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2495 Hwy 64W DAVIE COUNTY ENVIRONMENTAL HEALTH_ P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 990004431Tax.P[N!EH#: 5719-33-5440 Billed To: Fran Bassett Subdivision Info: Reference Name: Location!Address: 2495 Hwy 64 West-27028 Proposed Facility: Residence Ptaperty,&ize: 7.2 Acres - -� ATG4*gl**T§?9uance of this Operation Permit"shall indicatethe sy§tem 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. System Type:S.T.Manufacturer Tank Date 'Z Tank Size/600 Pump Tank Size /. System Installed By: �Q$ 6 tiE.H.Specialist: Date: GPS Coordinate: l - 3'xi0d Max-C" r$ V 1 1 d I r7a ejv DCHD 11/06(Revised) ` DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street l L� Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004431 Tax PIN/EH#: 5719-33-5440 Billed To: Fran Bassett ,Subdivision Info: Reference Name: LocationiAddress: 2495 Hwy 64 West-27028 Proposed Facility: Residence PE6perty;Bize: 7.2 Acres Site Type: $New ❑Repair ❑Expansion -ATC Number: 5848 **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 5 #Bathrooms 7 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size �. Zr~C Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) Tank Size GAL.Pump Tankw/i' GAL. Trench Width611 Max.Trench Depth3b Rock Depth Linear Ft.` Site Modifications/Conditions/Other: /cCGI G�Ci�� Contact the Da 'e County Environmental Health Section for final inspection of this system between :30—9:30a.m.on 4he day of installation. Telephone#(336)751-8760. r 'nJ Z-t-l2 �3 Drive l� �b X112 Environmental Health Specialist /h fen Date: DCHD 11%06( Revised) She woJd like APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC fi Davie County Environmental Health P.O.Box 848/210 Hospital Street 7� 0 Mocksville,NC 27028 Ike9✓ (336)753-6780/Fax(336)751-8786 n1 1 (� q l ppl1ca i' SLaluation/Improvement Permit ✓A thorization To Construct(ATC) of Application: Repair to Existing System Expansion/Modification of Existing System or Facility g�� t • THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED ff1� ' NFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed F2An1 CES MASS E -T- Contact Person Billing Address Pa 1P 10X S q Home Phone 33(o qo7—0(0-1 City/State/ZIP A t-t-15tt0-6 C- 2'1373 Business Phone 3:5&-3&q-24gZ7 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION "Date House/Facility Comers Flagged ' NOTE: I A survey plat or site plan must accompany this application. Included: Site Plan Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name N LtS 6 6-SS CT'T Phone 33(p- 4-07_0 4P7 S Number Owner's Address 00City/State/ amu-1311126 AIC, Zip Z73'13 Property -rnTIO "-I> —7,+I15 HWY &q W Address City MOM-SVI l_(L Lot Size .Z Tax PIN# — Subdivision Name(if applicable) Section/Lot# 1 PA) �N '�n(, Directions To Site: T 40— t:J*�i+ 1(0 5— on "I'jy 4q �j — 10 Z. 1", S —C e're� rt � � N t'f Oil 0-A �E s'-dj/ 4v A road —" ,D j DM1- Ci 0Yt (0 w V lvy „-� 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 o Does the site contain jurisdictional wetlands? Yes o Are there any easements or right-of-ways on the site? es No Is the site subject to approval by another public agency? Yes o Will wastewater other than domestic sewage be generated? Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People 1 #Bedrooms #Bathrooms 2 Garden Tub/Whirlpool ft No Basement: Yes Basement Plumbing: Yes o LwttT".L 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: ConventionalAccepted Innovative Alternative Other Water Supply Type: County/CieyWater New Well Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes No If yes,what type? Sign given Yes No Account# Revised 11106 Invoice# 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 responsible for the proper identification and labeling of property lines and comers and • locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. �f � Site Revisit Charge Property owner's or owner's legal representative signature Date(s): f/-180— /? Client Notification Date: Date EHS: Sign given Yes No Account# Revised 11/06 Invoice# i i �� i � �' � � � � � / 1�1- pl \Zy, � �. �� _�, � � . �- .I � � i� I� �Q �, �P� � � , . off, � � _ � � � � _ "' oQ ` i •� ��` ��' � ' ' Davie County Environmental Health P.O.Box 848/210 Hospital Street MocksAlle,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account M 990004431 Tax PIN/EH#: 5715-32-2267 Billed To: Fran Bassett Subdivision Info: Address: PO Box 6762 Location/Address: Hwy 64 West-27028 City: Statesville Property Size: 7.18 Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization 7b 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: ew ❑Repair ❑Expansion Permit Valid for:Xyears ❑No Expiration Residential Specifications: #Bedrooms 3 #Bathrooms 2 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Apo Type of Water Supply:,K6ounty/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions: Systek Type LTAR e air LO�J�/r�•l7 U. Site Plan • j 1 tits Or ,ti / . J15d Eb6wlar� / 2.So' Environmental Health Specialist Date i.p.11-06 FH � CCDbC 2607-08„2!« 09:.11 » 3367513931 P 2/3 AUG 2 4 2UO1 _ APPLYCON � VALUA' . z10NAMPROVEMEW PERMIT & ATC tol vee "rontnentitl.tdcaltlx P.O.-Bok 848/2101 iospitai.Street Mbcksvilltr NC 2:7628 (336)1$147661-Fax-(3S6)75-1L:8786 Application For: 13Site Evaluation/Improvement Permit b Authorization To Construct(ATC) Both Type of Application: i(New System []Repair to Existing Systcun nExpanslowModifteation.of Existing System or Facility T'`**jMPDX7AN1*mv THIS APPLICATION CANNO7TBEPROCESSED UNLESS ALT.OF THE REQUIRED INFORMATION IS PROVIDED. Rofer to the INFORMATION BULLETIIV for instructions. APPLICANT INFORMATIOtN Name to be Billed Contact Person 514M6 Billing Address P 0 F3 p T 2. Horne Phone 33(e - D 7-Ne a City/State/ZIP STA NC, 2-1� 7 BusinessPhone_7Dtj- b_/- 2D32 _ 5 Name on Permit/ATC if Different than Above $A ME Mailing Address City/StatcJZip__. PROPERTY 1NFORMATION *Date House/Facility Corners Flagged__ -0�1 NOTE: A survey plat r►.r gite plan must accompany this application. Ineludcd: ❑Sitc Plan OPlat(to scale) (Pcrnut is id for 60 months sitc plan,no expiration with complete plat.) _ Owner's Name ��tP _Z_-e Phone Nutnber MLg,�5'S�3 L-3 Owner's Address Vo.o G¢W?, )NNjy City/StawZip - CS-L” Ij-C, '12CA Property Address_ 1-1 w C,-( Ci Lot Size_,, K At R1r,S Tax PIN# (,t Subdivision Name(if applicable)5v1, c71oy4o-� o:z 1, < S ection/Lot# �. _ Directions To-Site: 1�w� l�.`{ lu f✓�-� pr�so�r �. �N lr -� �,(A,( If the answer to any of the following questions is"ycs",supporting documentation must be attached. Are there any existing wastewater systems on the site? Dyes 19i4 Does the site contiin jurisdictional wetlands? nYes�'f•To Are thers any easements or right-0f--ways on the site? I?Yes[]No Is the site subject to approval by another public agmuy? UYes EKo Will wastewater oilier than domestic sewage be.generated? DYcs i IF RESIDENCE FILL OUT THE BOX BELOW (#People I #Bedrooms _.3 #Bathroorris__• 2- Garden Tub/Whirlpool &Yes ❑No Basement: ❑Yes WNo Basement Plumbing: UYcs 9% •. IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footagc of Building•- _#People #•Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICU ONLY: #Seats Type system requested, li.onventional ❑Accepted ❑Innovative ❑Alternative u0ther._..