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5226 Hwy 601N (2),.yth;s: o-ct a:-: .:•` ,:, .y: .r.,:r. _ -. . ,— .. �. x. a...: ... -, s _ ... jo 4 DAVIE COUNTY HEALTH DEPARTMENT. IMPROVEMENT PERMIT and OPERATION PERMIT�� "IMPR0V M T.IPERMIT **MOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater 1 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 kticle 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME .� Mi Cc, �. ry e �aS PROPERTY ADDRESS (r3 Q/ Al, , — 70,Q 9 DATE LOCATION GAL. TRENCH WIDTH r%� ROCK DEPTH �t LINEAR FT. 1?.�''�' ti. SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE ,"a# BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes to COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/,No LOT SIZE k . -, iI 1= TYPE WATER SUPPLY ►:1 '0. DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE)6ALr� 'PUMP TAMES GAL. TRENCH WIDTH r%� ROCK DEPTH �t LINEAR FT. 1?.�''�' OTHER r : REQUIRED SITE MODIFICATIONS/CONDITIONS: J ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. I^hl i� I � N L IMPROVEMENT PERMIT BY _ _:. , -*ar, •— �..� "` **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. OPERATION PERMIT AUTHORIZATION NO. C) '�A-9 INSTALLED BY H c� S 'Q` s�• \Ao w\ q 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. UL;tw 1V/ 1D ZT APPLICATION FOR SITE EVALUATIONAMPROVEIVIEN1 IE OW Davie County Health Department Environmental Health Section P. O: Box 665 2 5 1996 Mocksville, NC 27028 i7L 1. Application/Permit Requested By ; t% mS 1 Mailing Address _a�! I?< --v (,=3bS Y414 L PIZ Home Phone,L?_ ss el 2 7 a'5 Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation . P Septic Tank Installation Permit 4. System to Serve: ❑ House 2r Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. Ifhouse, m�bile home: Subdivision Section __Lot-#-� ❑ Basement/Plumbing No. of People - r ❑ BasemenVNo Plumbing No. of Bedrooms 2 Vwashing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions 6. If business, industry, place of public assembly, other: No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: ❑ Public Specify type No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures Private ❑ Garbage Disposal 8. Property Dimensions Sewage Disposal Contractor 9.., Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No i if yes, what type? , ❑ Community 'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change.. Effective October 1, 1989. Directions to Property: PROPERTY INFORMATION REQUIRED: Tax Office PIN: # 3Q I3-qq -,C$7) PROPERTY ADDRESS, as follows: 4 I Road Name: 6,6 Id E}-1►G1^ 1_2`, s op City: S+ IG r SUBMIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. 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. DATE SIGNATURI T CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY FHD CK ONE: �Y1'I OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: e consent to the authorized representative of the Davie County Health Department to enter upon above described ated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment l system. ` DATE SIGNATURE . DDHD �. r r• . 357 s •J� i O 01 2�0 (1.75 A) op 6`m Nim U53v INDEXE �Q (46.09 A) CQ ti 5402 Q co I N 100 to cn 2050 19 0-8 (89) 173 (912) �� (175) No (988) f ' r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAMEDATE EVALUATED �; R 111 ADDRESS P ccr. o PROPERTY SIZE 3) (o 1 y 021 PROPOSED FACIILTY X" C4 LOCATION OF SITE %OI N O(z Water Supply: On -Site Well _ Community Public Evaluation By:C C1,... Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S S Sloe % HORIZON I DEPTH 41 Texture group L_ CL Consistence "S - Structure 2 Mineralogy HORIZON II DEPTH 4W Texture groupC C Consistence _ Structure R Mineralogy HORIZON III DEPTH Texture group Consistence - Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 55 S .SJ RESTRICTIVE HORIZON-- SAPROLITE — CLASSIFICATION .5 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: • S • EVALUATED BY: LONG-TERM ACCEPTANCE RATE: —3 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 :lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Ve.