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4248 Hwy 158 -Y O "AUTWORIZATION NO: Q 915 DAVIE COUNTY HEALTH DEPARTMENT Gtr p "t Environmental Health Section PROPERTYINFORMATION 1 PermittP.O.Box 848 Name: Vl)cwerr� Mocksville,NC 27028 Subdivision Name: Phone#:704-634-8760 --- Directions to property: J n" Section: Lot: AUTHORIZATION FOR r � WASTEWATER Tax Office PIN:# � .SY_$,TEM CONSTRUCTION Road Name: i o `Zip: **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. (Incompliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION L P`�F 17 IS VALID FOR A PERIOD OF FIVEYEARS. ENVIRONMENTAL HEALTH SPECIALIST. DATE ISSUED fY � +i•.., r'w..tan �[ x. {✓� :f'rt; rr'zje'""tYF�'=y�->' S. �1+ °,ft la°'��;•- {' /h'' • '6a4 n(iu yam...-i}''i: �Fi i•�''/ ji'ri'S`U'�'"j{ �;'t: f/Y:C+=•ic.,.y;.i�k+� Yl�?y'� „r fr}'1' ♦ �.'tF-1 SOO 01- DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION x. Subdivision Name: irecfions toproperty: .} ret :;p _ Section: _.. Lot: t IMPROVEMENT �Z PERM T Tax Office PIN:# r'- _ �+• 1: , 'w^a*�`+ '<�,�ey' a �`}- Road Name: d. �f Zip: M **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. f (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section:1900 Sewage Treatment and Disposal Systems): ' ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE, PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE 4' ; INSTALLING THE SYSTEM. 1 RESIDENTIAL SPECIFICATION:BUILDING TYPEtL_'�16*#BEDROOMS -'3 #BATHS 2 #OCCUPANTS I GARBAGE DISPOSAL:Yes.00) COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIEr #SEATS INDUSTRIAL WASTE:Yes or No � r i.LOT SIZE O s�nsa� TYPE WATER SUPPLY�7 DESIGN WASTEWATER FLOW(GPD) LO NEW SITE V REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE L Opo GAL. PUMP TANK GAL. TRENCH WIDTH 3 ROCK DEPTH P LINEAR FT. �D OTHER ` REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT V.'} w ;+ "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)6348760. OPERATION PERMIT SYSTEM INSTALLED BY: C .S iV� �J�J y d AUTHORIZATION NO. q 1 OPERATION PERMIT BY: C DATE: j♦ "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 05/96(Revised) i t . APPLICATION FOR SITE EVALUATIONAMPROVEMENT PEWATC ` Davie County Health DepartmentD): Environmental Health Section P.O.Box 848 JIM 2 1997 Mocksville,NC 27028a Fop- (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed &uoBNe Do,ttvy Contact Person C!'U len.e �Q,�-fo•t/ Mailing Address /��/ �deN wcv� DR Home Phone 2/6– 76 S Zd VK City/State/Zip W/,vSTav Ya-4eA4 /✓C - 2- 7/d Business Phone 9/0' 760 �ya7 2. Name on Permit/ATC if Different than Above Mailing Address 0�q City/State/Zip 3. Application For: [v/]'Site Evaluation [gl�ipr vement Permit&ATC [ ]Both 4. System to Serve: [ ]House [vf"Mobile Home [ ]Business ( ]Industry [ ]Other 5. If Residence: #People---/— #Bedrooms 3 #Bathrooms A— [vMishwasher[ ]Garbage Disposal [,]'VVashing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/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 [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [LKo If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***SOF THE PROPERTY MUST BE y SUBMITTED WITH 99HIS APPLICATION. Property Dimensions: 11 OS ����-� WRITE DIRECTIONS(fmmLocksville)TO PROPERTY: /Tax Office PIN: #�- Property Address: Road N es�l YO v WIZ L 'rg v �s�� /�0 "S< -f City/Zip /1 C�✓Q�CQ� 7f}!��v �19 If in Subdivision provide information,as follows: `7�yeR e w�// fit a. Sf'aC K 04r JDviQ -� r 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 to cojiduct all testp ocedures as necessary to determine the site suitability. DATE –9� SIG ATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAWING YOUR SITE PLAN: L.u Nd I i i y h T /. iL;e fast' 29 ' w a � I N V 72� ''t© o • � .� is , 1 -< ter . T R.4 41N .475 A Q* ..:. p� : ' ` 615 N — �•;.. `. .. e ' . sem-- 27• 31 -270Acq s f 1g1a;2lOmE (646.80) 4 x ' (1-1AC)(u ' ° 7� V� p : -*728 , 44r 6_8 Q 13 Ao "BLAND CHURCH a 20'<1ct2 OF CHRIST :?• m ..g V 2. 6 - ,. . • -794 _ '' - , ,� k '-? .� CO 3 a . 483.78 4 126 24.01 _ .�t7•.... a c '2 Ac 15 0. 11:7 A; P� d7 7E N GP/0 90) f ?3 M A28.79AC o "' (8.4 �), }�.. x(15 ,A4,; )3 � - ` —Ac 825 ,so 43. t 21 .0 1 ,r^ Pro 43 7.9 Ac tqo- 400 5.50 (2.25 Ac) �.: 8`35.56 5../ AC-- . �.7a .. • N - U�.e ' 442.5 .s. ? X4:56 E i i 590,44 ' 66 w I AG Jh 6 ' e , ? ArllI•�Acl a•. Ki F 3` nC r AC - j ." $5 O' 1•.O 4'5uLiV AC (j. 462.50 '' .. �• • , �� (520.74), m N, rY _ r 51i 50 fS.M. ` n r 264: co 17 2 za ac 4 8 21 ., ---14.28 A,c}'`i(� _ — tarn a vQ� , a a 5T9 ct rpt_ 1k44 { � tst. E Al.5 AC)r .u . .. - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation 4 APPLICANT'S NAME t"wV� DATE EVALUATED PROPOSED FACILITY Q PROPERTY SIZE cNr's SUBDIVISION ROAD NAME J�FS E Water Supply: On-Site Well Community Public Evaluation By: O1t"uger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position $ Slope% HORIZON I DEPTH Texture groupL C L Consistence FIT Structure Mineralogy = ' HORIZON II DEPTH Texture group Consistence Structure k, Mineralogy ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 RESTRICTIVE HORIZON — SAPROLITE CLASSIFICATION $ ,5 LONG-TERM ACCEPTANCE RATE ►3 SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE. OTHER(S)PRESENT: a� REMARKS: �" •'��� 'T �1 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) LIAR-Long-term acceptance rate-gal/day/ft2 DCHD(O1-90) ■■■■■■■■c■■ce■■■e■■■■■ecce■■■e■■c■■■■■■c■■■eee■eee■■■eeec■■■■■■■e■ ■■■■■■■■c■■■■■■■■■■■■■■c■■■■eeeee■■■■■■■■■■■■■■■c■■■■■■■c■■■■■■■c■ ■■cec■■c■■eee■■■■■■ae■■■■■■c■ec■■■c■■■c■■■■■c■ece■■ec■■■■■■■■eee■■ ■■e■■■eae■eee■■■c■■■■■■■■■e■■■■■■■cc■■■■■■■e■■■c■■■e■■■■■■■ecce■■■ ■■■■■■■■■■■■■■Ire :���e■■■c■■r■r.����■■■■■■■■■■■■■■e■■■■■■■■ce■■■■■■ ■■■■■ce■■■■■■■■■■■■e■c■■_�nel�■■■■■■■■■e■■■■■■■e■■ecu■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■'■■■■■■■■■■■■■■■■■�!