2161 Hwy 158 (2) DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section /
P.O.Boa 848/210 Hospital Street �Ct 7-
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 989900603 Tax PIN/EH M 5749-29-5480
Billed To: Bonanza Mobile Homes Subdivision Info:
Reference Name: Location/Address: Highway 158-27028
Proposed Facility: Residence Property Size: see map
**NOTE* i�is�iiprovein nt/Operation Permit DOES NOT authorize the construction 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). 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 /0/1/ #People 3 #Bedrooms -, #Baths -�?-
Dishwasher: Garbage Disposal:❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: El
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:El
tr
Lot Size C Type Water Supply_ Design Wastewater Flow(GPD) C��o Site: New Repair 0
System Specifications: Tank Size/ GAL. Pump Tank GAL. Trench Width� Rock Depth 4� Linear Ft c&V
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie 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.on the day of installation. Telephone#is(336)751-8760.****
Environmental Health Specialist's Signature: Date: '! 0 2—
DCHD 05/99(Revised)
_ DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Moclksville,NC.27028
(336)751-8760
Account #: 989900603 Tax PIN/EH#: 5749-29-5480
Billed To: Bonanza Mobile Homes Subdivision Info:
Reference Name: Location/Address: Highway 158-27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3170
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 WASTE WATE NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
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.
Nomc
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Septic System Installed By:
Environmental Health Specialist's Signature: Date:
DCHD 05/99(Revised)
n \} 4P UCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
-� - Davie County Health Department
F�� 2 Environmental Health Section 0
,Fi\V,6 P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
p,�'• (336)751-8760
****1MPO�RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer
; to the INFORMATION BULLETIN for
riinstrr�uctions.
1. Name to be Billed � /'/7� Illd Contact Person (/2/ f
Mailing Address ZX).,,/J d N n Home Phone 9
City/State/ZIP #10 P� /lT��� K/ i� w Business Phone _Zj 6--254-1--Zi
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: Site Evaluation ❑ Improvement Mit/ATC ❑ Both
4. system to Service: ❑ House G��Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: ! # People '� # Bedrooms J # Bathrooms 1_
f_ ishwasher ET Garbage Disposal "asking Machine O Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: &County/City ❑ Well ❑ Commu;:o
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes
If yes,what type?
***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client.with THIS APPLICATION.
1
Property Dimensions: S WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PIN: # / ' 5OL
S'
Property Address: Road Name
City/Zip �y1Ye 0� ' �✓ Ctr } �v�S- f o C r� CJ_
If in a Subdivision provide information,afollows:
Name:
Section: Block: Lot: '/4ate Property Flagged: D-�
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 amVowned by
to conduct all testing procedures as necessary to determine the sitesuipbility.
DATE 2-- NATUR>J
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS•
Account No.
Revised DCHD(07/99) Invoice No. C��
-moo
N
CD 185;
(3.93A)
6773 0N
(2(3 8)
1646
604 230
meq, (28p)
0586
(204)
(2.78A) , G500000030
2414 =° co0412
(3.30A) .�
5480 w
257
158
N (362)
463
0209
116 co 148 N 406
206 289 _ co(133) SR 1641
2118 0 ^ (1.01A)
(473)
31854
ti
rS0 r moo,
" 5058 N
. DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
_ Account #: 989900603 Tax PIN/EH#: 5749-29-5480
Billed To: Bonanza Mobile Homes Subdivision Info:
Reference Name: Location/Address: Highway 158-27028 /
Proposed Facility: Residence Property Size: see map Date Evaluated:
Water Supply: On-Site Well Community Publicy
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
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 L
SITE CLASSIFICATION: �S EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: 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
CONSISTENCE
Moist .
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sti4 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 05/99(Revised)
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MonsonMENNENMEMNONMENNEN EMEMiiiiNNEN Monson
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Parcel#: G500000030 Page 1 of 1
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Parcel#:G500000030 Account#:82531341
Owner Information Tax Codes
ARREN CHANDRA ADVLTAX-COUNTY T
161 US HWY 158 FIREADVLTAX-FIRE TAX
EOCKSVILLE NC 27028
Property Information Township
nd(Units/Type): 1.620 AC MOCKSVILLE
ddress: 2161 US HWY 158
Deed Information Local Zoning
Pate: 02/2016 Book: 01011 Page: 0573
Plat Book: 0010 Page: 129 9
Legal Description PIN
1.734AC LOT 1 US HWY 158 5749295480
Property Values
uildin 88,08
BXF•
nd: 28,40
cl
Market: 116 48
ssessed: 116,48
eferred:
Sales Information
No. Book Pape Month Year Instrument Qual/UnQual Improved Price
00685 0170 10 2006 WD Unqualified Improved 116,500
00999 0070 08 2015 TD Unqualified Improved 86,500
01011 0573 02 2016 WD Unqualified Improved 58,500
00190 0604 10 1996 WD Qualified Improved 96,000
00345 0068 08 2000 WD Qualified Improved 140,000
00685 0170 10 2006 WD Qualified Improved 116,500
00813 0837 12 2009 WD Qualified Improved 127,500
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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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=1414363 6/9/2016