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5332 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001747 Tax PIN/EH #: 5813-89-7885.01rh Billed To: Randy Hauser Subdivision Info: Reference Name: Location/Address: Highway 601N-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2929 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 Form/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 WASTEWA CONSTRUCTION IS VALID PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 17—�� ell) 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. / J y � X9Y/a'� 1 - Septic System Installed By: xF-&A— ,1 �J V -!Y ri,/� Environmental Health Specialist's Signature : Date:'�i DCHD 05/99 (Revised) Account #: 990001747 Billed To: Randy Hauser Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 U/ (336)751-8760 V� IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5813-89-7885.01rh Subdivision Info: Location/Address: Highway 601N-27028 Property Size: see map ATC Number: 2929 **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. Residential Specification: Building Type /7 #People 4 #Bedrooms J #Baths Dishwasher: ff" Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply IVIl/ Design Wastewater Flow (GPD) (ZMd Site: New Repair ❑ System Specifications: Tank Size /M# GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width ff6 " Rock Depth /- " Linear Ftp IMPROVEMENT/OPERATION PERMIT LAYOUT -APPROVED EFFLUENT FILTER RISER(S) IF 6 -BELOW C FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Ae,l sl�ls=�i� a Af 05r1Pe Environmental Health Specialist's Signature: Date: 712/0 DCHD 05/99 (Revised) w _ APPUCAinON FOR SITE EVALUATION/IMPROVEMENT PERM CE l`9 Davie County Health Department Environmeafa/ Health Section 5 e Y P.O. Box 848/210 Hospital Street�� Mocksville, NC _27028 ' C-� (336) 751-8760 0�� AL HEALTH INR .Nre,6mv I ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS Alrir?!!l-MQUIRED I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for/Li�n�rspt+ru�c�tions. 1. Name to be Billed ReNI)L( Hntocr' Contact Person `^� G�( cif Mailing Address o . y -pepq r,doe j�� �� Home Phone :h36 ^ 1(0,3 City/State/ZIP 1`1 I h 0 7t` 5 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address Ci /state/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both a. System to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People 3— # Bedrooms 3 # Bathrooms ol- W–Dishwasher 1-1 Garbage Disposal tr Washing Machine ❑ Basement/Plumbing ❑ 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 Bell ❑ Community B. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 'N-N'o If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW.. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: %—� �^ 9�� WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: #/ r/ 3,_ ( �(PS•ol X00/ 11f. fatc��2DS 5cin�r��e 1 Property Address: Road N me Just �4� City/Zip 0 faq t, If in a Subdivision provide information, as follows: Name: Section: Block: Lot: a Date Property Flagged: 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 1, 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 o:•rsscd by to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE 011a, THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 4-- Site Revisit Charge j S t Client Notification Date: EHS• Q�ccountNo. I �! 79 -7 Z Re sed sed DCHD / ) C� e �` oA� Invoice No. 3 / 9 s I A I IV -11, Angle Iron Tax, Lot 6.07.* Tax map -B-3 rilf James A4.4hisonant, II/ . and 'wife Mailo L Whiso'nont DB 185.0 PG 355 Found �2.�¢= E` / 11211 OR S Oso r. /.20, 112".1 EIR Part of Tax Lot 6. 10 - OIN Parcel 1 eom 2.091 Acres D �oe�i C) y V x Ie Iron fund 4�ee.�, 372.58' 41 z Par Tdx.,L( Pat 1.836 i nn - L=t1"C �S � �% APPLICATION FOR BitE EVAUIAMON/1MPROWMENi PERMIT is ATC Davie County Health Depattment NOV 2 3 1999 r Ll -7 3 3 Envfravtmanar! Haanith SKOon O 6c A 9.0. Box 649/210 Hospital Street Aof 1 Hookoville, VC 67026 1—�Ok ins (296) 9131-9760 Or"219VItTAtn"t Tnts ANTLICR21Cbi Cato= 8m Vr4=8S= UNI.t88 stns. Tilt IMQUI su wrOMTIMI I8 IMOVIDiM. Rotor to the INT VMTION 13ULLITIN for instructions. 