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2888 Hwy 801NDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 989900157 Tax PIN/EH #: 5832-98-5445 Billed To: Sue Miller Subdivision Info: Reference Name: Location/Address: 2888 NC Highwary 801 N.-27028 Proposed Facility: Residence Property Size: 3.3 Acres ATC Number: 4992 **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. System Type:_ S.T. Manufacturer Tank Date—/0/7 Tank Size = Pump Tank Size 1 ` System Installed By: 'e ( l E.H. Specialist: fV Date: DCHD 11/06 (Revised) y DAVIE COUNTY ENVIRONMENTAL HEALTH �,Q D P.O. Box 848/210 Hospital Street 3 0 Q' Mocksville, NC 27028 ?'�\ (336)751-8760 Fax # (336)751-8786 **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 2L # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: Kounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)1 (DO Tank Size'W GAL. Pump Tank MA GAL. Trench Width 12-1 to Max. Trench Depth� Rock Depth Linear Ft.OF25°% Site Modifications/Conditions/Other: As stbted in 15A NCAC 18A:1969(5% P acceptedi �z v Contact the Davie County Environmental Health Section for final inspection of this system between Environmental Health Specialist c Date: <2-1 q—oq DCHD 11106 (Revised) AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900157 Tax PINfEH #: 5832-98-5445 Billed To: Sue Miller Subdivision info: Reference Narne: Location/Address: 2888 NC HighVary 801 N.-27028 Proposed Facility: Residence Property Size: 33.3 Acres Site Type: Aw ❑Repair ❑Expansion ATC Number: 4992 **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 2L # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: Kounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)1 (DO Tank Size'W GAL. Pump Tank MA GAL. Trench Width 12-1 to Max. Trench Depth� Rock Depth Linear Ft.OF25°% Site Modifications/Conditions/Other: As stbted in 15A NCAC 18A:1969(5% P acceptedi �z v Contact the Davie County Environmental Health Section for final inspection of this system between Environmental Health Specialist c Date: <2-1 q—oq DCHD 11106 (Revised) • r Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ,' *\ (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 989900157 Tax PIN/EH #: 5832-98-5445 Billed To: Sue Miller Subdivision Info: Address: P. O. Box 1569 Location/Address: 2888 NC Highwary 801 N.-27028 City: Mocksville Property Size: 3.3 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: VNew ❑Repair ❑Expansion Pennit Valid for: ❑5 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms,r People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: Vounty/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1989(5) Site Modifications/Permit Conditions: men^ ted Systems may also to tee System Type LTAR Initial I 22 Repair Site SySkc i 34,9 Environmental Health ecialist Date i.p.l 1-06 w CATI(. OR SITE EVALUATIONAMPROVEMENT PERMIT & ATC 2QQ9 Davie County Environmental Health AvG P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Applicati or: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC)Both of Application: ❑New System ❑Repair to Existing System DExpansion/Modification of Existing System or Facility ***IMP0RTAN7*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATIO9IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be BilledLl �,• /�`� /LL t=/L Contact Person .cce Bilfmg Address _P0 % vX /SG -J Home Phone 33<., City/Stake/ZIP—,���'� /?Syt* It,- N C J70, Z Z%- Business Phone 334, - %> � • � �� Name on Permit/ATC if Different than Above, Mailine Address PROPERTY INFORMATION *Date House/Facility Corners NOTE: 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 Ji_i a- /-/E/VS!_ e t / Phone Number 07 j �-6,0 Owner's Address �� k VVJ A] Property Address X21, Al Lot Size_ -', 3 &,1c Tax PIN# Subdivision Name(if applicable) Directions To Site: f'6-6 i ./J f'ofi k1el)JI'Mi City/State/Zir�70, Y CityYZLKKSt/:'/!r 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? 