139 Grover Rdvx
DAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT. PERMIT
**NOTE** This improvement permit DOES NOT authorize the construction or installation 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)
NAME .J �%O�ROPERTY ADDRE55 ( "� oE• 7�a�� DATE ��a7�
LOCATION
SUBDIVISION NAME LOT NUMBER. SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS .# BATHS # OCCUPANTS GARBAGE DISPOSAL; Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE A? 12t TYPE WATER SUPPLY (e DESIGN WASTEWATER FLOW (GPD) NEW SITE 4,-�REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE /DDS GAL. PUMP TANK GAL. TRENCH WIDTH 6 " ROCK DEPTH /�� LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FIM INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704)'634-8760.
OPERATION PERMIT
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 10/95 .
Davie County Health DepartmentENVIRONMENTAL; HEALTH SECTION i.
-,� P.O. Box 665
Mocksville N.C. 27028
AUMIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
G.S. Chapter,130A, Wastewater Systems)
***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.***
�► AUTHORIZATION NUM.
NAME .w'F�f�t-1 (Y�,o e - - DATE'"
NAME ON IMPROVEMENT PERMIT (If different than above)
r
SITE LOCATION"
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
*HNOTICE*H:THIS AUTHORIZATION fAR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR PERIOD [FrFIVE (5) YEARS.,
T1 tt7 p(� G
ENVIRONMENTAL TH SPECIALIsr
D,. - DATE
CHD'.,�1-C�75
s y..
- ' i.,..3 ., 4 �x YS- ...Y t s.-i.. .. n=R.'i:`F}.+�;r'- �ri.v e}-' Via» E .. T.. .. }.S .+la•3 .'"T C1u 3vx_. eIW f3*.-.- r . •.-aYx <iA ..Ya 4�a-.�.. i�rK «G.1
. APPLICATION FOR SITE EVALUATIONAMIPROVEMENT P C
Davle.,gounty Health Department D [E @ IE Q U R
r ff•-- iEnvironmental Health Section
r P.O. Box 848 AUG 3 0 1996
Mocksville, N627028
(704) 634=8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
? THE REQUIRED INFORMATJON IS PROVIDED.
t
1. Name to be Billed '- 1 gacq- S CO Pe� Contact Person r hri<�w G . ft WJ
Mailing Address (-70W l)ST!y (00 A:EL Home Phone %04 —Kia as 40
City/State/Zip �i
0 'S 01 Lk �"vC_ x10 ` J Business Phone R 60 -7 LOS Cl i Cl Q
:.
2. Name on Permit/ATC if.Different than Above
Mailing Address City/State/Zip
3. Application For: 1
pp [ Site Evaluation [ ]Improvement Permit &ATC [..]Both
4. System to Serve: [ ] House [vNobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People # Bedrooms._ # Bathrooms �a [Dishwasher [ ] Garbage Disposal
[4Washing Machinef [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
.\ r
If Foodservice: # Seats " Estimated Water Usage (gallons per day)
7. Type of water supply: [County/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [v] No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A FLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: l� S ` {S£ o 1'r; WRITE DIRECTIONS (from Mocksville) TO PROPERTY.
Tax Office PIN: #-5--75'1 - 41 - 6.22 ; LP `'1 ! QS�t
Property Address: Road Name (] S'/
City/Zip n �. t��y 1 �' _ hs ;
If in Subdivision provide information, as follows: &-7
Name: ;
Section: Lot #: ;
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 am 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 6q0 rl/Q Q I -PC � FVOn cQS uct all testing procedures as necessary to determine the site suitability.
DATE '9-- ?j O - C1 LP SIGNATURE C, -R, .
Revised DCHD (06-96)
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NAME
ADDRESS
PROPOSED FACIILTY
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
DATE EVALUATED
PROPERTY SIZE
LOCATION'OF SITE ���✓
Water Supply:
On -Site Well _
Community
Public
EvaluationBy:
Auger Boring ✓-
Pit
Cut
FACTORS 1
2 3 4
Landscape position
41Slope
%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Bt'
Texture group
Consistence
Structure
S
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: i (/
LONG-TERM ACCEPTANCE RATE: I L
REMARKS:
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
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 :lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V=;.f-y friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm
Wet
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic
Structure
3C --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 watef 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
■
■MEN■
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■ENEM
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Parcel #: J600000096
Davie County, NC - Basic Estate Search
. Basic Search Real Estate Search Tax Bill Search Sales Search 0
VYew Prooertv Record for this Parcel View Mao for this Parcel View Tax BIII Information
Parcel #: 1600000096
Account #:17361000
Owner Information
uildin :
Tax Codes
BXF:
OPE TRACY SCOTT& COPE CHRISTY M
nd:
ADVLTAX - COUNTY T
Market:
139 GROVER ROAD
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
(Units/Type): 12.090 AC
Ess:
MOCKSVILLE
139 GROVER RD
Deed Information
Local Zoning
Date: 08/2000 Book: 00344 Page: 0748
Plat Book: Pa e:
Legal Description
PIN
12 AC HWY 64
5757289501
Property Values
uildin :
57,58
BXF:
3,10
nd:
96,38
Market:
157 06
ssessed:
157 06
Deferred:
Cl
Sales Information
No. Book
Page Month Year Instrument
Qual/UnQual
Improved Price
1 00344
0748 08 2000 FD
Unqualified
Improved 0
View Property
Record for this Parcel View Mao for
this Parcel View
Tax BIII 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,
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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=1461683 6/23/2016