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4168 Hwy 601S0 Account #: 990004462 Billed To: Dan Schmucker Reference Name: Proposed Facility: Residence ATC Number: 4776 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5754-12-5924 Subdivision Info: . Location/Address: US Highway 601 S-27028 Property Size: 22 acres **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. f y System Type: S.T. ManufacturCk Date Q'— Tank S ize_/Gv Pump Tank Size �n 6 System Installed By: pu)QVt E.H. Specialist:kate:,t�ate: �r/ DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004462 Tax PIN/EH #: 5754-12-5924 Billed To: Dan Schmucker Subdivision Info: Reference Name: Location/Address: US Highway 601 S-27028 Proposed Facility: Residence Property Size: 22 acres ATC Number: 4776 Site Type.,4ew ❑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 # Bathrooms Z # Peopleq Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or,Dimensions of Facility)_ Lot Size Type of Water Supply: ❑County/City.&;ell ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) S Tank Size GAL. Pump Tank GAL. Trench Width 13to Max. Trench Depth � Rock Depth %Z+� Linear Ft. Site Modifications/Conditions/Other: _`'G�%�1 � t�� PVY !' 1,Vv�..�Vally Contact the Davie County, Environmental Hdalth Section for final inspection of tlfis system 8:30 = 9:30a.m on the day of installation. Telephone # (336)751-8760. i� 11,1C !�' 1 rj 1�E�7Sc� R k As stated in 1.5A NCAC 18AA969(5) accepted Systems may ;I be used nvironmental Health Specialist Xk A D,/,. 3 DCHD 11/06 (Revised) OCT 5 .201 Type o �X ill 1�Na� OR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC '27028 (336)751-8760/ Fax (336)751-8786 /7< < P"le dry ?. *@ natio /Improvement Permit Authorization To Construct(ATC) oth em ❑Repair to Existing System ❑Expansion/Modificationof ExistinXB stem or Facility '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 A /J �'� _A.,"" �% ` C c w. v r_ �. r Contact Person ,t ,n/ S �_ , Billing Address cy z Home Phone - 6.5 City/State/ZIP �lo��csv; /1� ,,!/: C , X70 g Business Phone 60 7- ;,v6 - 55Z.;7-- Le!/f Name on Permit/ATC if Different than Above. Mailing Address YKUYElt1 Y 1NPUKMAl'1UN *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: JK Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name'„ a n {.a„ , % n/� n v% �� v ,��� rr %S Phone Number Owner's Address �T r- City/State/Zip Property Address —City— Lot ityLot Size Tax PIN#_ Subdivision Name(if applicable) Section/Lot# Directions To Site: Kv/ c, rd 5a/,5 d��� �c,r �0 n�hf 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 JVNo Does the site contain jurisdictional wetlands? ❑Yes j(No Are there any easements or right-of-ways on the site? ❑Yes ?)No Is the site subject to approval by another public agency? ❑Yes [ZNo Will wastewater other than domestic sewage be generated?❑Yes VNo IF RESIDENCE FILL OUT THE BOX BELOW # People 9 # Bedrooms — ( # Bathrooms s'Z Garden Tub/Whirlpool ❑Yes ONO Basement: ❑Yes /No Basement Plumbing: ❑Yes KNo 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; YConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water VNew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes V 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 respdnsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # ' �62 Z Revised 11/06 Invoice #n% (09t/) C� Co 7-.2 y Se h'c " Yl* -4 t { F Y, Liodsr Sev� G ssr �;c s•'fC ;f cap St `� gCG9rv�^,rj- �o SSP S Al k-1 of /iovsc �/ 6c�,•:.r% ,ase, � q A° I -t c/% TaP-?— o C'e4 cc r oy) f/ c2 S rt ons �� cce>'s� hov:,� s • �� . ,o or iso or� LI,,J 5 G R- qq 77 601 o�tsv,'/lt GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC -`GIS/Mapping System O�c Click Here To Start Over Quick Search: (County ID c Active Layer. rVj Use. Map Tres GIS PARCELS (Map Tips Available) 1= — - ----- — Map Layers I ResultsI 06 000003508 5.1 6AC HWY 6 1 v 273 I� 238,E 21600 I I 178. �2739_`` r r 12 e 249 U -- ** 31 20 383.fi3 `P 1 93 — 31.66 —MO 50-----3D4 i 227 143 «4128;*_ d 870} = 30 X26 32 ^'41360— ;- �ya_ 4148*, xogn C-161,)--474,31- ------- -161). ,474....31?;��+�, l a� h � V 536 X175-319.49 cr - rn w +'+ 4186; a 63 a 19r-500 4188 — s 92.31 a; N+ 4198&— N . 4208 Oo81ft, 4234 H A�� f 424©. http://maps.co.davie.nc.usIGoMapslmap/Index.cfm?maimnapservice=gomaps&CFID=41... 