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� _AUTHORIZATION NO. „� �� S�DAVIE COUNTY HEALTH DEP RTMENT � r�:,
�� - Environmenfal Health Section PROPERTY I FORMATIQI� ,_ �,,,,,'�
;Permitfee s : � ' . ' '` , . � ` ' P.O: Box 848
. '`Name: � .•�� 1 i �} � � �'�'"1 GE-�i ��i i`�' -�-� � �G,7Mocksville,:NC. 27028 Subdivision Name '
, 4_ -,- .�� . . � , �.µ Phone # ,336 751-8760 `: r
Directions to property: �`�.'�'-� � ' j`�`�� �'`'t�
° .� . AUTHORIZATION FOR - S
ection: Lot:
WASTEWATER Tax Office PIN:# .
' SYSTFM CONSTRUCTION � '
Road{Name: � �i��.i (��1 � Zip: �= �u2�'
,.
**NOTE** This Authorization for Wastewat�erSystem Construction MUST BE ISS[1ED by the Davie County Environmental Health Sect�on prior
to issuance of any Building�ermit,s: This Fomi/Authonzation Number should be presented to the Davie Counry Building Inspections ;
Office when applying forBuilding Permits.''
`: (ln compliance with Arficle 11, o�G.S, Chapter 1.30A; Wastewater Systems Section :1900 Sewage Treatment and;Disposal Systems)
' �. � f:� I, ***NOTICE*** THIS AUTHORIZATION FOR VI�ASTEWATER CONSTRUCTION
`` ' r.� '� �' ; •--..,,,' �cf , •. O '. ' , : ;: . , ' IS VALID FOR A:PERIOD OF FR'E YEARS, , ; : : ,
-� ENVIRONIv�IE A HEALTH SP CI�T DAT ISS ED �
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DAVIE COUNTY HEALTH DEPARTMENT
" ,IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ,
Rermitte '„s
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Subdivision Name: l ;i
.M~TI�uections to property: t . ! t r'; -� `# Wh Section: - Lot:
IMPROVEMENT
PERMIT
Tax Office"PIN:# -
Road Name: Zip
i v r C.lr/ • c. J
,NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any was system An ,
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frdm this Department prior to the
construction/installation of a system or the issuance of a building permit.
(Iii compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems)
***NOTICE***:THLS PERMIT IS SUBJECT TO REVOCATION IF SITE,.,,
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ;
ENVIRONMEPTTAL HEALTH SPECIALIST `'' DATB ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ,
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE yy���� ����# BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
E .
COMMERCIAL SPECIFICATION; FACILITY TYPU—, PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes o 0
LOT SIZE TYPE WATER SUPPLY 0 T DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
-2
SYSTEM SPECIFICATIONS: TANK SIZE�00 ® GAL. PUMP TANK GAL. TRENCH WIDTH f.6 ROCK DEPTHe20 LINEAR FT. ! c
OTHER p
REQUIRED SITE MODIFICATIONS/CONDITIONS: i-�% G 1 t.1��a l�y� K� � l D' or-r,1 ftF 1, t "J e
DCHD 05/96 (Revised)
O
C?
DCHD 05/96 (Revised)
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t -1 73 50
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
f ' tP.ertnitte
Name " :: t i "i ,' ti •. tl1 1" is Subdivision Name:
ft .�
Directions to property: 1 �4=' ' It;'' / Section: Lot:
IMPROVEMENT
Tax Office PIN:#
� PERMIT
Road Name: L I V i.,., �,:1 t. zip:
* ,NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic lank 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.
(Th 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'H$ALTH^SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
y.,..- INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICA`fION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPEf ,' 1 LkZh4# PEOPLE # PEOPLE/SHIFF # SEATS INDUSTRIAL WASTE: Yes oNo
