2021 Hwy 158DAVIE COUINTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPRIIV@LtT FERMI
**NOTE** This improyement 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)
NATO: /VAP11_r Y/% 1r I PROPERTY ADDRESS�r, z- ^ * -- %r . i�� DATE
LOCATION e^.7 !/"J ,i%.S / �i/, r`' .t ii%i: Jls ✓ ��%/t✓ ,
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS ,' t BATHS 0 OCCUPANTS GARBAGE DISPOSAL: Yes
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT A SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)! FEW SITE L REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIIE,! i f GAL. WTANK ,GAL TRENCH WIDTH ROCK DEPTH /;%y LINEAR FT.
�/ r I N
OTHERS/a/r 4!
REQUIRED SITE MODIFICATI�NS/CONDITIONS:
***THIS PERMIT IS AJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR FAST
SEE THIS PERMIT -BEFORE INSTALLING THE SYSTEM.
Ll
Il
•��/� L
IMRRDUEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL 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.
SYSTEM INSTALLED BY
�C''�mAr✓ '7/Dn
T
AUTHORIZATION NO. OPERATION PERMIT BY �i-�/�c!!e.[l/ DATE
**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
- 'Y L'A(f Jve "�t'W •Ywfd 4"- '�� fkC `•.,- t. t w!` ..•, Y,t •'•y.Yh 4 . -"., . -.. , , . /�
Davie County Health Department
y ENVIRONMENTAL HEALTH SECTION
t P.O. Box 665
Mocksville, N.G. 27028
AUTHORIZATION 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.***
J AUTHORIZATION NUMBER
NAME 0'/ DATE N2 tl 127
NAME ON IM(PROVDENT PERMIT (If different than above)
SITE LOCATION .+c'S`8' - dL✓4V/ /7/: 71, ,� `� %/ri S D,�/
COMMENTS/CONDITIONS OH AUNRIZATION TO CONSTRUCT WASTEWATER SYSTEM
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
A5 'lox
ENVIRONMENTAL'HEALTH SPECIALIST ' DATE
DCHD, .10/95
_ ,,.2,h. ..
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By _ r �e-s
Mailing Address. L �Q Z) t Q -n Home Pt
KA r) e k .�12�` le Nc Business
2. Name on Permit if Different than Above
3. Application for: ❑ General Evaluation Septic Tank Installation Permit
4. System to Serve: ❑. House Ny obile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section - Lot #
DEC i i iso
No. of People
No. of Bedrooms
No. of Bathrooms o
Dwelling Dimensions
6. If business, industry, place of public assembly, other:
Specify type
No: of People Served
No. of Sinks
No. of Commodes
No. of Urinals
No. of Lavatories
No. of Water Coolers _
No. of Showers
Water Usage Figures.
7, Type of water supply: Q'Public
❑ Private
8. Property Dimensions 1� S Owe �5
Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this
sytem is intended to serve?
If yes, what type?
❑ Basement/Plumbing
❑Basement/No Plumbing
2✓Washing Machine
❑ Dishwasher
❑ Garbage Disposal
Gd Yes ❑ No
E(Community
t
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
PROPERTY INFOR1i&TIO1T REQUIRED:
Directions to Property:
To-� 4",4 � 58
Rctvar\oc Take �e-F-�-
Tax Office PIN if S7 V q 17-{10k
Road Name �IUJu 4 i 5s
Lox # (if available) IVIA
City M r)c_ksy i e-,
-r-i rs+
road.. 60
Q,�ecL.
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred fro this application.
�5
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 19 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Dave County He Its h Departent to enter upon above described
property located in Davie County and owned by u 0�i►'� i
to conduct all testing procedures as necessary to determine said ite's suitability for a ground absorption sewage treatment
and disposal syst m.
a
DATE SIGNATURE
DCHD (1/93)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME l �LS DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On -Site Well _ Community Public' 7/
Evaluation By: Auger Boring // Pit Cut
FACTORS 2 1 4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 2
Texture group
Consistence
Structure f
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: _ArQ e 2! to EVALUATED BY: A//
LONG-TERM ACCEPTANCE RATE:
REMARKS: e5��z2 ".J
DCHD(01-901
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+ --.-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 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/fu
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Q� Davie County Health Department
Environmental Health Section
U ' C P. O. Box 665 „
7 Mocksville, NC 27028
U
1. Application/Permit Requested By. v
Mailing Address
2� '
Home Phone✓°� B
2. Name on Permit if Different than Above
3. Application/Permit for:
4. System to Serve: ❑ House
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
No. of Bathrooms
ss Phone %� (°� e
General Evaluation
❑ Mobile Home
❑ Other
Dwelling Dimensions
If business, industry, place of public assembly, other: Specify type
No. of People Served l20
t.
No. of Sinks
❑ Septic Tank Installation
Place of Public Assembly
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
No. of Commodes No. of Urinals Z
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: 5 'PubIic ❑ Private ❑ Community
8. Property Dimensions Z -1//a' almca�, Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes, what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property: 74
o CatI
a�
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from is appli tion.
ATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. I OWN the property. C�2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
If
disposal systeM.
DATE SIGNATURE
DCHD (12-90) 1
."sem-I'V- 91
•` APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
' R O. Box 665KS 0-)1- -
Mocksville, N.C. 27028 ���'q #-/v _ 9/ _ r19
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requesyd By U Business Phone
2. Address A v G. a7L14
3. Property Owner if Different than Above
Address
4. Permit To: a) Install_A!f�Alter Repair-�
b) Privy Conventional —Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. aT If house or mobile home, tate size y
home and number of rooms.
