4610 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
•� �, A P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
`JJ IMPROVEMENT/OPERATION PERMIT
Account #: 990002283
Billed To: Kim & Jack Bledsoe
Reference Name:
Proposed Facility: Residence
Tax PIN/EH #: 5823-11-7152.KB
Subdivision Info:
jylr
P&,k
Location/Address: US Highway 601 N-27028
Property Size: see map
ATC Number: 3157
**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.
2DishResidential Specification: Building Type #People 7 #Bedrooms '?V #Baths --2—
Dishwasher:
washer: j!r Garbage Disposal: ❑ Washing Machine: I< Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #SSe�ats Industrial Waste: ❑
Lot Size Type Water Supply ��_ Design Wastewater Flow (GPD) 7' Site: New Repair ❑
System Specifications: Tank SizVgV GAL. Pump Tank GAL. Trench Width jj� Rock Depth pez ;Linear Ft,,W
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 - BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. &,o 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
12
C
Environmental Health Specialist's Signature:2a� Date: J Z
1
DCHD 05/99 (Revised)- �� . `� 0 �---
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002283
Billed To: Kim & Jack Bledsoe
Reference Name:
Proposed Facility: Residence
ATC Number: 3157
Tax PIN/EH #: 5823-11-7152.KB
Subdivision Info:
Location/Address: US Highway 601 N-27028
Property Size: see map
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 Fonm/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATE ONSTRUCTION IS VALID A 1j ERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
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 shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time. 3j ��D fX?e
r -
Septic
System Installed By:
Environmental Health Specialist's Signature :
DCHD 05/99 (Revised)
Date: .01// / /b
'IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #"t 2r,,,
Property Address: Road Name V
City/Zip
If in a Subdivision provide information, as follows:
WRITE DIRECTIONS (from Mocicsvillc) to PROPERTY:
Name:
Section: Block: Lot: Date Property Flagged: _ I� _0/�CTL,
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
to enter, upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site ita 'lity.
DATE S -6-0a SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
propertygincs and d43cnsio% structures, setbacks, and septic locations).
e-
p.; y-> Account Na.
.Revised DCHD (07/99) Invoice No. c::�-[ L�
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department Uj
D
Eavilwnmental Health Section
P.O. Box 848/210 Hospital Street
NN f 5 2! 1)
Mocksville, NC 27028
(336)751-8760
***IMPORTANT***
ENVIR NNM H
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE COUNTY
INFORMATION IS
PROVIDED. Refer to the INFORMATION BULLETIN for instructions.��;
1.
Name to be Billed
}� Contact Person YY �CJ�
Z (�e/�
o Ii w\,/too
Mailing Address
t"V
9 .S Home Phone % % 0(
City/State/ZIPV
Business Phone
2.
Name on Permit/ATC
if Different than Above
Mailing Address
City/State/Zip
3.
Application For:
❑Site Evaluation. ❑ Improvement Permit/ATC Both
4.
system to service:
>(Hfouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S.
If Residence:
# People_ # Bedrooms_ # Bathrooms
>eDishwasher IJ Garbage Disposal X'Washing Machine LI Basement/Plumbing II Basement/No Plumbing
6.
If Business/Industry/Other: Specify type # People # Sinks
# Commodes
# Showers # Urinals # Water Coolers
IF FOODSERVICE:
# Seats Estimated Water Usage (gallons per day)
7.
Type of water supply: County/City ❑ Well El Community
8.
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes o
If ycs, what type?
'IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #"t 2r,,,
Property Address: Road Name V
City/Zip
If in a Subdivision provide information, as follows:
WRITE DIRECTIONS (from Mocicsvillc) to PROPERTY:
Name:
Section: Block: Lot: Date Property Flagged: _ I� _0/�CTL,
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
to enter, upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site ita 'lity.
DATE S -6-0a SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
propertygincs and d43cnsio% structures, setbacks, and septic locations).
e-
p.; y-> Account Na.
.Revised DCHD (07/99) Invoice No. c::�-[ L�
...C. C. Bledsoe
a/w Hekri,W.'Bledsoe
DB 1420PG83
3/4'EIP
Tax ;Lot .47
T61 M
T _ \ -
Gary-Bledsoe
aJw Annette K-Bledsoe .
DB 177 OPG 399 `
6
3/4"EIP(bent).
l 99'. North,of Property. lJne
co
of :,Tax. Lot .fib
Tract 1
2.000 res+/
Inclusive of road
ts
New Lot Una
7ota1
i
100 E..-
- „417.07
Part of:Tqx Lot :6
^
Tract` 2 _
1.817.Acres+, .--i nctusNe of rood
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//! pot�bM,M3iV'wµ°nN
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92:52' sp'�'
P 6`nN
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
SoiVSite Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990002283 Tax PIN/EH #: 5823-11-7152.KB
Billed To: Kim & Jack Bledsoe Subdivision Info:
Reference Name: Location/Address: US Highway 601 N-27028
Proposed Facility: Residence Property Size: see map Date Evaluated:
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut e�
FACTORS 1 2 3 4 5 6 .7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 3p !' V <t
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: �� EVALUATION By:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS: r
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
Mineraloev
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
ME
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Parcel #: C30000006802
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search +Q
View Property Record for this Parcel View Man for this Parcel View Tax Bill Information
Parcel #: C30000006802
Account #:82519347
Owner Information
BXF:
Tax Codes
Land:
BLEDSOE KIMBERLY
Market:
ADVLTAX - COUNTY T
ssessed:
610 US HIGHWAY 601 NORTH
Deferred
FIREADVLTAX -FIRE TAX
MOCKSVILLE NC 27028
Pro a Information
Township
nd (Units/Type): 1.920 AC
CLARKSVILLE
ddress: 4610 N US HWY 601
Deed Information
Local Zoning
ate: 09/2004 Book: 2004E Page: 0922
Plat Book: Page:
Le al Description
PIN
2.000 AC HWY 601
5823117252
Property Values
Building:
133,6101
BXF:
of
Land:
26,11
Market:
159 72
ssessed:
159,72
Deferred
Sales Information
Vo. Book Page Month Year Instrument Qual/UnQual Improved Price
00433 0001 08 2002 WD Unqualified Vacant 2,500
2004E 0922 09 2004 DC Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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oP�r�
r'
oaU��
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=1456445 8/9/2016