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1810 Hwy 64E , :� DAVIE COUNTY�NVIRONMENTAL HEALTH ^ � P.O.Bpx 848/210 Hospital Street ��j � « Mocksville,NC 27028 (336)751-876Q Fax#(336)751-8786 3l��6� OPERATION PERMIT , Account #: 990001662 Tax PIN/EH#: 5757-49-4013 . Billed To: Linda Dillingham Subdivision Infa Referenee Name: Location/Address: 1810 US Hgihway 64 E-27028 � � Proposed Facility: Residence Property Size: 1.2 acres ATC Number: 4601 **NOTE**The issuance of this Operation Pemut sball indicate the system described on the ATC has been installed in compliance wit11 Article 11 of G.S.Chapter 130A, $ecrion.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:l,D D� S.T.Manufacturer �io� Tank Date ��"��-� Tank Size l,d C� Pump Tank Size��;r�i� G z.-1-�1-��S J.�'a-'�' . . System Installed By:��R,__nt D ccP� .e S E.H. Specialist: o ,ns Date: � ' �- l � d'7 � rl`f'�'`-ta' w/�I i�a �S � ' � �ih f _ �, (p� �� U���� : , � �� , �,a, ti.� � �t � � �yy � _ (� p� � � w � I� �� n r � s . � - J��' \ � r V `� `� � . � D— - �� ,��� s��t � �o ���°�-7 � � (� f S ' � ('�'iy1 �1z�� �a� � h , • . .D�d P �o�-�s � �' . � ' ' , ' 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 #: 990001662 Tax PIN/EH#: 5757-49-4013 . Billed To: Linda Dillingham Subdivision Info: Reference Name: Location/Address: 1810 US Hgihway 64 E-27028 Proposed Facility: Residence Property Size: 1.2 acres ATC Number: 4601 Site Type: ❑New ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MLTST 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 � #People � Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats , Square Footage(or Dimensions of Facility) Lot Size .7. �t e S � Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)34¢B ' ;Tank Size�GAL.Pump Tank f�QQOGAL. Trench Width 3�� Max.Trench Depth 34`� Rock Depth 1'�-� Linear Ft. �40 �c��.�.ti. Site Modificarions/Conditions/Other: �,c ,� F �d . � .� r�cce�ted Syste,�is mav al�o�bcs use 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. Gy f I ( r � � x �� � I �, � � s � � �h� I I � I I Ja a d � P� ��� ,� � �, �o lo(o,o Q o , �,Y-�i-�l, _ � ,��,t w x (w °'. �`i � � 3 � �'�u,� i� � _ P i � � � .� � � � � � ,�.� s , '� �a'�' r � . �,, �Puc �".� � �r� � 1 ' - � ; r ��� Q,....N, �...�d.i v, �'�I�.e�aw� -��. r.�2v� �� pyb��v�'�Y or. (�d �� .(�ls� cl�o�O P � B��s. Lti�;.�5 0�. co�1��-� /'2,-�-�-e- e � 4 c � 6 ��_0 Environmental Health Specialist Date: � DCHD 11/06(Revised) '� .y .. ,.a � � ' I 1�i��I� R SITE EVALUATION/IMPROVEMENT PERMIT & ATC _' y, �. ' ��� Davie County Environmental Health � �,p01 F�� 1 9 P.O.Box 848/210 Hospital Street ' Mocksville,NC 27028 •t �ON�EC�p�N��_,,,.�.�"'� (336)751-8760/Fax(33�751'=8786 , Q� � �,G��1��.� "' plication F ite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both � T 'pplication: G�iQew System ❑Repair to Existing System ❑Expansion/Modification of Existing System 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 ��`�� b�s%/�'„U�� n,•. Contact Person_�,'„�A ,/��//:r.G/1�h,. Billing Address ,�`'�d O �Yl�► I �w�. �P Home Phone_ ���- ��.�- 4 �/a City/State/ZIP i:o r r:�//� /�,(►. Z.�f6 �.'_ Business Phone =S� E - S 7 S-2/n/ � Name on Permit/ATC if Different than Above Mailing Address � City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan OPlat(to scale) (Permit i§valid for 60 months with site plan,no expiration with complete plat.) Owner's Name f�o,r�nN.� �1.�:td A ��ll;,.����,�.�-r . Phone Number 3�C •-S��,S"• �/o/ Owner's Address_��p�s ;� ; � ( f��,�, f2�', City/State/Zip__j�,y�t�,� r/,�. 2..