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1413 Hwy 64E
�. ' ''�` • ..DAVIE COUNTY HEALTH DEPARTMENT . � �� �:#�f� . � P� 9� . Environmental Health Section ��,� � P.O.Boa 848/210 Hospital Street I � � Mocksville,NC 27028 � (336)751-8760 Account #: 990004133 Tax PIN/EH #: 5748-91-8998 " Billed To: Bradley Chilton Subdivision Info: Estate/Geneva Foster Lot#5 Reference Name: Location/Address: Hwy 64 East-27028 . Proposed Facility: Residence } Property Size: 5.242 ac. ATC Number: 4523 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 Sewa eatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW ION I AL D FOR RIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: 10 2l� � , � CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis 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 giiarantee that the system will function satisfactorily for any given period of time. 1� , � � _ . _ _ , � ' ` ! � �A � � . ra�I� � � r' ` ��°,�k�° �,' „ -�y- 1� � � � �� ,.�__ ., , Septic System Installed By: � �r ' ��� � Environmental Health Specialist's Signature: l. � � Date: ����/��' DCI-ID OS/99(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH . • ' �' P.O.Box 848/210 Hospital Street �d, ' Mocksville,NC 27028 ���� (336)751-8760 Fax#(336)751-8786 v'���� ' . Io1 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION . �i, f'�cco�nt #: 990004133 '��x PifV.%EH#: 5748-91-8998 � BiEled Ta: Bradley Chilton Sub�iivisinrt lnfo: Estate/Geneva Foster Lot#5 Re€'�rer�ce Rla��e: Lacationiac�c3r�ss: Hwy 64 East-27028 - f�roposed Fa�i€ity: Residence Pfo�ert�SizQ: 5.242 ac. J+ ATC Nut�tb�r: 4523 Site Type: 63Qew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the I?avie County Environmental ` Health Section prior to issuance of any building pernut(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,piat or the intended use change. • i Residential Specifications: #Bedrooms � #Bathrooms �� #People�Basement0 Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size •/l"1� a�rt� Type of Water Supply: ounty/City ❑Well ❑Community Well System Speci£cations: Design Wastewater Flow(GPD)�Tank Size �jOa�AL.Pump Tank�AL. / ., ^ � � Trench Width�(.o Max.Trench Depth ��r Rock Depth /d �Linear Ft. ��0 ', Site Modifications/Conditions/Other: Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. � c,�'�.� ✓' a w c� �v�✓' �`�`.� S �'"``'t' b �' �(`c�►.v�. �-� �.; 5 G o� d �l r i�1 � v'-' � �, �r('-} ,�,� s��, ��� d�r,r�� � G�'� P (M-C Nt \ � �� . . ��°�� � � P��c p u r/ .?�� , . , ` � R J � � � .� fl�� ��/ � � , r r _ /''N.� O � ,.. �(�Pf't ��'F. p �� / � , �,�,r. � i �..,.� ; ` � �� � �- �..'�./' —. —_ } . . Z r . / � � `JJ� �,`� _ - '. , _ � c�►Q. � Q�•,� � _ � ��-�k'�,f P�y�• o . � 6 � � 'r � f.r��`�'��C ��!`� Sad<- d � � � � w . Enviro en al Health Specialist Date: �� Q� DCHD 11/06(Revised) � ����s�� �o��' z. _ DAVIE COUNTY HEALTH DEPARTMENT ,Q� - - � ' ' Environmental Health Section ��"� _ �;y ., . , ` � P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 �� ,d� (336)751-87G0 � `���� 1 IMPROVEMENT/OPERATION PERMIT Account #: 990004133 Tax PIN/EH#: 5748-91-8998 � Billed To: Bradley Chilton Subdivision Info: Estate/Geneva Foster Lot#5 Reference Name: ' Location/Address: Hwy 64 East-27028 " Proposed Facility: Residence Property Size: 5.242 ac. ATC Number: 4523 **NOTE**This ImprovemendOperation 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 PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �'1�h�� #People � #Bedrooms W #Baths 2•5 Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement wlPlumbing: ❑ BaserrSentlNo Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size J.2'�./V�S Type Water Supply wELL Design Wastewater Flow(GPD)� Site: New� Repair❑ System Specifications: Tank Size 1�GAL. Pump Tank GAL. Trench Width� Rock Depth� Linear Ft.�� ocher: f�E� ��o �7t.