-y 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 3C -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(01-901 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■eE.■■E■.■.E ■MEMO.■ ■.■■.■.■.EEE■■■■■■■■■■■■■.■■.■■■■■■■■■M■EEEs ■EE.■■EE■■EEE..■M■■.■ ■■■■■■■.■■■..■■■■■■■■■■■■■■■■■■■■.■t■.■t.EEt...EEEE■■.E■■■■NOEMENNEN ■t■ ■■■■.■■■■...■.....■O...O..E.■.E■..■■■O■EEE■EOE■EEE■■EEEEE.EEE■ENO � ■.■■■■.■■■■■■■■■■■■■■■■■■■■■.■■■ ■■■■■■■■.■EEEE■..■.■■■■.■■■■■■■■ ..................■........ ...................�....SEE...■.■■■■■■ ........................... ................... ■..■■■e■■.■■■■■E■■ ■■■■■.■■■..■.....■■.■■■■■■■■■■■..■.■■.Et■tEO■■ MMMMMMMM ■.■■.■■■■ ■.■.■■...■■.EEO■■■■■■EEMO..E■EE■.■.E■■■■�■■■_�■o■=eEEomM■eMEMM■II■■ ■■■■■■■■■........■..■■....■■.■.■■.■...■■ ..■ ■ ■■■■ ■.KNEES ■■ ■■..■■EOE■■■■■■■■■■t■■■■.■.■EEE■■.■....■■EEE■■.E■ ■■O■EEMEME■E■EM■ ■■■.....■■...■■■..■■.■■Kt..E.EE MEM.■■■eEEE.E■EEE■■EMEMMEMMEMEM■ ■.■■■..■■OK■■■■■■■■■■■■■■Ott■.. ■■■■■EOHEO■■...E...■■■.E.■■■EO■ ■a■■E■■.■.E.■.EK■E.EEtE.E■E■...EE.■..■■.■MMEmomma=E■■■■.E■.■■ME■■■ ■.■■■■■■■■■■■■■■■■■■■■■■EE■■.■tE.■■■■KEE■.EE■■EEE =EE■.EEEK.tE.E■■ MEMO■EEE.■■■■EE■■■■■EE■■■■■■■■.EEEEE�EH■EE�EE■EEe ■e■e■=E■ee■■E■.I ■■■■.■..■..■EEO■■.00Et.EO.O.EOKE..�■ ■MME■t ■E■H■■■.EE■ ERKE.t■ � ■■■■E.O■■■.■■E.00EEOEOE..Et.■■■■■■ ■E■ME■E■■■n■■■I■�MEMO■ E■■�ME ■ ■■■..■.KEEKO■■■■■■■■■■.EUOE.EO.O■O■■■■■EE■EEESE■E■ ■ MEMO OEM ■■■ ■■■■■■.N■■E■K■OO■■EM■■■KtO■■■■■�t■■■EHH�■E■H■NE■t■.EMONON■■ N �� ..vO■■■■■ ■■MEM■ mom�E..■■M.t.■■.■.■■■ NONE MEMERNME MI ....................■MEMO■.E■■QM►\■■.■EHE■M■EMEMMOM. ■MEEMO�■EMO■O� Ci MUSEUM iiiiiii ■■■■t...■■.■■■■..■■■■■■��w■nrw.■■■...i■■E.M■M■Ott■ E■tE■..�■ ■.■.■■■ ..t■�u■■EnEE■M■■■EM.t■■.■E■t■EE■■E■E��■■■■E.■ MIN.�■ mom HC.■E■t■■■ ■t■■ ■t.OE000.■■.M►�■t.■...■■■.■M■..M■MI/�■■.■■■.E ■N ■E.■II■■■■■■I MEN ■■■M■■■■■■E.M■■■E�.EEEE■r,�e•••O_ MENNEN ImirE E� MeSEUM � ■ .Oe�OMME=■■M■. . ... 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OMEN ■■■■■■N■■■■■■■■■■■■■■■■i�■■ ■I►�■■■ ■■■■■■■■.■■■■■■■■E■■u■■ ■ +i`•.ti.c ".1 J 4� "I Fy f ''��^.iti+ r� �.1ro Y.. .yy a.,; . p..i / �„ , ; �: �•.:ia i£�w-r;r(i fFry �. . -�..` �f0�. Davie County Health Department ENVIRONMENTAL HEALTH SECTION y, P.O. Box 665 Mocksville, N.C. 27028 / I AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of S.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 lldidding Inspections Office when applying for Building Permits.*** AUTHORIZATION NUMBER NAME \ 2 S N V,)-SDATE N2 0 a y7 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION &0N. COMMENTS/CONDITIONS N AUTHORIZATION TO COMISTRUCT WASTEWATER SYSTEM '+ z: **WICE*H THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ti Lj ENVIRON D1TAL HEALTH SPECIALIST DATE T7nCxn °'10/95 Parcel #: B30000005204 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 BIII Information Parcel #: 630000005204 Account #:21031750 Owner Information Tax Codes ADVLTAX - COUNTY T FIREADVLTAX - FIRE TAX ESKINS JIMMY L & DESKINS PEGGY 226 US HWY 601 N OCKSVILLE NC 27028 BXF• 45 Property Information Township Land (Units/Type), 1.000 AC li4ddress: 5226 N US HWY 601 CLARKSVILLE sses. 17,06 Deed Information Local tonin Pate: 03/1996 Book: 00185 Page: 0884 lat Book: Page: Le al Description PIN 1.00 AC OFF US HWY 601 5813992050 Property Values uildin • BXF• 45 Land: 12,56 arket: 17,06 sses. 17,06 eferred• Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved Price 1 00185 0884 03 1996 WD Qualified Vacant 6 500 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP. U11,07ri-I 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=1464367 8/10/2016