�e ,�Z Property Address G� City�,- � . '�Z r, �.�,- Lot Size /. a i91�, Tax PIN# J 7 � Subdivision Name(if applicable) Section/Lot# Directions To Site: G S�L�'" t S' � . Un ` � ...�'� � )_ , / If the a er to any of� e following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes ❑No Does the site contain jurisdicrional wetlands? OYes ❑No . Are there any easements or right-of-ways on the site? OYes ❑No � Is the site subject to approval by another public agency? OYes ❑No Will wastewater ofliei than domestic sewage be generated? ❑Yes ❑No IF RESIDENCE FILL OUT THE BOX BELOW � #People � #Bedrooms _� #Bathrooms /� Garden Tub/Whirlpool ❑Yes X�o - Basement: ❑Yes f�o Basement Plumbing: OYes C�o IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness 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 OAlternative ❑Other Water Supply Type: �'County/City Water ❑New Well OExisting Well ❑ Community•Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes fc�Pdo 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 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 responsible for the proper identification and labeling of properiy lines and corners and locating and flagging or staking the house/faeility location,proposed well location and the location of any other amenities. ��r�,-' �•�`�-�'`���" Site Revisit Charge �erty owner's or owner's gal representative signature Date(s): a .,y_p � � Client Notification Date: Date • EHS: �, � ,� \ Sign given ❑Yes �No Account# Revised 11/06 Invoice# –���— . . � �� _ _� : �a �o . - � � x ��K� ��� � �� �.��i �Z .�TS �`�' � �; �� �, �� , . ; ,. � �" E o. �� � w _� � ��„s � � :F , . '�.a ,_ _<'y�"—+a*s , �' � .� z. �a 1� � °," —a.cD `. _ " �� � °` N .p � •� � - �` . . +�� "ae�"'. � �z��`� � �.e�. �v� r +� �ti '���'9as.� � : �� � :.,��� � �� �""� � '6 = y�'�� . s���� � � � �q8�� .. .° �j � � �i ¢ ,�'� � t�° r Y4'�# 3 1_1 �- � a. 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" y�s`�,s`r�,M1x� �' s�� � 3'�.��d. ��i+a�"Y� �,j�si�� ���� � � e � � w. � s�¢ . .� °�.'" , ��, "� a ��ia ,w�a � � ��o , �h � � � � �� � a � �.. ��� � , , � �dm ��� � � ��'e,,r�rc:�q°a,. . . . � ��` �, ,�� 7,�`�,����.� ��.a �„• ;q� � ��� ..�� .�a�"a� :" � . ., � n." �aa � �'o � * ��.�m��� �,° �rr � ' �`� ""���^� a � � �i � �' � � �` s '" SP> w� ,�aa� � ^:� .e.,-..z�� 'I�"��,,..i �a'�`� � _ _ —_J � DAVIE COUNTY HEALTH DEPARTMENT '- � Environmental Health Section . , a Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001662 Tax PIN/EH#: 5757494013 Billed To: Linda Dillingham Subdivision Info: Reference Name: Location/Address: 1810 US Hgihway 64 E-27028 - Proposed Facility: Residence Property Size: 1.2 acres Date Evaluated: `3— a� — O � Water Supply: On-Site Well Community Public �-� Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 . 3 4 5 6 7 Landsca e sition • �. L L G G � Slo % ( �j _3 HORIZON I DEPTH G — � �� Texture rou C C_ ri- Consistence � � Structure � ,� Mineralo I� �'/ i� ( HORIZON II DEPTH - �— Texture rou Consistence �� Structure k Mineralo �" HORIZON III DEPTH ` Texture rou Consistence Structure ' Mineralo HORIZON IV DEPTH � Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRIGTIVE HORIZON � SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . Q O• G. SITE CLASSIFICATION: r v � - �.�.`�.I� L.�,o EVALUATION BY: �.b�� 11-3 v� `� LONG-TERM ACCEPTANCE RATE:_�• � � O ER(S)PRESENT: REMARKS: �G��. � 1L e�., p-� , LEGEND � I, n c aFe Position R-Ridge S -Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace FP-Flood plain H-Head slope Text� . . 