150 Fred Lanier RdAccount #: 990003664
Billed To: Dwight Myers
Reference Name:
Proposed Facility Residence
ATC Number: 4133
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #:
Subdivision Info:
Location/Address:
Property Size:
5719-15-7746
w9
_
'
r/�40";ef"
US Highway 64 Vf27028
1 + acres
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 YEAR
Environmental Health Specialist's Signature: AZA d Date: 0 S
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
given period of time.
a
Septic System Installed By: ) T'
Environmental Health Specialist's Signature : f / Date:
DCI -ED 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003664
Tax PIN/EH #:
5719-15-7469
Billed To: Dwight Myers
Subdivision Info:
Reference Name:
Location/Address:
US Highway 6427028
Proposed Facility Residence
Property Size:
1 + acres
ATC Number: 4133
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 & #People #Bedrooms g #Baths Q
Dishwasher:, Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #P/eople #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: New ❑ Repair ❑
System Specifications: Tank Size,/,,�,(QGAL. Pump Tank,& GAL. Trench Width I / Nir Rock Depth Linear Ft./2'0
Other: �I.-,1,��! C' At stcted in 15A NCAC
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the ie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. f the
installation. Telep ne # is (336)751-8760.****
d
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
APPLICATION
�11t� � 9 2005
a
` ENVIROt�P,1EMAN
E EVALUATION/IAIPROVEA1ENT PERMIT & ATC
County Health Department
onmenta/ Heaitiy Section i
848/210 Hospital Street
,,ksville, NC 27028
(336)751-8760
***IMPORtiPANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I
INFORMATION IS PROVIIDED. Refer to the RMINFORMATIOON BULLETIN for instruuctions.��7L�
1. Name to be Billed f/'/ C�/T-� Z_ /V V, �S Contact Person Delv1/r/-i1- ( 'l / z—ie'l
Mailing Address b/ J� /3 'eolr'I/�/D�D% DD )—/V, �Q� Home Phone
City/State/ZIPl�O Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
City/State/Zip
3. Application For: P-�glte Evaluation ❑ Improvement Permit/ATC ❑ Both
4. System to Service: E& Tiouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. Type system requested: ❑ Conventional M—c-onventional modified ❑ innovative accepted
6. If Residence: # People # Bedrooms h # Bathrooms 2
[BDishwasher ❑Garbage Disposal (Washing Machine
7. If Business/Industry /other: verify type
# Commodes
# Showers
121asement/Plumbing
# Urinals
# People
❑Basement/No Plumbing
# Sinks
# Water Coolers
IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day)
8. Type of water supply: ❑ County/City 2r Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 13'No
If yes, what type?
***IIIIPORTitNT*** CL NTS MUST OMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PAT tr SITE PL MUST BE SUBMITTED by the client with THIS APPLICATION.
Property DimensionsP I Al eA i 'i WRITE DIRECTIONS (from Mocicsville) to PROPERTY:'
Tax Office l'IN: # - J • 0 I U� - l/�, 11 f %-� /�'S7
Property Address: Road Name USS, '/T/ l/ A p G E I uT
City/zip Mek N1/14t- Y-101,911- Q /y,
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
Date home corners nagged: d b 3 D n s
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 ant responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by li/t'i-/��
to conduct all testingproceduresas necessary to determine the site suitability.
DATE 9' O SIGNATURE
TIIIS AREA MAY BE USED FOR DRAWING YOUR STI'E PLAN (Includ all of the follow' g: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Sign given
Revised DCHD (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EIIS:
Account No. 13 G
Invoice No. ��
PREU NA
-__ LEGEND
N.I.P.= NEW IRON PIN I
= R/R SPIKE
= COMPUTED POINT
IN WATER
x. = UMARKED POINT
IN C/L OF RD.
MYERS
1�' EKE
49' f.
413 82
AREA =moi
INCLUDES H
N -mss! 61 \
jj 69.01
V •- 41 �
.� lI
y
I- GF+ADY L TUTTEROW, CERTIFY THAT UNDER
MY DIRECTION AND :•UPERV1SION, THIS MAP
WA'- DRAWN FROM AN ACTUAL FIELD 7URVEY
MADE BY TUTTEPOW '-JRVEYING COMPANY
-
elm
PW0FE` ,IONAL LAND ;URVEYOP L-2527
TUT1'EROW Si1RVEYING COMPANY
1 '4 --DI_ITH ,SAL I ;BURY S T.
MOD'S'VILLE, N,I=. X7028
3.36? 751-561 b
41
415 AC.
R/W
W
� LAKE
64
NO SCALE
N
d
VICINITY MAP
x
c� • r
NN NO^ ` •jam CD
sN �
Q
N
50 25 0 50 100 150
SCALE IN FEET
PLAT OF SURVEY FDR
DWIGHT L. MYER,`'
REV I S I ONS SCALE, j " _ ` APPROVED BY, DRAWN BY-
DATE,
Y-
G.1- TUTTEROW FILE NAME, MYERS-DL
T , SEPT- 18 -_'UD(
BEING 1 .415 Al'-- TAKEN FP --,IA THE DWIGHT L M 1 ER`-, PROPERTY
(D.B 54. PG 49 ')(D B 113, Pv. :1 13) LONG IN TriE CALAHALN TCIWNSHIP
DAME COUNTY, NORTH CAROLINA
DRAWING NUMBER -
TAX MAP REF.: H-2, P/0 16
FACTORS
1
DAVIE COUNTY HEALTH DEPARTMENT
Landscape position
' • J ' '
Environmental Health Section
HORIZON I DEPTH
Soil/ Site Evaluation
APPLICANT INFORMATION
PROPERTY
INFORMATION
Account #:
990003664
Tax PIN/EH #: 5719-15-7469
�-
Billed To:
Dwight Myers
Subdivision Info:
�V728
Reference Name:
Location/Address: US Highway 64
Texture groupG�
Proposed Facility:
Residence
Property Size: 1 + acres Date Evaluated:
7!
Water Supply:
On -Site Well Community Public
e�
Evaluation By:
Auger Boring
Pit � Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
G L
Consistence
Structure
�-
Mineralogy
HORIZON II DEPTH
Texture groupG�
Consistence
Structure
e�
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
C
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
EVALUATION BY: 2—,�2/11
OTHER(S) PRESENT:
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
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firth EFI - Extremely firm
31t
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)
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Parcel #: H2O000001604
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search 0
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
Parcel #: H2O000001604 Account #: 52684000
Owner InformationTax
n
Codes
rMarket:
YERS DWIGHT L
1
ADVLTAX - COUNTY TA
1981 WD
150 FRED LANIER ROAD
sed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
2015 WD
Unqualified
Property Information
0
Township —�
�Land (Units/Type): 238.010 AC
2015 CD
CALAHALN
ddress: 150 FRED LANIER RD
0
4
Deed Information
2016 XX
Local Zoning
Date: 01/2016 Book: 01009 Page: 0069
211,000
Plat Book: age:
Legal Description
PIN
38.005AC HWY 64
5719157469
Property Values
n
93 29
rMarket:
Price
1
864,81
1981 WD
958 10
sed:
15183
Deferred:
806,27
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved
Price
1
00113 0068 02
1981 WD
Unqualified
Improved
0
2
00995 0764 07
2015 WD
Unqualified
Improved
0
3
01001 0637 09
2015 CD
Unqualified
Vacant
0
4
01009 0069 01
2016 XX
Unqualified
Vacant
211,000
View Proper Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnettView.aspx?prid=755566 7/5/2016