House Dimensions
Bed Rooms -3 Bath Roomsy Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures
commodes
lavatory
urinals
showers 21-
dishwasher
/
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system beenppproved? Yes '1-1 No
9. a) Property Dimensions
b) Land area designated to building site M
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
garbage disposal
washing machine
What type?
I
This is to certify that the inforJnation is correct to the best of my knowledge.
Date'` �/ Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
NO
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
{ Environmental Health Section
Soil/Site Evaluation
NAME • P6 DATE EVALUATED
ADDRESS PROPERTY SIZE 19 t.07C,
PROPOSED FACULTY LOCATION OF SITE IST"
Water Supply: On -Site Well Community Public t -
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
4r2
Sloe Z
02
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
7.0
g
a1(
Texture group
/ G
Consistence
'
(�
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: Alf"
-<� 70 /Yc
LONG-TERM ACCEPTANCE RATE:
REMARKS: `vr r/ So, / —
DCHD(OL-901
EVALUATED BY: l
OTHER(S) PRESENT: O `/f
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 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
SC -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mi neralozy
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
■■■mmo■
■mmomm■
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■mommo■
SOMEONE
■■
T
Davie County AWK 7ye,7
artin'
. _ and dome NealtFrcy
210 HOSPITAL STREET / P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634.5985
March 19, 1991
Roy Potts
P. 0. Box 11
Advance, NC 27006
Re: Site Evaluation
Highway 158 East
Dear Realtor:
As requested, a representative from this office visited,the aforementioned
site on March 18, 1991. The site was found provisionally suitable for the
installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure.
Dame County Nealtfi 7ye,artment
and .dome AealtFr eY
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
Wade Leonard
34 Town Square
Mocksville, NC 27028
April 5, 1991
Re: Site Evaluation/19.5 acre tract
U.S: 158E. across from Oak Grove Church
Dear Mr. Leonard:
On March 18, 1991, this office evaluated a 19.5 acre tract on U.S. 158
East of Mocksville across from Oak Grove Church.
The soil conditions on said tract range from provisionally suitable to
unsuitable. Two sites were evaluated that were determined to be provisionally
suitable; however, due to the soil limitations the proposed systems will be
modified and oversized.
The proposed systems will be designed at 0.2 gallons per square foot per
day, thus a 3 bedroom house would require 600 linear feet of line (or 200
linear feet per bedroom.
If you have any questions, feel free to call.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
' . DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED /— V*` W
PROPERTY SIZE 14�e
LOCATION OF SITE X15-7
Water Supply:
On -Site Well
Community
Public rl
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1 2 3 4
Landscape position & I .L
Sloe % %a
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
MineralogyL
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:
LONG-TERM ACCEPTANCE RATE:
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 clay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR-Very 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
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
■■■■■■■■■■■■■■■■■■■■■e■■■
■■■■■■■■■■■■■■■■■■■■■■■■■
■
■
Davie County Nealt� Department
and .Mame Aealtlf Oyency
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
April 10, 1991
Joe Ferguson
C/o Roy Potts
P. 0. Box 11
Advance, KC 27006
Re: Site Evaluation/.19.5 acre.tract
U.S.•158E. across from Oak Grove Church
Dear Mr. Ferguson:
On March 18 and April 8, 1991, this office evaluated a 19.5 acre tract on
U.S. 158 East of Mocksville across from Oak Grove Church.
The soil conditions on said tract range from provisionally suitable to
unsuitable. To date three sites have been evaluated that are determined to be
provisionally suitable; however, due to the soil limitations the proposed
systems will be modified and oversized.
The proposed systems Will be designed at 0.2 gallons per square foot per
day, thus a 3 bedroom house would require 600 linear'feet.of line (or 200
linear feet per bedroom.
If you have any questions, feel free to call.
Sincerely,
Robert B.. Hall, Jr., R. S.
Environmental Health Section
RH/wd
Parcel #: H50000002404
Davie County.. NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search A
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: H50000002404
Account #:82528096
Owner Information
Building:
Tax Codes
BXF•
[TES CHARLES ERIC
Land:
ADVLTAX - COUNTY T
Market:
021 US HWY 158
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
0
00713
Property Information
05
Township
nd (Units/Type): 19.490 AC
Improved
MOCKSVILLE
ddress: 2021 US HWY 158
0494
04
Deed Information
Unqualified
Local Zoning
Date: 04/2013 Book: 00923 Page: 0817
00923
0817
Plat Book: Page:
2013 CD
Unqualified
Legal Description
0
PIN
19.49 AC HWY 158
05
5749174108
Property Values
Building:
Month
BXF•
23,36
Land:
142,88
Market:
166 24
ssessed:
166,24
Deferred:
Vacant
Sales Information
No. Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
1 00184
0900
01
1996 WD
Unqualified
Vacant
0
00713
0248
05
2007 WD
Unqualified
Improved
0
00922
0494
04
2013 CD
Unqualified
Vacant
0
00923
0817
04
2013 CD
Unqualified
Vacant
0
00154
0061
05
1990 WD
Qualified
Vacant
60,000
00161
0468
11
1991 WD
Qualified
Vacant
50,000
00184
0902
01
1996 WD
Qualified
Vacant
55,000
00897
0834
07
2012 WD
Qualified
Vacant
130,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Page 1 of 1
ONYlr
0001rik-'s
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/itsnetfView.aspx?prid=949393 6/8/2016