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 a'IQ1S� 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 Stt�ist�i�� SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angulaz blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�v , 1:1,2:1,Mixed ` lY� . 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/ft2 , DCHD OS/OS(Revised) _ _ _ _ ■■��■���■■�■■��■�■�■�������■s■�■■�■■■���■■■�■�■��■��■�■■�■�����■�■ ■�■�■�■�■■���■��■���■���■■■■�■���s�■����e��■�■■�■����■����������■ ■■■■�■���■■�s��e��■�■�■�■■��s�■■ ■■���■■��■�■�■���■�■■�����■■��■■ ■���■����■��■���■�■�■■�■�■��■�■������■�■�����■�����■�����■�■■��■■■ ■■��■��■���■■■■■■■■■�■�■��■■��■■����■■■�■o���■�■�o�■��■■�■��e����■ ■�����s■■■e■�■s��a�������■■��■■■�■�������■�����■■■���a�������■�■�■ ■���■�■��■�������■��■�■■■■■■�■��■�■����■■��■��■■���■■■��■�����■�■■ ■■■■�■■�■■■t�■����■■����■��■�■�■�■�s�■�■�■�■���■���■�����■■■■��■�■ 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■�����■��■�■���■�■■��■�■���■���■��■■■�����■■���■�����■�■e�■���■�■ ■■■���■■���■��■�■��■■�■�����■�■■ ■��■��■������■�■��■��■�■�■�■■■�■ ■�■�■■��■�■■�■■■■■�■■■■�■■��■■��■��■��■�■���■���■�■■■�■■�■������■■ ■���■���■�■�����■■����■■�■■����■�■��■�■������■����■���■�■�����o■�■ , � � � Davie County Environmental Health , . � " P.O.Box 848/210 Hospital`Street Mocksville,NC 27028 ' (336)751=8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990001662 Tax PIN/EH#: 5757-49-4013 Billed To: Linda Dillingham Subdivision Info: ' Address: 3900 Mill Run Road Location/Address: 1810 US Hgihway 64 E-27028 ' City: Terrell Property Size: 1.2 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: ❑New �Repair ❑Expansion Pemut Valid for: �5 Years ❑No Expiration Residential Specifications: #Bedrooxns .3 #Bathrooms � #People `f Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): .3 G 6 Type of Water Supply: C�County/City ❑Well ❑Community Well Site Modifications/Pernut Conditions: S stem T e LTAR Initial ��,0 Re air �4.�. p• 3 Site Plan (�7 —o � � -6 � S � y b � � 0 � _ j � � � ���/ � , i N. (� � .Y e � � _ r � J _�,l ��I . Y� f ' � F � � �a � K(�G � N ( Environmental Health Specialist ' Date � —02 � � � i.p.l l-06 Parcel#:J600000089 Page 1 of 1 v��f� Davie County, NC - Basic Estate Search �ov��.� Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search � View Pro�ertv Record for this Parcel View Ma�for this Parcel View Tax Bill Information . Parcei#:J600000089 Account#:21182000 • Owner Information Tax Codes ILLINGHAM NORMAN&DILLINGHAM LINDA ADVLTAX-COUNTY T 900 MILL RUN ROAD FTREADVLTAX-FIRE 7AX ERRELL NC 28682 Pro e Information Townshi nd(Units/Type): 1.100 AC MOCKSVILLE ddress: 1810 E US HWY 64 Deed Information Local Zonin ate: 03/1999 Book: 00210 Page: 0286 Plat Book: 0002 Pa e: 009 Le al Descri tion PIN LOTS 21-24+48 JAMES 5757494013 Pro e Values uildin : 39 83 BXF: 65 nd: 17 91 arket• 58 39 ssessed: 58 39 eferred� Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00054 0595 04 1954 WD Unqualffled Vacant 0 00158 0692 04 1991 NW Unqualified Vacant 0 00230 0286 03 1999 WD Unqualified Improved 15,500 00145 0124 09 1988 WD ualified Im roved 20 000 View Prooertv Record for this Parcel Vfew Mao for this Parcel Vfew Tax Bfll 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, piats, 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. Ddvie 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 iaw, includfng without Ifmitation the implied warranties of inerchantabiUty 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. 1.5A http://maps.daviecountync.gov/itsneWiew.aspx?prid=1469370 6/23/2016