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4209 Hwy 601NDAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003918 Tax PIN/EH #: 5812-95-4681 Billed To: Darious Drennen Subdivision Info: Reference Name: Location/Address: US Hwy 601 N-28028 ATC Number: 4348 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 WAS UC N I V D FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Sign e: Date RTIFICATE OF COMPLETION . C41211 **NOTE** The issuance of this Certifi a of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compli with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall ' NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. 0-r Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 1J Satl owl 110 Fl Nt s}4 v uwQ- DAVIE COUNTY HEALTH DEPARTMENT •, Environmental Health Section P. O. Boa 848/210 Hospital street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003918 Tax PIN/EH #: 5812-95-4681 Billed To: Darious Drennen Subdivision Info: Reference Name: Location/Address: US Hwy 601 N-28028 Proposed Facility: Residence Property Size: 6.46 Acres **NOTE* This Improvement/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 = #People 2 #Bedrooms #Baths .2 Dishwasher: Ef" Garbage Disposal: ❑ Washing Machine: PJB Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size (OJ64049 Type Water Supply V/tjj— Design Wastewater Flow (GPD) 4120 Site: New U Repair ❑ System Specifications: Tank Size IWO GAL. Pump Tank Other: GAL. Trench WidthW Rock Depth 4 A Linear Ft.`l6D' Required Site Modifications/Conditions: /nn-r4jU. orf C' -'W wk, kw�� Ne&- Zcao ICED 'W" LA)6 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.***.* ,'A 5011 V CHD 05/99 (Revised) tAST 4 wz Ll irk !r'jcirl � OF i�P4 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC : 27028 (336)751-8760/ Fax'(�(336)751-8786 Application For: ❑ Site Evaluation/Improvement Permit 9Authorization To Construct(ATC) ❑ Both ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed N, le 5 0/- e ,e/s/40 At/ Contact Person v Billing Address /? 0. H!x /OqZ Home Phone - -rZ ( City/State/ZIP ,filar- kSV//Ze 410, R702Y Business Phone 1s 3 0 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address A/ City/ rvTd f/,� Tax PIN# Jr8 %2-9s- y6e/ Subdivision Name Section/Lot# Lot Size Directions To Site:�d ( 4 Date House/Facility Corners Flagged If the answer to any of the following questions is "yes", supporting docuineiitation must be attached. Are there any existing wastewater systems on the site? ❑Yes E[No Does the site contain jurisdictional wetlands? ❑Yes V&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 9No Will wastewater other than domestic sewage be generated? ❑Yes ❑No IF RESIDENCE FILL OUT THE BOX BELOW # People cO-j # Bedrooms41 # Bathrooms Garden Tub/Whirlpool P -Yes ❑No Basement: ❑Yes IlNo Basement Plu❑Yes ❑No 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: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Waterew Well Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ESO 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 understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance 'th applicable laws and rules on the above described property located in Davie County and owned by �,g )4 f Site Revisit Charge roperty owner's or owner's legal representative signature Date Sign given ❑Yes ❑No Revised 2/06 Date(s): Client. Notification Date: EHS: Account # Invoice # APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT!' Davie County Health Department Environmental Health Section APR P.O. Box 848/210 Hospital Street ' 6 x Mocksville, NC .27028 (336) 751-8760 ENV1Rp 44t7 �� H ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQU INFORMATION IS PROVIDE athheINFORMATION BULLETIN for instructions. 