LOT SIZE�TYPE WATER SUPPLYi,. ,—:J ) T' -f DESIGN WASTEWATER FLOW (GPD) �= j' NEW SITE REPAIR SITE f ,
_..... ...�..i. M+�'.,: 11 `tom
SYSTEM SPECIFICATIONS: TANK SJZI O GAL. PUMP TANK GAL. TRENCH WIDTH -vim ROCK DEPTHLINEAR FT. (< Y
OTHER
REQUIRED SITE MODIFICATIONS(CONDITIONS: 1"'�i�!�_�(' J k^�= E �= 1 i7� C:S-F 1 4i• L 1 t
IMPROVEMENT PERMIT LAYOUT
f *APPROVED EFFLLrE FILTER* *RISER(S) IF 6 BELOW FINISHED GRADE*`
f i-
fECT. ._
..� T
j Y
**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.
1 3tSixxxxNHX
OPERATION PERMIT
SYSTEM INSTALLED BY: µ
r
AUTHORIZATION NOJ, OPERATION PERMIT BY: DATE: '
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THATSYSTEM DES RIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE'
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREA ENT -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 05196 (Revised)
s:
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APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department
Environmental Healtfi Section
P.O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
i @ L5 ow 15
AR b 2000
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
.r' /./ 1 1/-\ I til. C r
1. Name to be Billed
Mailing Address
City/State/ZIP
2. Name on Permit/ATC if Different than Above
Contact Person
Home Phone
Business Phone
Mailing Address City/state/Zip
3. Application For: ❑ Site Evaluation 911
Improvement Permit/ATC
a. system to service: ❑ House ❑ Mobile Home ❑ Business
S. If Residence: it People
# Bedrooms
❑ Industry
❑ Both
i9' Other ..
M Bathrooms
O Dishwasher 1.1 Garbage Disposal II Washing Machin II Basement/Plumbing H Basement/No Plumbing
6. if Business/Indu try/Other: Specify type N People _ # Sinks
# Commodes. i Showers 1i Urinals r Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of Water supply: 0/ County/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes (�Io
If yes, what type?
***Ib1P0RTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY xP;F0:2,`riATlvi. REC1uES 1 ED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #
Property Address: Road Name / 4 ,i1 w,
t W/ g
City/Zip 41V
If in a Subdivision provide information, as follows:
Name:
Section: Block: I.At:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Date Property Flagged: �e— 6- —0 C,
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 1)3viiegounty He It Departmen
to enter upon above described property located in Davie County and owned byILLS
to conduct all testing procedures as necessary to determine the site suitabil' .
DATE ��� �DOU SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (I elude all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
so- ('0
Revised DCHD (07/99) 10
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No.
Invoice No.
~
P;3
/
PROPOSED
PARKING
/
198
AREA
~
----_' --_.`-°
�
� ry
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #: 990001085
Billed To: Faith & Victory Ministries
Reference Name: Tyler Lynde
Proposed Facility: Church Property Size:
PROPERTY INFORMATION
Tax PIN/EH #: 5729-85-3410
Subdivision Info:
Location/Address: N.C. Hwy. 601 N.-27028
200 X 100 Date Evaluated:
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
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
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RA'
REMARKS:
EVALUATION 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
Mois
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
DCHD 05/99 (Revised)
Parcel #: H40000000601
Davie County, NC - Basic Estate Search
. Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: H40000000601 Account #:8300266
Owner Information
Building:
Tax Codes
BXF•
HE PARC INVESTMENT GROUP INC
Land:
ADVLTAX - COUNTY T
Market:
4
652 US HIGHWAY 158
ssessed•
FIREADVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Unqualified
Improved 150,000
Property Information
1986 WD
Township
Land (Units/Type): 1.000 AC
MOCKSVILLE
[Address: 1687 N US HWY 601
Deed Information
Local Zoning
Date: 04/2011 Book: 00857 Page: 0079
Plat Book: Page:
Legal Description
PIN
1.43 AC HWY 601
53273410
Property Values
Building:
46,6001
BXF•
3,60
Land:
138,00
Market:
4
188 20
ssessed•
188 20
Deferred:
2011 WD
Sales Information
No. Book Page Month Year Instrument
Qual/UnQual
Improved Price
L 00331 0007 04
2000 WD
Unqualified
Improved 0
? 00857 0079 04
2011 NW
Unqualified
Improved 0
3 00857 0082 04
2011 WD
Unqualified
Improved 150,000
$ 00130 0191 02
1986 WD
Qualified
Improved 75,000
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
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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=1477090 8/10/2016