3257 Hwy 158y.
t
Permittee's'�+ : .' E COUNTY HEALTH DEPARTMENT
Name: 4tEnvironmental Health Section PROPERTY INFORMATIO
P.O. Box 848,
Directions to property: Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
• Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
AUTHORIZATION NO: a 0 7 2 0 A Road Name: �'-= �� -� � i
P ;
**NOTE** 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 f6P-Buildit�g Permits.
(In compliance with Article 11 of G.S. Chapter, 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
it
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/ t
r ' ��� ��" i •-- ..-- � �{-� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIR A NTENT 'EQLT i�SPECIALIST DATA ISS ED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 0i4% # BEDROOMS # BATHS # OCCUPANTSGARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE>>����TYPE WATER SUPPL�U1�1! 1{ 1 DESIGN WASTEWATER FLOW (GPD) r�'� `� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH `– �"'' ROCK DEPTH LINEAR Fr..'—
OTHER
T.-OTHER n�1� � {I��fclJ� {'V d .L � , 7 1 L1�3104.1 io,)
REQUIRED SITE MODIFICATIONS/CONDITIONS: �` %t' \130" r�t�"^" Ivy' i a' � , � LA��s`-�I ��%t: t � C; C) Cc � . L, .) 1�
IMPROVEMENT PERMIT LAYOUT
FOR FINAL INSPECTION
PERATION PERMIT
fDT
>5
ox
ceQr'; jtd
�-I�a�.
F THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
�
S
L , I S� LED BY: i
1
U
AUTHORIZATION NO. 2721�� OPERATION PERMIT BY: AT .
"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.
DMD OM2 (Revised) q? -01
'µ£ms• iA - • e v T -a),. yr.:. •: , 's'v._• ve+i" , r r::-: - , ,. .t
permitt'e's� 1 ' 1, 4 IE COUNTY HEALTH DEPARTMENT
?°-` �'� t I r Environmental Health Section PROPERTY INFORMATIO
Name
i r (. P.O-Box 848 '
Directions to property: t Mocksville, NC 27028 Subdivision Name:
F
'A 1:. # Phone #: 336-751-8760 r
,��-a rte« �' �-� r .
Section: Lot:
AUTHORIZATION FOR
^5 WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# f'. -
-
y
AUTHORIZATION NO: 002720 A Road Name n7 .. t." � ,ip: ~�'r
**NOTE** 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.
(ln compliance with Article 11 of G.S. Chapter,I30A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
`--- -•I ( a 1- ti ; t. IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRON ,MENIAL;�4EALTH SPECIALIST DATA ISSU D
RESIDENTIAL SPECIFICATION: BUILDING TYPE 4 �O(A #BEDROOMS L # BATHS # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No
t
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE,-!--/-..d1I-[#— TYPE WATER SUPPLY l-0L)1Qj DESIGN WASTEWATER FLOW (GPD) r-`� NEW SITE REPAIR SITE
it u 1
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
(1T1 -IFR 1W A i., I- �1 In:-.) � �Tl•JJ1 J v. q ,ham. ir-V-1 J 1 L� 1 �ii ��/ l IV^' lb T
REQUIRED SITE MODIFICATIONS/CONDITIONS: t4, c V C' J
IMPROVEMENT PERMIT LAYOUT
C.
art
FOR FINAL INSPECTION THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT ����
SyLED BY:
Ig�D�
AUTHORIZATION NO.OPERATION PERMIT BY: ATE G
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN CO PLIANCE
WITH ARTICLE I 1 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:—,
*\
. DCHD021012(Revised) _. �• / ✓ `'
&(1/4.1� Cc�r ark
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
II j II I/ APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME ����� 417(� kc -n- PHONE NUMBER
ADDRESS SUBDIVISION NAME
At, a �Da,� LOT #
DIRECTIONS TO SITE ZpcZ-ave(,t,l
IN'
DATE SYSTEM INSTALLED lts
NAME SYSTEM INSTALLED UNDER 4 rbc
TYPE FACILITY , P� _NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY l SPECIFY PROBLEM OCCURRING �aXIL'
hluds 4 -iia 0
--
DATE REQUESTED - l 12-11 o ' INFORMATION TAKEN
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
\ Rw.1f93
a
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation'''
APPLICANT INFORMATION
Water Supply:
Evaluation By:
On -Site Well Community
Auger Boring a/ Pit
PROPERTY INFORMATION
Public v
Cut
FACTORS
SITE-
1 2 3 4 5 6 7.
Landscape position
l�
Slope %
HORIZON I DEPTH
_ (�
Texture group
Consistence
S
Structure
Mineralogy
HORIZON II DEPTH
Texture groupe
Consistence
Structure
Mineralogy,
HORIZON III DEPTH
Texture groupyul
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
~—
RESTRICTIVE HORIZON
SAPROLITE
—
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
0 -
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
EVALUATION BY: Vt:�
OTHERS) PRESENT:
REMARKS:
LEGEND
T, n s ape 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
Test
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
CONSIST ,N .E
Moist
VFR - Very friable. FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3�et
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
LYQte.T _ ' •' _.
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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MEMNONMENNEN
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Parcel #: F600000016
Davie County, NC - Basic Estate Search
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Parcel #:F600000016
Account #:8300127
Owner Information
Building:
Tax Codes
BXF•
ICKS GREGORY SCOTT & HICKS TAMMY LYNN
Land:
ADVLTAX - COUNTY TAX
Market:
257 US HIGHWAY 158
ssessed:
READVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
00852 0496 02 2011 WD
Property Information
Improved 75,500
Township
nd (Units/Type): 0.380 AC
FARMINGTON
ddress: 3257 US HWY 158
Deed Information
Local tonin
Date: 02/2011 Book: 00852 Page: 0496
lat Book: age:
Le al Description
PIN
1.70 AC HWY 158
5850376906
Property Values
Building:
59,08
BXF•
3,38
Land:
12,85
Market:
75 310
ssessed:
75,31
Deferred:
3
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved Price
1
2001E 0198 07 2001 WL
Unqualified
Improved 0
2
00439 0885 09 2002 WD
Qualified
Improved 62,000
3
00852 0496 02 2011 WD
Qualified
Improved 75,500
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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5.71�
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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/itsnetfView.aspx?prid=1460821 6/8/2016