1. Name to be Billed /1011ry_^► m / �'1cue Contact Person )t /�'Jry'11 Mailing Address 1` S�/S Home Phone (/ 9Z' 3G `/`� City/State/ZIP — S UAi Business Phone -7*- 311 2. Name on Permit/ATC if Different than Above �g r Cvs lj Mailing Address City/State/Zip �VlYY?P C'� 3. Application For: Sia Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: H7Conventional 13 Mobile Home ❑ Business El Industry 13 Other S. Type system requested: ❑ conventional modified ❑ innovative C/ / 6. if Residence: # People #Bedrooms 7 # Bathrooms �2 126ishwasher W6arbage Disposal L4dWashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats EstimatedWaterUsage (gallons per day) 8. Type of water supply: ❑ County/City Cd Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes [YNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBAH77ED by the client with THIS APPLICATION. Property Dimensions: 04 Tax Office PIN: # 55 la�5y6� Property Address: Road Name City/Zip Acc e"rll, l K If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 6C//j aih) /asr c�, //i r GP7 f �Ulr �:, -7/ 41/2Cr Date home corners flagged: 05, 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. Jr, also, understand that I am responsible for all charges incurred frons 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 SIGNATURE N, /' THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). s7 Sign given )[.i �- f Revised DCHD (05/03 - `7f Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. �6 U Invoice No. Y -7 -Ty 221 \ I V co/'y� / n i V , \ C O Q \ •. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Ac,qount #:.990003568 Billed To:- Michael Drennen Reference Name:' Proposed Facility:• Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5812-95481 Subdivision Info: Location/Address: 601 N-27028 6.46 acres Date Evaluated: 41.2L Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut .FACTORS 1 2 3 4 5 6 7 Landscape position NS Slope % o HORIZON I DEPTH Texture group Z)4 GL Consistence SS 51P Argsp 1 T Structure TZ GQ Mineralogy HORIZON II DEPTH _. - 2 ,- 22 Texture group; C_ S • C ,'L Consistence ; S . S S Structure - Mineralogy S HORIZON III DEPTH ZZ - I -K - Texture group S ` 6'r Consistence F45 S S S Structure A 1C Mineralogy -- HORIZON IV DEPTH t Z 2 Texture group Consistence Structure L L Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P5 S -341 LONG-TERM ACCEPTANCE RATE I O 0.3 1 D SITE CLASSIFICATION:ptl.( LONG-TERM ACCEPTANCE RATE: 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 , extur 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 of 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 Structur 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 " DCl ID 05/99 (Reviscd) EVALUATION BY: OTHER(S) PRESENT:`` ■..■.■.■r■■..■■.■■■■■■■■.■■..■e.■■■e■e...■■■...■■■■■..■■...■ ■ ■e■ ............................................................ an no ............................................................ ■.. ■■■..■■.s.......r..■■er■■■■■■■.■ ■■■.■...■■■.......■ summon I■■ ■■....■....■e.......■■...■■eeea■■eee.ee.■eeee.■■seeee■■.■■e■ C ■■ ■■■.■■■..■.■■■...■............■....e.........■........■e...e■ ■■■ ........■....................C..........................e■■� Olin ■■■■■■■■■.■■■■■■■■■■■■■■.■■■■■■■.■.■■■■■■■■.■■■.■..■■■■■■■■ ■ ■■■ ■■■.■■■■■■■s■■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■.■.■...■■a■■■a■ 1 ■■ ■■...■■.■■■■■■■■■■■■■■■■s■■■■■■■a■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ CC ■■■ ■.....■■■■■■....■■.....■/■■■....■..■■■■.