�t9`S S�s'��N�,�'I�l��Ql�l�lOn1 ��Ct� Required Site Modifications/Conditions: �'N l�,J J � F-r�'o lu�, r�L �'J�o�r}� IN[PROVEMENT/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 ofthis system between 8:30�a.m�.to�30 a.m.or 1:00 p.m.to 1:30 p.mj.on�e day of i�llatio #is(33G)751-8760.**** � / �` �ao �)8� �� � �� � p� � �lo� �o�- . � �, � � ���� �t �I�hX 7��.+t� ��I �,� � ia'. �� ���� t� �� � Environmental Health S ' �st's Signature: Date d� 5' DCHD OS/99(Revised) � ��� � . ' � Davie County Health Department Environmental Health Section' P.O.'Box 848/210 Hospital Street 'I Mocksville,NC 27028 , (33�751=8760/Fax(336)751-8786, Improvement Permit Bradley Chilton 353 McCullough Road Mocksville;'NC 27028 Re: 5.242 Acre Tract/Highway 64E !I Tax PIN. 5748918998 � Dear Client(s): This Ixnprovement Pern-ut 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 or the intended use change. � System To Serve: �.�Wastewater Design Flow(GPD):�Valid:�'S Years ❑No Expiration System Type: ❑Conventional �cepted �Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions:�11�E�(���R� W�.�.� 100 —rt7r11 N�LI— Site Plan , �l� Q ' � � L1"�" � � �I - ��►��- �� � v �.�s��'"'" . a�, ,�o ` s ���� � � �� � ' -- a , ...._ I�b' � E ' e t 1 H a cia ' Date i.p.letter 7/06 ! .xy,;. -. ' � 'i y t' ' � � � ' � • - APPLICATION FOR SITE EVALUATION/IMPROVEMEN I�B�A�['� [� Davie County Health Department Environmental Health Section �I OCT - 5 20Q6 , P.O:Box 848/210`Hospital Street �� , ' Mocksville,NC 27028 ; Et�MMRONMEWTAI HEALTH , (336)751-8760/Fax (336)751=8786 :� pA� u�,�y Application For: � Site Evaluation/Improvement Permit B'Authorization To Construct(ATC) oth � ***IMPORTAN7***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 i Contact Person � � Billing Address Home Phone� City/State/ZIP�'f o�.(cs v�l���JG s,?a.i 8 Business Phone 3 6 `��-� S S 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. 'i , (Pemut is valid for 60 months with site plan,no expiration with co plete plat.) I Street Address �W U� l„�{ F�.a+ City � ' I Tax PIN#5`j y� Q/$'.q Q�P - Subdivision Name Section/Lot# S Lot Size 5. �.4�A�v-�s Directio�n�/s To Site: �-u�c.�, � �f �a��- �-�;��.s or.�.� '�� c.���+,.1:� .r�ro� r�-�, is tSh Th� ���-f' I'y-�r't7�,c: C' p���l�� 16Hn Cro �5 f�c� � and �✓V, !o S6 . � . , i Date House/Facility Corners�Flagged � ! If the answer to any of the following questions is"yes", upporting documentatio must be attached. Are there any existing wastewater systems on the site? ❑Yes �o �,, Does the site contain jurisdictional wetlands? ❑Yes o 'i Are there any easements or right-of-ways on the site? OYes '�, � Is the site subject to approval by another public agency? ❑Yes o �I • Will wastewater othet than domestic sewagebe generated? pYes �o I IF RESIDENCE FILL OUT THE BOX BELOW I' #People � #Bedrooms #Bathrooms o�� ! Garden Tub/Whirlpool es ❑No _ Basement: es ❑No Basement Plumbing: ❑Yes �o � IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBnsiness - 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 systemrequested: C�'Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water �Iew Well ❑Existing Well �� ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?I�,❑Yes I�'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 pernut(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 with applicable laws and rules on the above described property located in Davie County and owned by�}(��L . �-e s��' � �-v nnFv'/�u/<a��,c� �a�(o��o�. F. 3 ca.n-�- �5-��.e o-� G���c�'a S� �o_�� ' ., �� �.�ic.cL������ � I Site Revisit Charge Property o s or owner's legal representative signature Date(s): �� Client Notification Date: Dat EHS: Sign given ❑Yes ONo , I', Account# �3-3 Revised 2/Q6 I' Invoice# Page 1 of 1 . . . I -: �� - � ir � ;- _ �'�,, 1 ' � ' - �- i I `\''1, — � i � � �'' � '�, ''1� � ,, � ,iti � � � � �il� � � � � ! , ,. .