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4572 Hwy 158 ,yz.5,1 I'i I DAVIE COMITY 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 B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME � Ci`Ccc.s w o �\ PROPERTY ADDRESS f I��71�f °�I DATE LOCATION , '� $ ©sr- e\> avo. S�`N�a Cit far a.A Z�klx V.) . SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATI N: BUILDI4NG TYPE o o a # BEDROOMS # BATHS # OCCUPANTS � GARBAGE DISPOSAL: Yes Na COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTEF,,Yes/No LOT SIZE TYPEsLiATER SUPPLY A � IESIGN WASTEWATER FLOW (GPD) NEW SITE Y REPAIR'SITE SYSTEM SPECIFICATIONS: TANK`SIZE aDb`ti GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT., si OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: i ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE,SYSTEM. 16 4 t7 �ao �s,o Loa, IMPROVEMENT 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:x-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE #.IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLEDBY.. - k F w 140 (Js s ^^V'' AUTHORIZATION NO. G i Ff OPERATION PERMIT BY 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 SHAH. IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 ''"_;aE .n c.,i,+,� ,... ;o�Y..f.n.a-Nr ..•`e 'Ij'.Fi�.�w f,h:.r ,...:t-c�{w� �d .�.;�.1- , -•t.s ' � �. . - '�r +f.. -'r �' _' . y s !� s V ' vie County Health Department 160. O ENVIRONMENTAL HEALTH SECTION P.O. Box 665 , Mocksville, N.C. 27028 } l AUTHORIZATION'FnD. WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11-of 4�1 514 G.S. Chapter 130A, Wastewater Systems) 4**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.*** DATE NAE 7--) ��\ t>g`Cty. s W o C. � G� ALHTHIORIZATION NLMBER NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION 5 COM01TS/CONDITIONS ON AUTHORIZATION TO CONSTRLET WASTEWATER SYSTEM HiHOTICE*ff THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTIONIISSVVALID 1FOR A PERIOD OF FIVE (5) YEARS. ENVIRON)ENTAL HEALTH SPECIALISt DATE DCHD 10/95 �;� ` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section 1 t' P. O. Box 665 Mocksville, NC 27028 Q� 1. Application/Permit Requested By - rr Mailing Address Home Phone/OJ 7WIR2-13_ /\J,- _ Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation O eptic Tank Installation Permit 4. System to Serve: 3-House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # L/ ❑ Basement/Plumbing No. of People / ❑❑ Basement/No Plumbing No. of Bedrooms 2"Washing Machine No.of Bathrooms o� 2-6ishwasher Dwelling Dimensions ab /� 6_/=ccT',gre ❑ Garbage Disposal 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 Uusage Figures 7. Type of water supply: ❑ Public Private ❑ Community 8. Property Dimensions E/Q 5t x a/0 -7ql Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes p'No If yes, what type? 'NOTE: Improvements Permits shall be validfrom date issued. Improvements Permits are subject to ed revocation, if site plans or the intenduse change. Effective October 1, 1989. PROPERTY INFORMATION REQUIREb: Directions to Property: 7000 by o&;_ STFrom Tax Office PIN: # 5$&/-,�,_ 9SEt, d PROPERTY f ADDRESS, as fo i l ows: 1 cjj5V/l[ A /No! • / /))/ �f fu5� Road Name: ��V . � l Sl SINI ,�� E. f1 f� /0 ( City: �jc1✓GtyCCe_ � I '(� SUBMIT A PLAT WITH THIS APPLICATION.L V rl v Q� �J Revisions effective October 1, 1995. 