■■■........./■■/■■ ■■■ iiiiiiriiiiiiiiiisiiiiiiieiiiiie■.iiiiviiiiiiiiiiiiiiiiii■iC■CC ■� iiir�CiiinCiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiriiiiiiiiiiiii■i■ii■ i ■■■■.■r■■was..■.■e■./■■■■s//■/.■■..■./................■/..C.C.■■■■ ■■■■■■■■rt■■n■■■■■...■■■►e■....■..■ri.■■...errs..■.■..o..■.�■...■I��r. no ■■.■■■r mums.■ ■■.■■■ mums■■ ' ■..■■e ■.M.■■ SOME ■■ ■.■■■ter■■■■■■■■■■■r■■^■■■■■■rr�■■■..■■■t'■■u■■■■.■.■■..■■ i � .0 ■■ .....ad..■..■■.■o■■.■.■■■.■.�t■■■■■■■■■■■■■■■■■■■■.ri■■i 9 a�� ■..C.■..■6��.■■► ■■.■■■■■.�i■■■■.■■■.■■■.■�,■■�,■.e■■■■.■.rtes ■■ ■ ■■■ C..■■�r..■....■......■!►�r■..■Ir..■.■■■■■.i■■.i■■■■■.■■■■ri■■r�■.■e■.■. ■■■■ ■.■■rr.► ■■■► ■■■■■■■■��eua.■■oi�■■■■■■r�■■rl■■■..■.■■erle■ ...■...■ ■...■.■.r�l.■■■■..■■■■■.■n■u■■■■rl ■■■■■■r�■.r�■■■■.■■■■■ii■■.■.■■.■.■ ■....■ ■.c■■i■■.■■■■■■■i■...��rr■■■■■■.■i■.■■.■■■■■■.■rro..■■ ■.■■■ ■..■/C�i■■■a■■►\■■.►\.r�r:,n i■..■.■.■rt...■s..■,■■ti...■■.■..■.tr■err� �■■..■ ■..■■ ■.tits■lamp.e■err■■■■■■■r�r■��/■■I/.■I//.■..r■■■.■I■ii��i ■.■ ■.■....■■■.► ■.►\..■►■i■■.■..■■.r�.ra....e■..,.......■..■.tt�u� on C ■■■.Emus, ►.t�.■■■t...►►. ..■■.■.■.►�■.■■.■/r.■r/../.../........■■ ■...■/.5;. '' llr►S; /►■!1/(i/.■.■...■■/■H■...%..II.m....■■■■..■■ .■ ■■■..isS'J��1.1r.►\G/ ty�.■......■//..i�..■%■/I,...■■■.■.■....■C■■� ■ ■.■■ ■■�!■ ■■■■\\■■■\n..-....�/■■■■It..■/.mums■......11■■■■.■ ■ .■r■ ■.■■■■I■/■■...■�.\■■■.■■.■.■�■■■■■.■.■■..■■.■.■ell.■ ■ ■■■■1�■■■.■t■■■.C■■■■■■r■■s�■■sin.1i■■..■■■■■U■■■■■■■■■u■■r�CC= ■../■./.■.mumu/ r■■■r■■�A�..r..rl�■■■■■■■■■■■■ ■■■.■■■■■�/■■ . ■■■■■■■■■■■err■■■■■ ■■■■■■■■u■■■■■■■■■■■■■■■■■■■■■■■■■t■ ■■.■ ■ ■./.■//....■■./■..■■/■.■/■■■/.■.■.■■■/■../■..........r.■ ■.■ ■..■.■/.■./■lis■■.■■./.■...■■■/../.......//■.....■..Elm on ■....■.......■■..■.■■■..■�■...�. ■.■■■LN::'��' iiiiiiiiiisei► iiiiiiiiiiiiiiCC�'iCCCCCiiiiiiiiiiiiiCiiiiiiiC■ C■ ■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street , Mocksville, NC 27028 Phone: (336)751-8760 / Fax: (336)751-8786 April 12, 2005 Michael Drennen PO Box 545 Mocksville, NC 27028 Re: Site Evaluation - 6.46 Acre TractlHWY 601N Tax PIN#: 5812954681 Dear Client(s): As requested, a representative from this office visited the above site April 11, 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. 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. Sincerely, c� Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s) S r, - dT Parcel #: D30000003207 Davie County, NC - Basic Estate Search Page 1 of 1 PVI -1 oo• �, UR Davie County Web Site Basic Search Ileal Estate Search Tax Bill Search Sales Search a View�Prooerty Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: D30000003207 Account #:82524665 97,28 Owner Information Qual/UnQual Tax Codes 35,22 arket: RENNEN KATHLEEN S ssessed: ADVLTAX - COUNTY T [Deferred: Vacant 0 BOX 1042 00619 FIREADVLTAX - FIRE TAX 08 2005 WD MOCKSVILLE NC 27028 Vacant 0 1 00665 Property Information 06 Township Unqualified nd (Units/Type): 6.460 AC 0 CLARKSVILLE 0288 [Address: 4209 N US HWY 601 2005 WD Qualified Vacant Deed Information Local tonin Date: 06/2006 Book: 00665 Page: 0174 Plat Book: Page: Le al Description PIN_ 464 AC OFF HWY 601 E 1 5812954681 Property Values ulldin : 97,28 BXF• Qual/UnQual Land: 35,22 arket: 132,50 ssessed: 132 50 [Deferred: Vacant Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price l 00331 0595 04 2000 WD Unqualified Vacant 0 00619 0665 08 2005 WD Unqualified Vacant 0 1 00665 0174 06 2006 WD Unqualified Vacant 0 1 00612 0288 06 2005 WD Qualified Vacant 35,000 View Property Record for this Parcel View Mao 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.daviecountync.gov/itsnet/View.aspx?prid=1458512 8/10/2016