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2651 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT P d e -"TO -0 Environmental Health Section • P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000726 Tax PIN/EH #: 5820-25-7688 Billed To: Robert Hollis Subdivision Info: Reference Name: Robert Hollis Location/Address: U.S. Hwy. 601 K-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2150 **NOTE** This Improvement/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 ,mirt #People #Bedrooms y? #Baths -- Dishwasher: Er Garbage Disposal: Cd' Washing Machine: 21" Basement w/Plumbing: O Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: E3 Lot Size Type Water Supply ��_ Design Wastewater Flow (GPD) Site: New � Repair13 System Specifications: Tank Size/9d? GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width 36- ' Rock Depth/-.�i ~ Linear Ftg� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** F Environmental Health Specialist's Signature: Date: / /tgr DCHD 05/99 (Revised) W Account #: 990000726 Billed To: Robert Hollis Reference Name: Robert Hollis Proposed Facility: Residence ATC Number: 2150 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 hospital Street Mocktsville, NC 27028 (336)751-8760 Tax PIN/EH #: 5820-25-7688 Subdivision Info: Location/Address: U.S. Hwy. 601 K-27028 Property Size: 1 Acre 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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION CION�STTRRUCTION IS VALID FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signature: Date: 6-/6 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 s O WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. loo, Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: 1215 APPLICATION FOR SFFE EVALUATION/IMPROVEMENT PERMff & ATC D U U Davie County Health Department Environmental Health Section AUG i 81999 P.O. Box 848/210 Hospital Street PApe! Mocksville, NC 27028 d f (336) 751-8760 , ` ***IWORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. •1. Name to be Billedd 1 Contact Person f7 Mailing Address Al -'7J—'7 AD `Q—Al Rom P" City/state/LIP Business Phone 2. flame on Permit/ATC if /Different, OLS Above/�SS��n e- f7 Mailing Address r,(t!/ Cy VLS p 4 Com'" /Y Cityfstate/EiP � 3. Application For: P Site Evaluation ❑ Improvement Permit/ATC Both e. system to service: A House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: i People # Bedrooms _ Bathrooms Dishwasher Garbage Disposal Xwashing Machine O Basement/Plumbing ~� U Basement/no Plumbing 6. If Business/Industry/Others specify type # People # sinks #i Commodes f showers i Urinals • Yater Coolers IF FOODSERVICE: # Seats Estimated stater Usage (gallons per day) 7. Type of water supply: x County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONN,S/(from Mocksvilie) to PROPERTY: Tax 011ice PIN: # .s �' D -- –• Wog Property Address: Road Name ,i Cod Iol /%%c - Cityrip d If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: Z5 —/d- --$7 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 1, also, understand that I am responsible for all charges Incurred frons 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 conduct all testing, procedures ass necessary to determine the site a bility. DATE 'r 1 "/ SIGNATURE ' 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: I EHS: Revised DCHD (07/99) Account No. 2.26 Invoice No. 90.3 it, SITE • / %4M_ / \ A10 SCALE / \ VPCMYFrY MAP / \ O EDMONIA HOLMAN HOLLIS & \\ / ROBERT JAMES HOLLIS / D.B. 78 Pg. 176 / / I y�3bL 6� NEW IRON SET I NEW IRnN I I EDMONIA HOLMAN HOLLIS & SET I ROBERT JAMES HOLLIS I D.B. 78 Pg. 176 I I �3e J� a NEW IRON SET = 00 NEAR EDGE OF PAVE. �- Zm 0 o.. r Ww N� o w Ste. l'IRON FOUND 14' .BEST OF CENTER DAME COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000726 Tax PIN/EH #: 5820-25-7688 Billed To: Robert Hollis Subdivision Info: Reference Name: Robert Hollis Location/Address: U.S. Hwy. 601 N.-2 028 Proposed Facility: Residence Property Size: 1 Acre 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 $ iw Mineralogy'1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION C LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: U 7 LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: ! `a Ij 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 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) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) i ■ ■ ■ ■■■■■■■■■■M■■Me■MMM■■M■■M■MM■■■■■■■■■■■■■■■■■■■■■■■■■Mte■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■www■■■■■■■■■■■■■■■■■■■■■■■■■w■■■w■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■tea■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ iiiiiiiiiiiiiiiiiiiiiii�iiii::��■■■■■■■■■■■■■■■■■■■■■■■■ ONEEM iMEMNONMEMEMEMINMEME MEMMEMIMMEMEM MEMMME SEMEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■ilii■ilii■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ s■■M■■■M■■■MMM■■■■■■■■■■■■■■■■■■■■■■■■■SEN■■■■■■■■■■■■■■■■■■ ■■■MME■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMOS ■■S■■ ■■■E■ ■■■■■ ■■■■■ ■e■■■ ■■■■■ ■■■■■ ■E■■■ ■■■e■ ■■■■■ NONE ■■N■ ■■■■ SEEN NONE ■M■■ Parcel #: F300000108 A Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: F300000108 A Account #: 36460000 Owner Information 235,8301 Tax Codes 5,6501 HOLLIS EDMONIA HOLMAN& HOLLIS ROBERT JAMES 64,4901 ADVLTAX - COUNTY TA 305,9701 651 US HIGHWAY 601 NORTH 305,971 FIREADVLTAX - FIRE TAX OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 7.130 AC CLARKSVILLE Address: 2651 N US HWY 601 Deed Information Local tonin Date: 09/2011 Book; 2011E Page: 0905 Plat Book: Page: Legal Description PIN 04 AC HWY 601 5820257688 Property Values Buildin : 235,8301 BXF: 5,6501 Land: 64,4901 Market: 305,9701 ssessed• 305,971 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00078 0176 07 1967 WD Unqualified Improved 0 Z 2011E 0905 09 2011 DC Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 Q vt� 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/itsnet[View.aspx?prid=787717 1 8/17/2016