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 this application. -�k TO DATE SIGNATURE CONSENT FOR SITE EVALUATf6N TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 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 f the Davi County Heal epartment to enter upon above described property located in Davie County and owned by t t�MS to conduct all testing procedures as necessary to determine said site's suitability f9ea ground absorption sewage treatment and disposal system. C -- , DATE SIGNATUR DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation o NAME DATE EVALUATED ADDRESS S P -P PROPERTY SIZE / �"�-• PROPOSED FACIILTY � o v s`L LOCATION OF SITE I✓�� s� Water Supply: On-Site Well Community Public Evaluation By:CL L,.Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S Slope % 3 a HORIZON I DEPTH Texture SroupL C Consistence J Structure Mineralogy HORIZON II DEPTH 2 Texture groupC C Consistence Fa Structure 'F Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S _S RESTRICTIVE HORIZON -- SAPROLITE — — CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATE � ►-( SITE CLASSIFICATION: �' EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESS �h� C � 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-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 SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo¢]► 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(01-901 ■■■■..■■■■...■.■.NOON■N■■.■■■..■.■..■■.■.■.■■■.■ ....■.■■.■■■.■■■ ■■■■■■■■■■.■■■■■■■■■■■■■■/■■■/■■ ■NOON/■■■■■.■■■■.ee■■■estE■■■■■■ ■■■■■■!■■■■■■■■■■■e■■■■■■■■ete.■..■Ee.■...■■.■.■.■■ ■.NOON■■.■.■s ■Nee■.■■E■.■■■■t■■eee■■■■t■■.■e■ ■O■■■.■■■..■■...■....■.■.■NONE■■ ■■■■■■.N■■■■■■...■■■...■..�■...■■■.■■■...NMEN NIN MEN mommomon ME ■■■■s■■■■■.■■■■■.■t■■■.■■e.■E.eIS MEMEMEMMEMN ■■O■■■■NO■■■■■■NN■■■■■■■■■■.■■■ ■t■■■■..°■°.■■■■°.■■■■■■■■■■■■■t■■■■NN■!■.■■.■■ili■■N■■EON.■■■!.■■ ■■■■■■■■■■■t■■■■■■■■O■■■.O■■■■■■■■■■■■■■■■O■■■■ �■■■°■■°■.■■■■!■ ■■°■■■■■.■.■■°°■■■■■■■.■■■■■■■■■■■■■■i .■ ■ N■■= N.■■■■N■ ..■■■■■ ■■■■■=!O■■OE■.I� .°°■■■■■■O■■■■■■■■O■■■!■!■!.■■■■■■ N■. .E■■■ ■■°■■..■.■■■°■■■■■■.tt■°■■■■■■■°■■ ■O■..■.■■■■.■■.i■iN■.■■N.■..■N■ ■■■■■■■■■■■■■■!■■■.■■■■■■N■■■■O■O■■■■■.■■■■■■..■!■ ■ MEN.■■!.. ..■ ■■■■■■■N■■■■■■■■■N■Nee■N■O■■■■■U■■■.■NONE■.■■NN■■■O.■■■■■N■E■ ■■N■■■■■■■■■e■■■■■■■■■■■■■■Nee■■ ■■■■N■■ ■. 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L —_ Parcel#:E700000087 Page 1 of 1 ,; Davie County, NC - Basic Estate Search 0ou��, Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Man for this Parcel View Tax Bill Information Parcel#: E700000087 Account#:2516000 Owner Information Tax Codes RMSWORTHY WILLIAM CHARLES&ARMSWORTHY PEGGY ADVLTAX-COUNTY T 572 US HIGHWAY 158 FIREADVLTAX-FIRE TAX DVANCE NC 27006 PropertV Information Township nd(Units/Type): 1.570 AC FARMINGTON ddress: 4572 US HWY 158 Deed Information Local Zonin ate: 11/1968 Book: 00080 Page: 0123 Plat Book: Page: Le al Description PIN 16 AC HWY 158 5861683394 PropertyValues Building: 87,590 BXF• 110 Land: 37,440 Market: 125,140 ssessed• 125 1401 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00080 0123 it 1968 WD Unqualified Improved 0 View Property Record for this Parcel View Mao 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=1476473 6/15/2016