9�'es ❑No Does the site contain jurisdictional wetlands? ❑Yes CiiNo Are there any easements or right-of-ways on the site? ❑Yes O�No Is the site subject to approval by another public agency? ❑Yes Q?10 Will wastewater other than domestic sewage be generated? ❑Yes UM IF RESIDENCE FILL OUT THE BOX BELOW # People ,_ # Bedrooms - 3 . # Bathrooms ;Z Garden Tub/Whirlpool J;�i'es ❑No Basement: ❑Yes l�M Basement Plumbing: ❑Yes "o 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 26onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Z_?l o 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 permits) 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. Site Revisit Charge Property owner's or owner's egal representative sig ature Date(s): V71,912 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # -! d / 9DOIO Revised 11/06 Invoice # • doMAPS - Davie County NC Public Access Page l of l Davie County, NC - GIS/Mapping System Click Here To Start Over Quick Search:(County ID or Owner Ni Active Layer. DUse ,0Tap 7 ps �0U N� Q PARCELS (Map Tips Available) V i Addne 5UP 480 971 http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=4129... 8/7/2009 APPLICANT INFORMATION Account #: 989900157 Billed To: Sue Miller Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5832-98-5445 Subdivision Info: Location/Address: 2888 NC Highwary 801 N.-27028 Property Size: 3.3 Acres Date Evaluated: On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 7,Z 3 HORIZON I DEPTH O Texture group G G L Consistence q 1P Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH ' Texture group 0411%V13' Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P LONG-TERM ACCEPTANCE RATE .'Z -?-!5 25 ZS SITE CLASSIFICATION: P S EVALUATION BY: \ Jn Wa" U Z�Ati ciyl LONG-TERM ACCEPTANCE RATE: % 2457 OTHER(S) PRESENT: REMARKS: 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 CON IST +,N . , Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Mt NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic 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 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) ITAR - I.nnv-tr.rm acrP.ntanrP rat,- - an1hinvM0 1,nrrr ncinc m__..__�� ■■MNO■ ■■M■M■ MONS■■ ■MMON■ ■■■a■■ Manama ■E■NE■ ■■OMM■ ■E■■ME ■an■R■ ■■■■■■ ■■■e■■ ■a■■■■ ■ ■ ■■■ ■ ■ ■■■■MEM■ ■MMMMMM■ ■■mm■EM■ ■MMMM■M■ ■MEMMOS■ ■■■■■■■■ ■■MMEMM■ MONOMERS ■■M■■MM■ ■ Room ■■©rm MEMO ■S■■ SEEMS ■EEE■ ■EEE■ SOMME OMENS woman nomSi ■MMUM INNER ■ENNE■ C sons■■■■■■■ ■■■■■■■■■■■ ■M■■■■■a■■■ :::atom■ ■■MEMS■■ ■■E■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ONEE ME■■■■■■M■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■E■ ENE MEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■o■■■■■■■■■■■■■■■■■■■RNR■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■M■ GoMaps GIS Page I of 6 s Y " F ' V Ilk http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=54992&CFTOKEN=14359197 8/10/2009 Parcel #: C500000022 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 #: C500000022 Account #: 35951130 Owner Information uildin : Tax Codes BXF• INSLEY SUE HUNTER nd: ADVLTAX - COUNTY T Market: 888 NC HWY 801 NORTH ssessed: READVLTAX - FIRE TAX eferred• OCKSVILLE NC 27028 2011 WD Unqualified Property Information 3 Township nd (Units/Type); 2.252 AC 1995 WD FARMINGTON [Address: 2888 N NC HWY 801 4 00130 0702 Deed Information 1986 WD Local Zoning ate: 12/2011 Book: 00876 Page: 0501 Plat Book: 10 Page: 394 Le al Description PIN 2.252 AC HWY 801 LIFE ESTATE 5832985445 Property Values uildin : 29,56 BXF• 6,87 nd: 34,11 Market: 70 54 ssessed: 70,5401 eferred• 12 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00155 0688 08 1990 QC Unqualified Vacant 0 2 00876 0501 12 2011 WD Unqualified Improved 0 3 00110 0702 05 1995 WD Qualified Vacant 10,000 4 00130 0702 04 1986 WD Qualified Vacant 10,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 vP�r� �0014A. - 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/itsnet/View.aspx?prid=1463235 9/22/2016