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DAVIE COUNTY HEALTH DEPARTMENT
r' IMPROVEMENT PERMIT and OPERATION PERMIT
j IMPROVEMENT PERMIT
r
**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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
y )
NAME t- PROPERTY ADDRESS bO%[Y . " �1 f �� V DATE ' •� -9
LOCATION �o b N C l� ain�. ��.o• �� ` Qc� `*�9
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE dus Q # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL.: Yes No
COMMERCIAL. SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE iso TYPE WATER SUPPLY. Cn . DESIGN WASTEWATER FLOW (GPD) -NEW SITE ✓ REPAIR SITE
SYSTEM SPECIFICATIONS: TANK'SIZE o00:GAL. PUMP, TANK GAL. TRENCH WIDTH .3 ROCK DEPTH y/a F LINEAR FT..Od
r r,
OTHER Y� a;
REQUIRED SITE MODIFICATIONS/CONDITIONS: y
***THIS PERMIT IS SUBJECT ?0 REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
ro
N1601
CvI.0
/Ou F.
• IMPRDVEMENTePERMIT BY
**CONTACT A REPRESENTATIVE OF'THE-DAVIE COtNJTY',HEALTH DEPARTMENT FOR -,FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1;30-P.M11 ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
AUTHORIZATION NO. O'�LV� OPERATION PERMIT BY DATE 1 1
**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 136A, 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 10/95
h
Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
1 P.O. Box 665
$,00
Mocksville, N.C. 27026
t
AUTHORIZATION FOR WASTEYATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
r
G.S. Chapter 130A, Wastewater Systems)
***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.***
R
`
S �= N ey CAS �Q
AUTHORIZATION NUMBER R=
MOO �� G AR NATE
N2, P. 1 4
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATIOI
COIENTS/CMITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
i
ff+MOTICE"* THIS AUTHORIZATION FOR WASTEWATER SYSTEM.CONSTRUCTION IS VALID FOR A PERIOD OF FIVE.(5)
YEARS.
. EWIROIENTAL HEALTH SPECIALIST
DATE
DCHD 10/95, t..
APPLICATION FOR SITE EVALUATION/IMPROVEMENT
Davie County Health Department
Environmental Health Section�++��nnr�
P. O. Box 665 1+� EP .�G 141993
Mocksville, NC 27028 yCT7l��Tt
1. Application/Permit Requested By JP -++e, -6AXYi
I_ n �iYlocKS�/�lle h1C 2�c�28
Mailing Address "'
CIO
AQ
Home Phone (q0q) L4q- q(c1& t Business Phone I'`luy) CROACL)
2. Name on Permit if Different than Above
.11
3. Application/Permit for: pd General Evaluation )(Septic Tank Installation
4. System to Serve: V/House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision /' :� US e, Section Lot #
�emenUPlumbing
No. of People ❑ Basement/No Plumbing
®
No. of Bedrooms 'Washing Machine
No. of BathroomsDishwasher
Dwelling Dimensions 15���d l� �� 59' �� El Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes
No. of Lavatories
No. of Showers
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: N/Public ❑ Private ❑ Community
8. Property Dimensions ACY'CS Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes N No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
•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
incur re from this application.
-2�4-L�
DATE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED OPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. W3,12. 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 of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine s ' e's suitability for a ground absorption sewage treatment
and disposal system.
DATE AGNATURE
DCHD (12.90)
DAVIE COUNTY HEALTH DEPARTMENT
` Environmental Health Section
Soil/Site Evaluation
NAME
\ • \ , un L •r��
ADDRESS tv.R
PROPOSED FACIILTY f\ a ° s"
DATE EVALUATED
9-D 'g- '�3
PROPERTY SIZE ``,,
LOCATION OF SITE b U I N
Water Supply: On -Site Well Community
Public
Evaluation By: Auger Boring y Pit V Cut
FACTORS
I
2
3
4
Landscape position
1 _
L_
Sloe R-�'
O-fi°
�r-�3
d'8
HORIZON I DEPTH
b'
Texture group
C L_t-
Consistence
FM
I�-
Structure
Q
C
Mineralo
.I
: 1
'• 1
'
HORIZON II DEPTH
D"
LI D_
Texture group
4�_'
t,
Consistence
FZ
$
F�
Structure
1c_
Mineralogy►
:�
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
s s
Ss
s --
RESTRICTIVE HORIZON
—
—
--
—
SAPROLITE
CLASSIFICATION
S
s
LONG-TERM ACCEPTANCE RATEI
I j Lj
SITE CLASSIFICATION: ��� EV�LUATED BY:
cY�
LONG-TERMACCEPTANCERATE: y OTHER(S) PRESENT:
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-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 watef 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
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Daae County Nealt!r De artment
l
"We
and .dome. Nea tl y cy
210 HOSPITAL STREET/ P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634.5985
September 29, 1993 .
Jeffery & Karla Barneycastle
Rt. 6, Box 289
Mockeville, KC 27028
Re: Site Evaluation
Off Highway 601 North/5 Acres
Dear Mr. & Mrs. Barneycastle:
As requested, a representative from this office visited the aforementioned
site on September 28, 1993. Based upon the information provided on the
application for a site evaluation and after an evaluation 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.
Sincerely,
Charles E. Little, R.S.
Environmental Health Section
CL/wd
Enclosure
Parcel #: F30000000501
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 4:F30000000501
Account #:4814000
Owner Information
151,7901
Tax Codes
118901
BARNEYCASTLE JEFFERY E& BARNEYCASTLE KARLA D
48,8801
ADVLTAX - COUNTY TA
202,5601
203 US HIGHWAY 601 NORTH
202,56CI
FIREADVLTAX - FIRE TAX
01
MOCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 4.840 AC
CLARKSVILLE
[Address: 3203 N US HWY 601
Deed Information
Local Zonin
Date: 07/1998 Book: 00204 Page: 0186
[Plat Book: Page:
Le al Description
PIN
5.00 AC US HWY 601
5811926851
Property Values
Buildin :
151,7901
BXF:
118901
Land:
48,8801
Market:
202,5601
ssessed:
202,56CI
Deferred:
01
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00170 0706 10 1993 WD Unqualified Vacant 0
>_ 00204 0186 07 1998 WD Unqualified Improved 35,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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uu ti -
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=1471987 8/9/2016