E■■eEN■■■■■E■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Y Y ' k ro� Y' a is Olin I . 11 MEN 5 L 3�k 7� WIN, � ���� •� � Yv �*�,«aa"? atF., "° 4 .� �u�" ag a;a�r ��r�;,e py��'�a`'�``�r"�����r�{ �a �•��� B�� � ":. Y r1 KIM% o�s b 1 ���. � �tir��f•t r�. �,xy 3 F@. lE° too r s�� � �'� •' � ,� 7�.� ,yY¢ ''r ��r Pba° `w as '�'k¢ $,,s r .s`'�''�.m �"`��` "' 8. � g�F - hi!� 1 P'r."}kr ?�E .£'3'd,K•. �� �.." '�q��Y',i��}��' �; _.. �h""_-,� �J,�... a�9 k � -- �'4� r,3�f5t��# .A fl$. �� �'nq.� "�. -r a�'''.�,� s �" x x.� :. -"� � ' •,fi?� � y� .°, � .:t� x�,;s P}. fi '�.,p ,�'J� �r: : �+'�. f r e`',�,d �° ab r �:: A`�` ��'rn� � , ,��ava � �:a�,� �:- ,�7'. ��-r..- a' ���.P. s •;�°a +� v � ,. �S.J,!'zk`�`� � � '�'�� rxcr>� 3. u� +ga�r�4�' ��:�-,� k e ,�""a' � " ,f ��� �k '`�•1� by � F TO e�Pa a � � � ? �� ��� r c a '� ,� a'� � �•� � t �. �r.�•sit � �� �''fi s� €e �'� : zP a ,�''. &y A� y�',, ski `Ypit ` 011iy Vj u r.� �' �'"��� •� .'�` '��:cam' y.z � ti i � � '�-'�':- x ' `J �$ ���° �'��✓$ti�r '��}r rpt e .�Pbm�rp`i6°� a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Box 848/210 Hospital` Street Mocksville, NC 27028 Phone: (336) 751-8760 / Fax: (336) 751-8786 January 13, 2003 Michael and Jill Drennen PO Box 545 Mocksville, NC 27028 Re: Site Evaluation - 5 Acre Tract/Highway 601N Tax PIN#: 5822-05-2628 Dear Mr. And Mrs. Drennen: As requested, a representative from this office visited the above site January 10, 2003 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 oversized, modified on-site sewage disposal system. It should be noted that house location, soil conditions and topography may necessitate a pump station. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. Additionally, please have the tract surveyed and the corners flagged prior to making this request. Enc(s) If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section 4.49-E 519.35 °: •+ z .�.k.+t ar STH ,� ..� fssy� �. lr ' �.i ; ti �`: v'�• w �• t P '4 Daniel Batty y, D.B. 331, Py. 69&AX5: at+'Sir .::rate 7 • I •J.�' ' ^ `,, 4. Rest y 7� yt L lJan><ttl gip( 1 ,y� ;::iltinlarlc Point. M Pon4• �jp •, D.B. 33.1.�.P� $p6 `-.rs � 5^��, �� ,, ti •; ti q s{ 11 on w Zru.,• r .I l+. • ti 4 fir' t7 }I paV� �.._.+..�..—�'► x..i•r+ r . U.S. Highway 0.;,� '.' 60• Right—of z n -en NR�c +7 'r fctrit 't' i3 Go.;. N. C. a SEAL cry, . L-3940 y` •., SURA Z0 3E)Vd 3WOH 9NIAM AN1NnM UOTU8b0LL Litt £00Z/Otgo Parcel #: D30000003206 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search 0 View Property. Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: D30000003206 Account #:82520980 Owner Information Tax Codes BXF: DRENNEN MICHAEL WILLIAM & DRENNEN ]ILL LYNN ADVLTAX - COUNTY TAA 30,990 O BOX 51204 READVLTAX - FIRE TAX ssessed: KIACHAK AK 99551 eferred: Property Information Township land (Units/Type): 5.500 AC CLARKSVILLE ddress: 4207 N US HWY 601 Deed Information Local tonin ate: 06/2003 Book: 00488 Page: 0084 Plat Book: Page: Le al Description PIN 5.500 AC OFF HWY 601 5812958905 Property Values Buildin : 91250 BXF: Land: 30,990 Market: 122,240 ssessed: 122,240 eferred: 0 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00488 0084 06 2003 WD Unqualified Vacant 36,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information I<z Return to Basic Search Page 1 of 1 v5'.V o t� D U R� 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/itsnet/View.aspx?prid=1472295 8/10/2016