10/16/2007 GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC- GIS/Mapping System Ohmic s Click Here To Start over Quick Search: (County ID c �" tw Active Layer. F Else Map Tps FIs �0lt�4'IPARCELS (Map Tips Available) Map Layers I Results SMITH WILLIAM MATT EW 40N4, - 060000003401 15.600 AC HWY 601 S 238' 178,E 4106; I I. r 120,1 249 Oo$1ft 1431 4128,4 _ 41360- 4148a,_ 4208 ti 4234 f 4240. ! http://maps.co.davie.nc.usIGoMapslmap/Index.cfm?maimnapservice=gomaps&CFID=41... 10/16/2007 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page I of 1 Click Here To Start Over Quick Search: (County ID c Active Layer. W UseNap Tips GIs 0 E� 0 PARCELS (Map Tips Available) - 1 Map Layers I Results I http://maps.co.davie.nc.usIGoMapslmapllndex.cfin?mainmapservice=gomaps&CFIID=4l... 10/16/2007 s DAVIE COUNTY HEALTH DEPARTMENT •. "► ' Environmental Health Section Landscape position Soil/Site Evaluation APPLICANT INFORMATION Tax PIN/EH #: PRQQP TY INFORMATION 570_#=1Z= ccoun : 99000402 Billed To: Dan Schmucker Subdivision Info: Reference Name: Texture group Location/Address: US Highway 601 S-27028 ©- Proposed Facility: Residence . Property Size: 22 acres Date Evaluated: Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring ''- Pit Cut SITE CLASSIFICATION: P3 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Poston 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 NS - Non stickySS - Slightly sticky S - Sticky . VS -Very Sticky NP - Non plastic SP - Slightly plastic r 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 MinerajQgy 1:1, 2:1, Mixed N 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) M LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/05 (Revised) Landscape position HORIZON I DEPTH Texture group Consistence NRSMIAWMNME�... MIM HORIZON II DEPTH Texture group Consistence FEW= 9W_=rmaStructU ���® HORIZON III DEPTH Consistence ORIMMME .: ORWATM .�--- MEM"rte-z�®���� HORIZON IV• 'TH 7.0 w-®® T6xture group • Mineral • :SOWWETNESS RESTRICTIVE HORIZON— • • • ®s��s-®tee • �rr�s�r� • z��_® SITE CLASSIFICATION: P3 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Poston 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 NS - Non stickySS - Slightly sticky S - Sticky . VS -Very Sticky NP - Non plastic SP - Slightly plastic r 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 MinerajQgy 1:1, 2:1, Mixed N 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) M LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/05 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004462 Tax PIN/EH #: 5754-12-5924 Billed To: Dan Schmucker Subdivision Info: Address: 924 Mr. Henry Road Location/Address: US Highway 601 S-27028 City: Mocksville Property Size: 22 acres 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 Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: �2 ew ❑Repair ❑Expansion Permit Valid for:121fYears ❑No Expiration Residential Specificad6ns: # Bedrooms # Bathrooms Z # People R Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): - Type of Water Supply: ❑County/City,B'�lell ❑Community Well Site Modifications/Permit Conditions.: System Type LTAR Initial 0.3 Repair Site Plan 10:3-1 ~ _ T 'O L47L, \ 44co Environmental Health Specialist Date 1W07 i.rd 1 -06 Parcel #: 060000003402 Davie County, NC - Basic Estate Search . Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: 060000003402 Owner Information CHMUCKER DANIEL D& SCHMUCKER CLARA SUE 168 US HWY 601 S OCKSVILLE NC 27028 Property Information Land (Units/Type): 21.420 AC ddress: 4168 S US HWY 601 Account #: 82524951 I Tax Codes ADVLTAX - COUNTY T READVLTAX - FIRE TAX Township JERUSALEM Building: 227,83T Deed Information Local tonin Date: 11/2007 Book: 00735 Page: 0953 Plat Book: Page: 114,99C Market: 376,52C ssessed: Le al Description PIN 1.82 AC HWY 601 LOT 1 5754125924 Property Values Building: 227,83T BXF: 33,66C Land: 114,99C Market: 376,52C ssessed: 281,67C Deferred: 94,8501 Sales Information No. Book Page Month Year Instrument Qual/UnQuai Improved Price L 00120 0625 10 1983 WD Unqualified Vacant 0 > 00735 0953 11 2007 WD Qualified Vacant 115,000_ View Property Record for this Parcel View Map for this Parcel View Tax Bili Information « Return to Basic Search Page 1 of 1 0I, 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/itsnettView.aspx?prid=1467365 7/29/2016