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2078 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003936 Tax PIN/EH #: 5842-88-9833 Billed To: Stan Carter Subdivision Info: Reference Name: Location/Address: 2078 NC Highway 801 N.-27028 ATC Number: 4368 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date:'/6� �o CERTIFICATE OF COMPLETION **NOTE** The issuance of this 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 guarantee that the system will function satisfactorily for any iven Swy" Ua (UP C on c r+� < Or's f dcv g Period of time. /OCO -s t B 74 -74 t i y'-0y`w Septic System Installed By: �� �'� a je Environmental Health Specialist's Signature: _41— �� 'vate: t" DCHD 05/99 (Revised) l.0r Account #: 990003936 Billed To: Stan Carter Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5842-88-9833 2078 NC Highway 801 N.-27028 350 Acres * *NOTE * T kris improvemeent/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 A #People #Bedrooms #Baths oCooe✓<<� Dishwasher: d Garbage Disposal: ❑ Washing Machine: 0"� Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size -3O 4C Type Water Supply Design Wastewater Flow (GPD) &Vo Site: New Repair ❑ System Specifications: Tank Sizq," GAL. Pump Tank GAL. Trench Width �� Rock Depth 'ZLinear Ft.'49eJ Other: t f3lr/ Required Site Modifications/Conditions: d�Gt �/ �ff h 4Gii! (/e- 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. t on the'day of install 'on 2:a1ephnne # is (336)751-8760.**** En vironmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) rNFOkMATION davle county envheelth 330 761 6706 P•e TION FOP. SITE EVALUAT(ON.AMPROVEMENtPER-MIT & ATC Davie County Health Itepartttlent Environmental Health section Y.O. Box 8410210 Uosp tat Street MotksvlUN NC 24028 (326)751-8760/ Fax (2341) 731-8796 LvatroautirtA. tptovenxnt Yennit L; Authoriration'fo Construe(ATC) U Bah TA1S AFPL1(•ATION CI19VOT dEPROGB.P.fED UNLESS ALL OF T:(£ mgU'iliCD N IOVIDW i .6'01 10 the INFOILMATIO'h nUL1.I:'rrN for inamucoaa. APPUCANT INFORMATION Vtme m be Billet! S h0 ✓ _[tg�� (.Intact Person �Sf—� CGI?2q� _ - Biding Addressilio Y `s'—[ `iltome Phone City!StatelL1p.Ar/CAnri.�_1!'4,2.2aAAL--..._.. 8t•sinutPhotte ' Vame on Permit/.i1'C if neora.•t i aan.%bovc ov �Mailitnt Address PROPERTY INIFORMATMN NOPE: A iunay Irtal w dee play r.�u•t see: mpany ibis applieattoa. (Fcrrri: it valid for 60 awar is with site plan, no expirittioa s StretxAtldrees_,�D7t fy1.._r14006M-,� f-1ry Subdivision Name Semon%Lt ptat.)5SO, -og Directions To Sur: y[ L' S�_�- --ll,+ Beet, bC—.�-�-_ . _—_.._..__... ,.. �.-....-- •-• --- ----- batt!{oust'Fa¢ilityt:arraeraYlaAaei����—���� - It the answer to any of d w followin8.1w mons ►s'jros", supportkg docu"wipion must be snecbe,l. I An theme any tr tmftt trattewa'er tpttetm on the sitc7 0Ye: W40 i goes the aIte ;Unum Jurisdi.a )rul wetlands? :JYel jlNo f{ Are then any cesamrw or rill Pof-ways :+n the site? r.Ye : dtNa Is the sue "act to approval t.,, smother public agency? G Ya • CtTo • Witlwgtewslterorasshan.toeeaicwtva ebe utcr•tedT GYr �Vo Of R"IDENCE 17ILL OUT ME BOX BELOW 4A People _ _ a gdWramu M'� tti B.tltruoma _,� t]vdea lubJWlti-:poo: OYes AM lI Bacernent.OYet JCNO Bast:nomPlumbin GYet RNo IF NON-R£SIDHyCE FILL O1 n THR UOX BELOW Type of Pacil:ryiliutineas� _—• —_7041 Square Foo(n.le of Building_ _ it People...— Sinks eople•,Sinks _ al Ctsrr=wdcrl _ N Showers k Urinals — Estimated Water (!Uje (pJlons per -Jay) ,_(Attach documentation of similar facility water cirnsumrptior) FOODSER VICE OINLI' X Seats --_ _-- - '1'ypasyetomregttatcd. j.ConventionA •71Accepted Olnnovative -!Ahem!atw CtOther — Water Su Wlyrypo: /(CaantyrChy Wms,:r C Now Well Welt C ca."munity *al; Lo you antleipate sdditiooa w axpansmre : of tba facility otta system is intends I to 9crvc7 J Yes JENu If yes, what type t _ - _ TSia is to certify that the infottaanoa pro-dded on this application is out and c nreot soft beat of rtty knowledge. 