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1038 Maisey Ln DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Sheet Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 Account #: 990005046 OPERATION PERAPax PIN/EH#: 5814-50-4424 Billed To: Nancy Musselman . Subdivision Info: Reference Name: Location/Address: US Highway 601 N-27028 Proposed Facility: Residence Property Size: 14.6 Ac ATC Number: 4852 I O 3 g A,! f✓� **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. 727 J ' System Type: d S.T.Manufacturer Tank Date Tank Size Pump Tank Siziz—e7T�� / � System Installed By: B!' 'l f E.H.Specialist: � ate: � L o Ir \T ly �G \ We &Qv�b � �r ti � 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 0" Account #: 990005046 Tax PIN/EH#: 5814-50-4424 Billed:To: Nancy Musselman Subdivision Info: Reference Name: Location/Address: US Highway 601 N-27028 Proposed Facility: Residence Property Size: 14.6 Ac ATC Number: 4852 Site Type: L Kw' ❑Repair ❑Expansion **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 PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms _#Bathrooms a— #People_D_Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size . (Prtc-c Type of Water Supply: ❑County/City 0<11 ❑CommunityWell System Specifications: Design Wastewater Flow(GPD)360 Tank Size I,06aGAL.Pump Tank/ GAL. [ r I �I Trench Width l Max.Trench Depth 3�" Rock Depth1� Linear Ft. Sit i�I�difications/Conditions/Other: stated in 15A NCAC 18A.1969(5? �`"' ---OcCuptud Systemsmayetiso bt; UbLlu r 'Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. JQ o i — , �5PX O f` h U- Aye n I a-cLo Ito 11 VZ d5 7'U�c�t G�ail pY► . wood 5 00, r Environmental Health Specialist �l Date: 41--a 'a8 DCHD 11106(Revised) • Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005046 Tax PIN/EH#: 5814-50-4424 Billed To: Nancy Musselman Subdivision Info: Address: 3308 HWY 158 Location/Address: US Highway 601 N-27028 City: Mocksville Property Size: 14.6 Ac 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: GlIew ❑Repair ❑Expansion Permit Valid for: years ❑No Expiration Residential Specifications: #Bedrooms 3 #Bathrooms eL #People Basement❑ Basement plumbingO Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: unty/City k4ell ❑Community Well. As stated in 15A NCAC 18A.1969(5 Site Modifications/Permit Conditions: a1Gbt,r may alSn he usr System T e LTAR Initial ,cJ 0- a 7 Re air G 49,1-75-- Site 9, ?5Site Plan 0 �NS ` A. a A y Environmental Health Specialist Date 4��l 4V f i.p.11-06 APPLICATION FOR SITE EVALUATION/IMPROVEMEN Davie County Environmental Health P.O.Box 848/210 Hospital Street zq D �Z Mocksville,NC 27028 (336)751-8760/Fax(336 51- 786 2[708 ��iN�osrbfC� Application For: Site Evaluation/Improvement Permit Authorization To Construct Type of Application: ONew System ❑Repair to Existing System ❑Expansion/Modification of Existu� oci t '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 d R Contact Person �- 4 Billing Address Home Phone 3 City/State/ZIP C.� Business Phonef/-,!-- Name on Permit/ATC if Different than Above L 1// lot Mailing Address City/State/Zip �. PROPERTY INFORMATION *Date House/Facility Corners Flagged ( /0Oy 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,po expiry'lion with complete lat.) ./ �1� Owner's Name ' '� �'�='I S S M Phone umber -;f7/4 Owner's Address q - iii Q City/State/Zip ;n/1/i/J.. Property Address t,CI Al • Cit'_ I . Lot Size N,t;ne-. Tax PIN# l y-C0-LN L Subdivision Namefif applicable) Section/Lot# Directions To Site. Jy U) ( 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? ❑Peso 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? Yeso Will wastewater other than domestic sewage be generated? ❑Yes o RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes Ao Basement: ❑Yes` No Basement Plumbing: OYes ❑No 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:. Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ounty/City Water ❑New Well OExisting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑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 permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if c' 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 corners and locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. / Z `� ��'` � Site Revisit Charge roperty owners ofowner's legal representative signature Date(s): 13-- 2 t/ O d' Client Notification Date: Date EHS: Sign given 0Yes ❑No , A Account# V U Revised 11/06 i4 Jc� �� `' Invoice# _ � tt� � 3a F7' �� r S � i a � (291 �I 1 i ,93 ' ,sLAAL----------- i �, GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Zoom To Scale: O ." Click Here To Start Over Quick Search:(County ID or Owner Name) + ( ' ° Active Layer. OUseM T s &IJ -__ aP P GIS Deot Home Pave� Contacts I Deyartment I Inf PARCELS(Map Tips Available) Map Layers I Results I Address/Name/Parcel Search I Tools 77 r WATER t MnC1 s x http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=4129&CFTOKEN=61640881&initialize... 3/24/2008 GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Zoom To Scale: Click Here To Start Over Quick Search:(County ID or Owner Name) Active Layer QUsel-lap Tps GIS Dept Home Page I Contacts I Department I Inf 0 ,+ PARCELS(Map Tips Available) �-J Map Layers I Results ( Address/Name/Parcel Search I Tools —563 LM 84 5 � 5D � 3x7 sd �4 u 1786 .s 1. `n h 132 89AWI93 666 !t � N 0 ��a 7 t, 1 103_ 3A9 380 1559 N � WI G Chi I.w ti Icy a 377 * .. �a 386 S72- ;125\ fia 4Z5�� to q wLnCh 6y /p p�lt.,O 28_ S7t7 �O� hl� NIr c' a 1?09 . '�. .y � -0e �J 211 m 325_�r--^^^I327 qr� 9 g0 0 �9411 #4' http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=4129&CFTOKEN=61640881&initialize... 3/24/2008 GoMAPS -Davie County NC Public Access Page.1 of 1 . Davie County, NC - GIS/Mapping System ' Zoom To Scale: V _ Click Here To Start OverQuick Search:(County ID or Owner Name) Active Layer. Q Use Map Tips GIS Dept Home Page I Contacts I Department I Inf t/ 0 PARCELS(Map Tips Available) [!?,IMap Layers I Results I Address/Name/Parcel Search I Tools k AITI- � Int http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=4129&CFTOKEN=61640881&initialize... 3/24/2008 DAVIE COUNTY HEALTH DEPARTMENT Environmental_Health Section Soil/Site Evaluation APPUC dcNr l I#1F(99Wj WN Tax PIN/EH#: 5818-AMj1XjWY INFORMATION Billed To: Nancy Musselman Subdivision Info: 68��►- '44Z�f Reference Name: Location/Address: US Highway 601 N-27028 Proposed Proposed Facility:.. Residence Property Size: 14.6 Ac Date Evaluated: Water Supply: On-Site Well Community Public Y Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4' 5 6 7 Landscape position t_ L_ Slope % -5 HORIZON I DEPTH — Texture group GL G Y S C Consistence If P 'PAr Structure 5 (i. t �ic� !t& S ,� Mineralogy V9 r r P EW I HORIZON II DEPTH 2 t Q , Texture groupG �.c Consistence J f y! Structure Abk 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: `P EVALUATION BY: �d1I LONG-TERM ACCEPTANCE RATE: 0/�. 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 Tex SS -Sad 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 I?'I41S1i 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 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 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-gal/day/ft2 n(-urn nVn� ins..:—AN Parcel#: B20000003203 Page 1 of 1 oP�f� Davie County, NC - Basic Estate Search 0o U� 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#: B20000003203 Account#:80719750 Owner Information Tax Codes OOD TERESA S ADVLTAX-COUNTY T [ADKINVILLE, 09 COURTNEY HUNTSVILLE RD FIREADVLTAX-FIRE TAX NC 27055 Property Information Township [Land(Units/Type): 32.100 AC CLARKSVILLE ddress: 1038 MAISEY LN Deed Information Local tonin ate: 12/1996 Book: 00191 Page: 0834 lot Book: age: Legal Description PIN 2.096AC CHINQUAPIN RD 5814504424 Property Values uildin 7185 BXF• 45 13 nd• 156,60 arket: 273 58 ssessed: 273,58 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00182 0773 09 1995 WD Unqualified Improved 46,000 00188 0105 06 1996 WD Unqualified Improved 0 00191 0834 12 1996 WD Unqualified Improved 0 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/itsnet/View.aspx?prid=1464365 8/23/2016