�r,�t r::T� - -.i J�� . ��'4+�� �:� � �. � ';�T!%.�1"IU V"�Ci I'IC T.�':Q'R'.C.i���J ` _--. �!1 ±ry�,!.qIL' http://maps.co.davie.nc.us/outpuddavie_DCGISWEB3 3 882308912.png 10/4/2006 �� .� r ,-� . a �E°-w i �i " I�� i:. �. �. �, �. . � - .....--- ,��,� . ., . �+ . 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Billed To: Bradley Chilton ; , Subdivision Info: Estate/Geneva Foster Lot#5 � ..._. Reference Name: _ Location/Address: Hwy 64 East-27028 ' Proposed Facility: Residence . Property Size: . 5.242�aa Date Evaluated: O � � >. . , , , ,. •��, , , Water Supply: On-Site Well � Community Public Evaluation By: A,uger Boring ✓ Pit Cut FACTORS 1 2 3 4 : 5 6 7 ' ; Landsca e sition 'T j_,_, T . Slope % . , , �-1,2c, HORIZON I DEPTH � - Q O`_ ,D _ 1� ' p - C p p -� . Texture grou S �5�� S�L Consistence . . _ F: � '�S S -f' S , Structure �c cP., Mineralo .. ; _.: , So, , . , . , . _ HORIZON II DEPTH .3 Co_ �lc �p. •� Texture rou C S � ;Consistence �; ; 5 �` ' Structure � • � �r < �� _ Mineralo 5�- HORIZON III DEPTH , � l�-�}'Z '2p- � � _ � . Texture rou A G� G1� C�So , Consistence S- ; C ; S Structure . , �'_��IC " $ ,. Mineralo ' S-�'�c. I � £ , HORIZON IV DEPTH f 21- Texture rou 5 5a . � Consistence , ` Structure Mineralo ,� SOIL WETNESS ., "" ^ ^^ „" ' � RESTRICTIVE HORIZON '�, � '-4�2 'Z 2�-� — - SAPROLITE , . „�� ..,- ^ — _ ' CLASSIFICATION l S V LONG-TERM ACCEPTANCE RATE � 0.2L o.Z7 ,2y''� p,27 �, , - ; , � SITE CLASSIFICATION: � EVALUATION BY: � �C'�I-1�r� ., , , LONG-TERM ACCEPTANCE RATE: �'Z� ':- OTHER(S)PRESENT: ,, ': , j , xEMaiucs: �-�C ►w�-���'� �� �-F-�y,fl � n�'1�A�'3 ���N . , ' LEGEND , , ^. Landscaue 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 , , T�st�r� _ _ __ _. 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 lay SIC=Silty cla� C=Clay SC-San y c C'ONSI�TENCE . 11Zws� , VFR-Very friable FR=Friable FI-Firm VFI-Very firm EFI-Extremely firm 3�' t _. ' :. ' � NS=Non sticky SS-Slightly sticky S-Sticky VS -Very Sticky NP=Non plastic SP-Slightly plastic P-Plastic VP-Very plastic , . , �tructure ` ' . _ , SC-Single grain M-Massive CR-Crumb , GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic' • Mineralo�v , : •1:1,2:1,Mixed . •.. 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Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search � �View Pro�ertv Record for this Parcel View Ma�for thls Parcel View Tax Bill Informatfon Parcel#:J60000000208 Account#:82527125 . Owoer Information Tax Codes HILTON BRADLEIf D&CHILTON AMANDA P ADVLTAX-COUNTY T 53 MCCULLOUGH ROAD FIREADVLTAX-FIRE TAX MOCKSVILLE NC 27028 Pro e Information Townshi Land (Units/Type): 5.050 AC MOCKSVILLE ddress: 1413 E US HWY 64 Deed information Local Zonin ate: 30/2006 Book: 00685 Page: 0193 Plat Book: 0008 Pa e: 0391 Le al Descri tion PIN 5.242 AC BEANE B ETAI S DLOT 5 5748918998 Pro e Values uildin : 183 58 BXF: Land: 42 76 Market: 226 34 ssessed: 226 34 Deferred: Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved PNce 2004E 0314 12 2004 WL Unqualified Vacant 0 00685 0193 10 2006 WD uatified Vacant 57 000 View Pro�ertv Record for this Parcel View Ma�for this Parcel View Tax Bill Information « Return to Basic Search All information on this sfte is prepared for the inventory of real property found within Davie County. All data fs compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public informatlon sources should be consulted for verification of the information. All information contained herein was created for the Davle County's internal use. Davle County, its employees and agents make no warranty as to the correctness or accuracy of the informatfon set forth on this site whether express or implied, in fact or In law, including withput limitation the implied warrantfes of inerchantability 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/itsnetlView.aspx?prid=1457996 6/23/2016