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DUTY HEALTH DEPARTMENT
Environmental Health Section
PROPERTY INFORMATION
P.O. Box 848
Mocksville,, NC 27028
Subdivision Name:
Phone #: 704-634-8760
-
Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Tax Office PIN:#
Road Name: of f' ' 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/AuthorizationNumber should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTA :HEALTH SkCIALIST DATE ISSUED
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Tt DVIE COUI�TYALTI DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
ht e ' t
ame _ l -NAP) liCir1 Subdivision Name: '
Diirecgons to property: Section: Lot:
EWPROVEMENT
PERMITTax Office PIN:#
Road Name•��� A • Zip:
**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/mstallation of a system or the issuance of a building permit
(In compliance with Ardcle.11,of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems)
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AUTHORIZATION Ng --9 ` t � OPERATION PERMIT BY: DATE:—A-7
"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)
�► APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
i 1. Application/Permit Requested By
Mailing Addre
Home Phone
Davie County Health. Department
Environmental Health Section
P. 0. Box 665
Mocksville, NC 27028
2. Name on Permit if Different than Above
3. Application/Permit for: - ❑ General Evaluation Septic Tank Installation
4. System to Serve: C,4oXuse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
No. of Bathrooms //--
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
Section Lot #
asement/Plumbing
�❑ Basement/No Plumbing
6'Washing Machine
ta'Dishwasher
❑ Garbage Disposal
No. of Showers Water Usage Figures
7. Type of water supply: ❑ Public ❑ Private o munity
8. Property Dimensions f Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes A 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
incurred from this application.
DAT
and I understand I am responsible for all charges
,TU
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 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 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 said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE
DCHD (12.90)
SIGNATURE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
ArrLICANT'S NAME DATE EVALUATED ` f "0!7
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION ROAD NAME(%� /Y
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Jappo� Pit L/ Cut Lam_
FACTORS
1 2 3 4 5 6 7
Landscape position L
Slope %
HORIZON I DEPTH
Texture group,L
-GtL
Consistence
Structure
%l
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 RATE: i
REMARKS:
DCHD (O1-90)
EVALUATION BY: -0 Z
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
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Parcel #: E30000003501
Davie County,. NC - Basic Estate Search
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Parcel #: E30000003501
Owner Information
HOFFNER MONICA H
724 US HIGHWAY 601 NORTH
MOCKSVILLE NC 27028
Property Information
Land (Units/Type): 1.690 AC
ddress: 3724 N US HWY 601
Account #:82517106
Tax Codes
ADVLTAX - COUNTY T
FIREADVLTAX - FIRE TAX
Township
CLARKSVILLE
Deed Information Local tonin
Date: 06/2001 Book: 00375 Page: 0713
[Plat Hook: Page:
Legal Description PIN
1.748 AC US HWY 601 N 5821098684
Property Values
Building."
117,4501
BXF:
4801
Land:
24,54
Market:
142 47
ssessed:
142 47
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00194 0528 05 1997 WD Unqualified Vacant 0
2 00375 0713 06 2001 WD Unqualified Improved 0
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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=1476907 8/17/2016