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4680 Hwy 601N (2)DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: -Issued in Compliance With Article I I of G.S. Chapter 130a anitary Sew ge ystems ..�; , , ; Permit,.Nuber Name �z'�Gj�c`i- 4� / S y S f`. /�� Data / — J bb -J L� N� Location t . Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _T Business __ Speculation No. Bedrooms \ No. Baths �� No. in Family _ Garbage Disposal YES NO ❑ Specificationsf r Sys em: Auto Dish Washer YES NO ❑ Auto Wash Ma shine YES NO " Type Water Supply __— 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by '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 day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion �` ` Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for,any given period of time. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 'Soil/Site' Evaluation NAME ZZ - DATE EVALUATED ADDRESS PROPERTY SIZE ZOO PROPOSED FACIILTY LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z — HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence41 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: ?"-S - / LONG-TERM ACCEPTANCE RATE: - �r REMARKS: DCHD (01-901 EVALUATED BY: //� // 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 ' Moist VFR-Very friable FR -Friable FI -Finn 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 Mineraloity 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/fU ■ ■ ■ MEMO NONE MONO ■■N■ ■ APPLICATION FOR SITE EVALUATIONAMPROVEI SENTS PERMIT Davie County Health Department up Environmental Health Section (� P. O' Box 665 SEP z 3 I "1 Mocksvil e, NC 028 DAVIE COUNTY HEALTH Dr 1. Application/Permit Requested By Mailing Address ZE0 ;b�s— fey sd'4�_ Home Phone m- 3 a Business Phone .2. Name on Permit If Different than Above 3. Application/Permit for: ❑ General Evaluation ❑ Septic Tank Installation 4. System to Serve: ❑ House ltd' Moblle Home O Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown S. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions1-41 �X ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public [Private ❑ Community 8. Property Dimensions &�2Z. w Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes E?/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: t 09O/ riOG %�/9�f r- - 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 Incurred from this application. Parcel #: C300000043 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: C300000043 Account #: 82527518 Owner Information BXF: Tax Codes Land: LLIS EUGENE ADVLTAX - COUNTY T 680 US HIGHWAY 601 NORTH eferred• FIREADVLTAX - FIRE TAX MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 1.660 AC CLARKSVILLE ddress: 4680 N US HWY 601 Deed Information Local Zoning Date: 07/2006 Book: 2006E Page: 0286 Plat Book: Page: Legal Description PIN 1.66 AC HWY 601 5823127165 Propertv Values Building: 131,22 BXF: Land: 25d84Market: 157ssessed: 157 eferred• Sales Information No. Book Page Month Year Instrument Quai/UnQual Improved Price L 00064 0518 02 1962 WD Unqualified Improved 0 2006E 0286 07 2006 WL 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 000riti-.1-6 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/itsnettView.aspx?prid=1486246 8/10/2016 77.-.- AUT; ORl-ZATION No 179 2� AV - ,* 4- -A ." f rt s r a IE-COUN i p< t DT �, N metteeti Ei1V1C011 HEALTHDEI'Ai\1 1� Iti mental Health MENT p �- .t Sectiop , trections P.O,,,$ p r to propeny. Mocksville�x g48 ROPE Tv 0I Phone# 33' NC 2702g FpR AUTHORIZ 6.751-87bp Subdivision N �TjoiV S WAST ATIONF acne: This YSTEM C E�'ATER OR Section: to issue a Bion fo ante (In corn Office u y gui r '�' ONSTRU�,�ION Tax O L ►Yater Office P Phance with hen aPPlyin ldingnnits. System Cons °t' IN:# Article 11 g for Buildi This Fo Utrctioh Road E of G.S. Chaptegl3 Airs. r"vAurhoryZatUNUmEGSS(/Epb Name: 4 yr waste ber sho y the p -_ RONMENT k ater SYste uld be Prese a vie Coun zip, . HEgLT r ms SS ' . Hied to the ry Envuan P. *** ba n H SPE AL1ST Dgls NOTICE*** on l Sewage Treat p e County B i de�� Section SEED THISA�NO mentandpispos �nginsp�XPricir ? IS VALID F� ZATIO�r p0 � SYstems� b R A pERI� OF ASTEyygT FIVE Y ER CON ..EARS STRUCTIOn� '� �;� � � ^_ r' ..r ''4`�:. -.�; �� . .,_,art,.. , 'i-t •"'� "-'n:.-= •r°P'ryt �: ,•r� t, ' Y7�`7 9 2d DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION "Name: Subdivision Name: s r „Directions to properfy;' '` 3 .�fir' Section: Lot:. t »" IMPROVEMENT PERMIT Tax Office PIN:# - _ Road Name: 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/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) ' ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER VIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.' ; RESIDENTIAL SPECIFICATION:BUILDING TYPE _ #BEDROOMS_-_7__#BATHS #OCCUPANTS GARBAGE DISPOSAL.Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) / NEW SITE ✓ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE / OD GAL. PUMP TANK GAL. TRENCH WIDTH �ZJ ROCK DEPTH /LINEAR FT OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT *APPROVUE T FILTER* *RISER(S) IF 619 BELOM FINISH5 GRADE*, **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)634-8760. xxxxxxxxx OPERATION PERMIT SYSTEM INSTALLED BY: `�� Lj r t. . I AUTHORIZATION NO.�/ �OPERATION PERMIT BY: DATE. *"'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 NOWAY BETAKEN ASA . GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) ' l 'T's"'•rfiN'iwC '1+A +`�. ».,^a^^, u-.r+„w• ;.,¢r rw+rw xr� Z•y, �;J, "Y�x e � /� � DAVIE COUNTY HEALTH DEPARTMENT f IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee'.s e Subdivision Name: Directions to properfy: �, ! r'' r ' Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name: 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/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) K ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS �Y�M # BATHS —,-2— # OCCUPANTS —!�/_ GARBAGE DISPOSAL: Yes or No F � COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)if NEW SITE REPAIR SITE t, SYSTEM SPECIFICATIONS: TANK SIZE ' 1 �GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH -Z= LINEAR FT -.1 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT **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) 634-8760. XXXXHXXXX OPERATION PERMIT SYSTEM INSTALLED BY AUTHORIZATION NO. -,�r` 1�{ " OPERATION PERMIT BY: DATE: **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) (Y,n AUTHORIZATION NO. -,�r` 1�{ " OPERATION PERMIT BY: DATE: **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) • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) --i:f- 1-7 NAME (-.S- PHONE NUMBER ADDRESS SUBDIVISION NAME LOT # ti DIRECTIONS TO SITE 0 ! A-.,/ DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING 0 011 Nl DATE REQUESTED INFORMATION TAKEN BY --,. This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 -71 , 4 QZ-7--f3 )