-_ i Water Supply Type: C(County/City Water ❑Now Well ❑Existing Well C Conununity Well Do you antieipato additions or expansions of the facility this system is intended to serve? Ll Yes VNo If yes,what typo? _... _ TF+ie is f+, •rrfifv that thn infnrn+�tir,+,nri,o:And.....t•:........f:...s-- -- _-. DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation. APPLICANT INFORMATION PR pE�,tT]LINFORMATION Account 14431 Tax PIN/EH#: 573Z-Lz Billed To: Fran Bassett Subdivision Info: Reference Name: Location/Address: Hwy 64 West-27028 Proposed Facility: Residence Property Size: 7.18 Date Evaluated: qII Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position i.. Slope% 20 1 HORIZON I DEPTH Z v- 0-9-0 Texture group C Consistence Structure Mineralogy - HORIZON II DEPTH -LAD ' o. Texture group fi • . Consistence Structure; Mineralogy HORIZON III DEPTH + Texture group Consistence Structure Mineralogy HORIZON IV DEPTH ' Texture,group Consistence Structure Mineralogy SOIL WETNESS -- f RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O 27 SITE CLASSIFICATION: �S ^ EVALUATION BY: �'"` LONG-TERM ACCEPTANCE RATE: d OTHER(S)PRESENT: 1 . REMARKS: LEGEND Landscape Position R-Ridge S -Shoulder L-Linear slope FS-Foot slope N-Nose slope CG 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 M&I 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 S 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 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DAVIE Box ENVIRONMENTAL MEN ALHEALTH RECEIVED 84 H Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 DEC 19 2011 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION � �t91<IS•et� Account #: 990004431 TO Pl*EH#.• 5719-33-5440 0 • 8410d To: Fran Bassett i 5ubdIvision:Info: Rrfrieuvu Nome: tocadon/Aaaress: z4au Hwy m west-2IQd' Proposed Facil* Residence Pft6rty;S1ze, 7.2 Acres' Site Type: $New ORepair ❑Expansion -ATC Number: 5848 ... -: '*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. w*Qte%�2+ez 4,st=s,Section.1900 Sewage Treatment and Disposal Systems). TIES AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FM YEARS. This ATC is subject to revocation if site plans,plat —- •erllxvbtended:use change. Residential Specifications: #Bedrooms• #Bathrooms .2, #People BasementO Basement plumbing0 Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size"?.ZGC Type of water Supply: OCounty/City•OWell OCommunity Well System Specifications: . Design Wastewater Flow(GPD)3�0 Tank Sim=GAL.Primp Tank Ad GAL. Trench Width 31L Max.Trench Depth 36x Rock Depth Linear Ft mOr� Site Modifications/Conditions/Other: Contact the Da 'e County Environmental Health Section for final inspection of this system between :30—9:302.m.on�.ifhe day of installation. Telephone#(336)751-8760. 2�1 �2 Environmental Health Specialist Date: 2 "20 DCHD 11106(Revised) Parcel#: H2O000003803 Page 1 of 1 oP.7r� Davie County, NC - Basic Estate Search 1-OUK�! - Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#: H2O000003803 Account#:82528885 Owner Information Tax Codes BASSETT FRANCES C ADVLTAX-COUNTY T O BOX 84 FIREADVLTAX-FIRE TAX ALLBURG NC 27373 Property Information Township nd(Units/Type): 6.870 AC CALAHALN ddress: 2495 W US HWY 64 Deed Information Local Zoning Pate: 11/2007 Book: 00735 Page: 0437 Plat Book: 0009 Page: 182 Legal Description PIN LOT 1 7.181AC SHORE S D 5719335440 Property Values ulidin : 10,61 BXF: 84 nd• 54 93 01 arket• 6638 ssessed• 6638 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00735 0437 11 2007 WD Qualified Improved 65,000 View Property Record for this Parcel View Map 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/itsnetfView.aspx?prid=1018457 6/30/2016