1 undenland that any permit(') or ATC!t) issued live0tr zee subJact to suspemlon or ttvocatia a if thetitr. is ahead. itc intended use e`ungcs. or if the mfoinmtion subtnined in this opplisu on is falsified or chmacd I wndoa! and SAN I ane re+ppa.r;ble for all rhaysar Incurred hoot rAir opplkonae. i hereby grant rgt t efcntry to the Authorized Repmaetutive of the Davie County Health Denattnunt to conduct rtxeuary ingteettottt w telt a tluna with applicable taws a td ruka on the sbove dvicribcd property located in Davie Cuunty and owned by _ _��Sd�.fi1�.. —___—• r _ ;zee Revisit clu, �-j7YI4rter'spr o+eery tcgat reprep ttOOve sigtuture D TO 3E)gd 831660 NNIS GEOZ666 i0:81 GOOZ/9T/60 (: Win Notittratloa Darr: EHS:.to I _..—.. signgivcn 0Ycst7Nu Revised 2/06 Aiccum# 0 io. htvoice a TO 3E)gd 831660 NNIS GEOZ666 i0:81 GOOZ/9T/60 O ( ATION FOR SITE EVALUATION/lAIPROVEIIENT PERMIT & ATC Davie County Health Department EnvironmentaiRea/t/i Section q .� P.O. Box 848/210 Hospital Street( G ��Lt' Mocksville, NC 27028 c ,/z1 5. U_� 1. Name to be Billed Mailing Address (336) 751-8760 wo 5APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �l// �. �t7 Contact Person 55r7— �+ �H �r�1� ' /(/4///N �` l / 26 Home Phone 3,06 �qj `ICP'6 z- City/State/ZIP _ t/ 0--k'V1 C, yWAM Business Phone __5J / 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application. For: &-Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: b -House ❑ Mobile home ❑ Business ❑ Industry ❑ Other Type uyntem requested: is Conventional ❑ conventional modified ❑ innovative p ac Cep to d If itesidence: #People_ #Bedrooms_ #Bathrooms ❑Dishwasher ❑Garbage Disposal bee-,hing Machine If Business/Industry /other: verify type S. 6. 7. ❑Basement/Plumbing ❑Basement/No Plumbing # People # Sinks # Commodos # Showers # Urinals # Water Coolers IF FOODSERVICE: i#�Seats Estimated Water Usage (gallons per day) 8. Type of water supply: 1d" County/City ❑ Well ❑ Commul ity 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ yes 044 If ycs, khat type? ***L111'0RTAN7"*** CLIENTS AfUSTCOAfPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLA'r or SITE PLAN AfUST BESUBAfITTED by the client with THIS APPLICATipN. 22 7 Property Dimensions: /?CeC6— WRITE DIRECTIONS (from Nlodwille to PROPERTY:_ rr,�/ L� Tax Office VIN: L"S 5InA AN 2h, Properly Address: Road Name City/Zip J4 w' I m a Subdivision provide information, as follows: $� Pholve mil to liq Name: Section: Block: Lot: Date home corners flagged: G 2 7 — J 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. I, also, understand that I anu responsible for all char es Inncurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Ileallh D partment to enter upon above described property located in.Davic County and owned by e kh to conduct all testing procedures as necessary to determine the site suitability. DATE I !✓ 30 y SIGNATURE THIS AREA NIAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge DatF(s): Client Notification Date: EI -IS: y \1 511.'11 given ACCOuIlt NO. D &5-? Revised DCl.b (05/03 Invoice No. 5oZ 7 tl tl e \ J €1 \ to i lob � / � 1 i I r 4 APPLICANT INFORMATION Account #: 990000858 Billed To: Bert Bahnson Reference Name: Proposed Facility: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5842-88933` Subdivision Info: 9833 Location/Address: 2078 NC Highway 801 N-27028 Property Size: 350 Acres Date Evaluated: / -If _W Water Supply: On -Site Well Community Evaluation By: Auger Boring �� Pit Public l� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH �, �'r�• Texture group - G G Consistence ' r r✓ Structure Mineralogy HORIZON II DEPTH Texture group Consistence T, Structure Mineralogy HORIZON III DEPTH ` Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure' Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION:y —� �h P oU ' ✓ �! EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ' OTHER(S) PRESENT: RE MARKS: 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 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 1l�ist ; 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 Structure 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 DCHD 05105 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ SOMME NEON ■■■ONE ■■■■e■■■■■■■■■■■■el0Wl_ ": F.Ilie■■■■"FARINI mom ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■:EW■■■■■■■■■■■■■e.OWICHIlm■na UsIfUlArA nommoii iiiiNNEN iiiiiiiiiiiil iiiiiii ieiiiiiiiiiiiiiiii ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 January 19, 2006 Bert Bahnson 580 Yadkin Valley Road Advance, NC 27006 Re: Tax Pin. #5842-88-9833 2078 NC HWY 801 North Dear Mr. Bahnson: As requested, a representative from our office visited the aforementioned site on - January 18, 2006. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, it was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel, free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RBH/bml Pi ss 6jt`' ptni� Tax Map: 51K1 SrS� `1 y33 Address: / If sS- tS/a. y T Installer: EHS: Date: 41:1 - iD 7 Operation Permit Inspection Checklist Location and Separation Distances 1. Distance from septic tank/pump tank to foundation/basement 19L,feet 2. Distance from system to well if applicable feet 3. Any other setback (.1950) requirements Supply line 1. Material supply line is constructed of 564 Ko AUC diameter y' /� inches 2. Length of supply line (2' min.) g" yoyl,._ U 3. Amount of fall in supply line (1/8" per foot min) 4. Distance from ST/PT to the nitrification field/dist. device) b'3=feet To 0 A -e5 Septic Tank/Pump Tank 1. Visually inspect top of tanks(s), interior & exterior walls, baffle wand bottom V 2. Any honeycombing or exposed rebar present? Circle: YES or O / 3. Visually inspect sanitary tee, lids, and air vent for proper installation and sealant 4. Tank Serial Numbers: STB -766 PT 5. ST w/in 6" finished grade? Circle: (M or NO 6. Date of manufacture: ST - - /4- O G PT 7. Liquid capacity of tanks ST /i o 00 PT 8. Effluent filter type 16,/kc /C Y V 9. Pipe penetration seal present? Circle: YES or NO 10. Riser(s) present? Circle: YES or No Riser Type 11. Pump Tank riser 6" above finished grade? Circle: YES or NO 12. Riser approved? Circle: YES or NO Nitrification Field 1. Septic Tank outlet elevation 2. Trench Depth Readings (inches) (c" -r a I ?, `` 3. Number of Trenches 91 Distance between trenches 4. Trench Width 3' 5. Aggregate material type and size 3 4 5 6 57 (Circle) 6. Aggregate Depth (inches) / 1 7. Nitrification lines installed on contour? Circle: or NO 8. Innovative system type Instal er certified for installation? Circle: YES or NO 9. 2' earthen dam between ST (or d -box) and beginning of nitrification line? Circle: YES or NO 10. Stepdowns a. 2' undisturbed earthen dam(s) Circle: YES or NO b. Proper rise over stepdowns? Circle: YES or NO c. Solid pipe used? Solid, Corrugated or other? d. Elevation of each stepdown e. Are all stepdowns lower than the ST outlet elevations? Circle: YES or NO Distribution Devices 1. Type fi e Is the device waterti1/1"_ Is it level?_� 2. Distance from Dist. aevice to trenches ;k. 5 feet 3. Record elevations: Inlets Outlets Parcel #: C500000086 Davie County, NC - Basic Estate Search • Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: C500000086 Account #:8300758 Owner Information ulldin Tax Codes BXF• AHNSON MARY LOUISE nd: ADVLTAX - COUNTY T arket: 078 HWY 801 NORTH ssessed: READVLTAX - FIRE TAX eferred: (OESVILLE NC 27028 0 3 00329 0472 03 Property Information Unqualified Township [Land (Units[type): 324.980 AC 4 00910 0314 12 FARMINGTON::::::] [Address: 2039 N NC HWY 801 Improved 0 Deed Information Local zoning Pate: 12/2012 Book: 00910 Page: 0314 Plat Book: it Page: 107 Legal Description PIN 36.676 AC HWY 801 5842889833 Pope Values ulldin 325,68 BXF• 130,59 nd: 1,419,51 arket: 1,875,78 ssessed: 648,19( eferred: 1 227 59 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00165 0300 09 1992 WD Unqualified Vacant 0 2 00188 0481 07 1996 WD Unqualified Improved 0 3 00329 0472 03 2000 WD Unqualified Improved 400,000 4 00910 0314 12 2012 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP4 F riot, 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 . /maps.daviecounn'nc.gov/itsnet/View.aspx?prid=1490881 9/20/2016