�\■\■■■■■■■■■■■111■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■ ��►��:a■■■■■■■■■■■■cell,■■c■■■■■■■■■■c■ ■■■■e■■■■■■■■■■■1■■■■■■■■■c■■■■■■�.�i■■■■■■■■■■■cel■■■e■■■■e■■■■■■■ ■■■■■■■■■■■■■■cel■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■��■cce■■■■■■■■■■■ MENNEN11MOMMiiiiiii ■■■■■■■■■■■■■[1■■;teee!■■■■n■■■■■■■■■■■■■■■■■■■■■■■■i1■■■■■■■■eee■■■■ ■■■■■■■■■■■■■11■■I■■/�ii�iC!n��■e!�!!11t1e■ee■■ee■■■e■■■[le■■e■■■eeeeee■■ ■■■■■■■■■■■■■I■�.ti■■■■tc■■■c■■■■■c■■■■clrY.:===eeee�e�I■■■■■■■ceccce■■ ■■■■■■■■■■■■■■■■i�■■■■�■■■■■■■c■■cec■c■■c■■■ce■ece■■e■■■e■■■■eee■c■■ ■■■■■■■■■■■■■■■■1�■■■■�■■■■■■■■■■■■■■■ce■■■c■e■■c■■■ec■■■■■■■ecce■■■ ■■■■ee■■■e■■■■■■I■e■■e■■■■■■■eee■■■■■■■■■ee■■■■■■■ee■■■e■ee■■■■■■■■ ■■■■ec■■■■■■■■■Itr.■■■■■ue■■■■I�I�.�ne��■■■■[I■c■■■ee■■ce■■c■■ece■■■■■■■■ ■■■■■■■■■■■■■■■■I■■■■■■lefl■[I■■C\■f:1■■■■Ile■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■[I■■■■■■1■[I■f��l■■IJ■II lig■■■II■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■c■■■c■■■■■e■■le■■c■n■11■■tleiic:--�I�■■celic■■■cc■c■■■■■■■e■■■■■■eec■■ ■■■■■■■■■■ce■■■■I■■■■■ulr�■■cc■■■■■■■■■■■Iles■■■■■■■■■■■■■■■■■■■c■■■■■ ■■■eee■■■■■■■eef■ee■■eerie■■■■■■eee�i■■■■■eee■■■■■■■■■c■■■■■■■■■■■■e■ Davie County Health Department and Home Heafth Agency Environwnta[Heafth Section P.O.Box 848/ 210 HOSPITAL STREET COURIER 1109-4-06 MOCKsvLLE,N.C.27028 PHONE:(704)634-8760 June 6, 1997 Eugene & Ruth Dalton 1171 Edenwood Dr. Winston-Salem, NC 27103 Re: Site Evaluation/4248 U.S. Hwy. 158 Tax PIH: 45861-26-6511 Dear Client(s) : As requested, a representative from this office visited the aforementioned site on June 4, 1997.'; , Based upon the information provided on the application for site evaluation and after the evaluatioA was completed, the site was found to' be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. I ; Sincerely, (�_� Charles E. Little, R.S.— Environmental .S.- .Environmental Health Section CL/wd Enclosure(s) 4 Parcel#: E70000000902A Page 1 of 1 oAV'r Davie County, NC - Basic Estate Search oo �A. UN Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#: E70000000902A Account#:8301201 Owner Information Tax Codes ALTON CEDRIC D ADVLTAX-COUNTY TT 134 LEVY CT NW FIREADVLTAX-FIRE TAX LBU UER UE NM 87120 Property Information Township FLand (Units/Type): 1.000 AC FARMINGTON dress:4248 US HWY 158 Deed Information Local Zoning Pate: 02/2013 Book: 00917 Page: 0690 Plat Book: Page: Legal Description PIN 1.00 AC OFF LAIRD ROAD 5861266511 Proa Values Buiidin 43,26 BXF• 1,31 Land: 1875 Market: 63 32 ssessed: 63,32 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00418 0835 04 2002 WD Unqualified Vacant 0 00917 0690 02 2013 WD Unqualified Improved 0 00119 0214 08 1996 WD Qualified Vacant 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 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/itsneWiew.aspx?prid=1461814 6/15/2016