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4179 Hwy 601N, 1 • ky 44 "lv^1 ✓ i'- t <i ,a 'it Y v -'rwiT rr1 r'.{`r. , . AUTHORIZATION NO: DAVIE COUNTY HEALTH DEPARTMENT } Environmental Health Section PROPERTY INFORMATION Peunitt+�s P.O. Box 848 Name �`//� ,/�UiS Mocksville, NC 27028 Subdivision Name: Phone #:704-634=8760 oy- Directions to property:%T Section: Lot: 0'%U— AUTHORIZATION FORJAQ r E f y WASTEWATER Tax Office PIN:# ?61- 14 _ 49-!5 SYSTEM CONSTRUCTION r� Road Name:. Zip. Q **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/Authorization Number 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. ENVIRONMENTAL HEALTHSPECIALIST DATE ISSUED **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) 6348760. SYSTEM INSTALLED BY: APPLICATION FOR SITE EVALUATIONAMPROVEfi VATS f� Davie County Health Department lEnvironmental Health Section SEP 7 i� J�Vl�j P.O. Box 848 I 2 Mocksville, NC 27028 /V1rl { (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE P THE REQUIRED INFORMATION IS 1. Name to be Billed ANA J--�OL/ES Contact Person / � or ✓s �q U�4✓�'s Mailing Address 09 : l2kAC ' - C Home Phone /)I"V"/IC City/State/Zip , /Q Q-.� ;L703 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application Fot: [ ] Site Evaluation [ ] Improvement Permit & ATC [}moth 4. System to Serve: [ ] House [1Q Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People—M #Bedrooms_ # Bathrooms c Dishwasher [ ]Garbage Disposal [v]'Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: N41county/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [)' Yes [ ] No If yes, what type? CA r -�„� '�" M"Ar a d. e, EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **SAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 90 X U60 X 190 K 1(&v WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #o1 Z- - Lam_ - l�� Ss ; /�4 �O A. y P450( Property Address: Road ]Mame 40 i 5 /f—r 6el /✓ C-7A7r�n.5, ✓r �e� o ►./ �"}' � city/zip Nta e""' H & ,v C. Z?,O 8 j ;J e- c)P 7? look 4/- If in Subdivision provide information, as follows: Name: Section: Lot #: s-4-A-KYS 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 Davie County Health Department by Tay L,4ov� o fv to DATE 9 - 19 - 9 �% SIGNATURE_,A� Revised DCHD (06-96) upon above described property located in Davie County and owned all testing pAcedury¢ as necessary to determine the site suitability. THIS AREA MAY 13E USED FOR DRAWING YOUR SITE PLAN: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME,DATE EVALUATED _ PROPOSED FACILITY ,/f�JtY" PROPERTY SIZE f fA 6 SUBDIVISION ROAD NAME 6011211 Water Supply: On -Site Well Community Public tl� Evaluation By: Auger Boring r/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L, L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH o r Texture group Consistence r r Structure ,e Mineralogy• J 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_L SITE CLASSIFICATION: �/ EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 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 I 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 (01.90) ■■EME■EM■■EMEM■E■ ■■■■■■EM■■E■■■■M■ ■■M■■■ME■■E■■■■■■ ■MMMM■E■■E■■E■EM■ ■EMEMM■■■M■■EME■■ ■E■MEMMME■■E■ENM■ ■M■MEMMEM■■E■EMO■ ■■M■■M■ME■■■■M■M■ ■■E■■■■E■■■■EM■■■ ■■E■E■EMM■M■■■■E■ ■MM■■■E■■E■■E■■E■ ■MM■M■M■■MMMMME■■ ■MEMMM■■E■■EMME■■ ■■■■■EMEM■■M■■M■■ E■E■EM■E■■E■■EM■■ ■■■■■■ME■■M■■E■E■ ■ME■■■M■■■■■E■■M■ ■M■MM■M■M■■■M■■■■ ■■MMM■■■■■■■MME■■ ■E■■■■■■■M■■■■M■■ ■E■E■■■■M■■E■M■■■ ■M■M■■■■M■■EMM■M■ ■■■■■■■MESE■■■■E■ ■■■MEMO■■■M■■■■M■ ME ME No iii ii No ii NOME NONE OMEN ■■E■ ■■E■ ■E■■ ■■■MMM■ ■EMME■■ ■■MEMO■ ■MM■■E■ ■E■■EE■ ■MNEME■ ■■■EEE■ ■■■■■EMM■■■■■E■ ■■M■■EME■■■■MM■ ■■E■■ ■■ME■ME■ ■■EMM�i■■MMEME■ ■E■MEM■■■M■MME■ ■E■EM■■■EMEME■■ ■OMME■■MMEME■■■ ■MEM■■EMEMEM■■■ ■■EMO■ME■■■E■■■ ■■■■■■MEM■■■■■■ ■■M■■ ■■■E■EM■ ■E■■■ M■■■MME■ ■EMMEN■■MEMEME■ ■EMME■E■EMEME■■ ■E■E■■OMEMEME■■ ■■EM■■EME■■■■■■ ■■ME■■ME■■E■■■■ ■■■E■EME■■E■■E■ ■E■EMU■ ■■■■■ ■ ■■E■■M■■ ■M■■EMM■ ■MMM■■M■ ■■■■■■E■ ■■■■■M■■ ■■MM■E■■ iii Ems MEN ■■MEMMEM■■E■■ ■■MMM■M■■MM■■ ■■■■■■E■■■■M■ M■M■■M■■ME■E■ A■■■■■■■■■■■■ :X■■EE■■MM■M■ ■M■EE■MM■■E■■ ■E■M■■M■■ME■■ ■■■M■MEM■MM■■ ■■M■NE■■EM■M■ ■■■EMM■■EM■E■ ■■M■ME■■M■■■■ ■MNEME■ME■■■■ ■■M■M■■SOME■■ ■■■E■■EM■■■M■ ■■■■■■M■■■■M■ ■EII■■■ ■■11■M■ ■■MONS ■Ma,■M■ ■ENME■ ■E■NE■ ■E■M■■ ■■■N■■ ■■■EM■ ■MM■ MEMO NOME NONE MEMO ■E■■ ■ Parcel #: D300000032 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Vigw Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: D300000032 Account #:82515375 Owner Information Building: Tax Codes BXF: EA DANIEL Land: ADVLTAX - COUNTY T Market: 179 US HIGHWAY 601 NORTH ssessed: FIREADVLTAX -FIRE TAX Deferred: OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 11.950 AC CLARKSVILLE Address: 4179 N US HWY 601 Deed Information Local Zoning ate: 04/2000 Book: 00331 Page: 0595 Plat Book: age: Legal Description PIN 12.482 AC HWY 601 44220000 5822 -14 -6855 - Property Values Building: 77,4601 BXF: 901 Land: 91 59 Market: 16914 ssessed: 16914 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00176 0367 09 1994 WD Unqualified Vacant . 0 Z 00331 0595 04 2000 WD Qualified Improved 179,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 o ars 000riti-S 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/itsneWiew.aspx?prid=1471918. 8/10/2016