1. Sones to be Bitted TI m0T4-1 VI Coatwot swoon JSd SA,,1 PAA-ILE2'y- Nailing xdwhmsa 88 /1`) C;) VAC 1-1 �D t�oN rtwe►a 3 3!0 - -7 S 1. 3 a 3 0 city /statelasts 140 G V-,S,%1� -7U Z (5 swsA... "3± % 5 ( - `l L1 t1 U / fir`% :. steer on tess<it0m is Dile:eat than &bow. Neilieg sddrsss / CiJ!?/slate/tip 3.Appliostion Tor: H tits ItTaluation lel improve2ant Await/nc euoth t. stetan to sessioes 0 House 6t Mobiles Boas ❑ Business ❑ Industry ❑ Other a. It 'Residences 6 Veople i Bedrooms 3 e Bathrooms Z (/ Dieltratbos U Oasbage Disposal Vt-,ws A" wo3i n Mw"s t/piwbing a ww.thto plaabioq e. is aa4"wes/2n&wtry/otb"1 spsaitt type 1 people # sinks I Commodes a $horses f Usinals i watst C00410ts Ir 100083av Cit f seats lstimted hater Usage t9►11ons psz day) 7. Type of water supplys ❑ County/City Ila well ❑ Coxmunity a. Do you anticipate addition or espausioas of the 4cWty this system Is Intended to terve? ❑ Yes ❑ No Uyes, what type? AAeIMPOR1ANT*e• CUVM M1x COMPLEBMT116 REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Kitber s PLAT or SITR PLAN MUST RE SUBMITTED by the client with THIS APPLICATION. Property Dimemiow s5 et = 5 LA, T / WRITE DIRECnONS (from Mocknille) to PROPERTY$ Tel OtAce PINS N 58 C3 - 87 - -7 88 2-., TA %C.E V 5 t-1 vil &01 r-! O rt--rt4 Property Address Rad Name V S I) vJ `/ 6 0 j V -a o e1, /yIn t<1C.5 4 t L.Lt: To vi ASD Cityalp 610C 1 LL- Aj61Z7oZ8 JA t L N Cp , ��tt-Cx C.S ,�iLi= 1 I U in a Sabdh+b(os provide Islbrmation, as fbllomt O 1J T A 41 /WX i ✓vkA Tr L Namet T\ AA. 0 Ti-ly F. % � i (�A4A61t-r f w�' Set", Block: Lot: PF rtCEU IL Date Property Flsggedt Tib b to cef ft that the iafbrmattaa pra►Wed Is correct to the best of my IcMtvledgL I understand that any permits) Issued hereafter are subject to suspension or revocation, It The site plans or Intended ase cbnnge, or if the larormation submitted in this appilcatios b fabified or changed I, sbo, anderstaad that 1 am responsible for aU charges Incurred frons this appUcatloa. %hereby, give consent to the AuthorisedRepresentathl of the Davie County Health De $rtment to enter upon above described property located In Davie County and awned by -rM o-rq:1 �. Tull -F= to conduct all testing procedures as necessary to determine the site suitability. BATS n, (1-� "cj c% j SIQNATIJRE TM ARBA MAY 11IR USRD FOR DRAWING YOUR BIM PLAN (include all of the follmdugt 1xisting and proposed property tines and dlmeuslous, structures, setbacks, and septic loattlous RevbW DCHD (9714M) Site Revisit Charge we(s)t Iaient Nodfication Date: ERB: Account No. Uy Involce No. 1� i' Tax Lot 6.05 Tax M i n/f James H. Gentry / nod wife / Barbaro S Gentry DB 184.0 j j96 PG 625 A ss, W/4" E/PTax Tox Lot X07 maps -i n/f Jones M. Whisonant, ly and wife'I ,5�, F Maria L k1sonant D8 185 0 PG 355 1" x 1" Angb lron Op. / Found �1� Tax Lot 6.11 1/2" ER SLh� Tax Mop B-3 n/f United Statea of America DB 307 0 PG 476 Tox Lot 4 Tax Map B-3 n/f William Scott Pratt B° ^ /lssrOl`o/ ?• 08 191 O PG 687 1/2" E!R / kry�4� ~F Part of Tax Lot -6.10 / / .N Porce/ 1 q� 2.091 Acres +/— N W 1/2" DR Part of Tax Lot 6.10 �, Tax Tax :1 n/f, = Parcel 2`i 1.836 Acres +/— N -�Betty and i DB 1 Angle /run Found 176.99, C� 372.58' � J o, N N 29.07 30"W 372.57' N 29.0713011W APPLICANT INFORMATION Account #: 990000879 Billed To: Timothy Ruiz Reference Name: Timothy Ruiz Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5813-89-7885.02 Subdivision Info: Location/Address: U.S. Hwy. 601 N.-27028 Property Size: 1.836 Acre Date Evaluated: On -Site Well ✓- Community_ Public Cut FACTORS 1 2 3 5 6 7 Landscape position Slope % t HORIZON I DEPTH �� ♦� Texture group Consistence Structure Mineralogy HORIZON II DEPTH / 't '� y Texture group Consistence _ Structure bdbll /G Mineralogy HORIZON III DEPTH Texture group Consistence 44 Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE _ 2 SITE CLASSIFICATION: a___. ��"�' �lS/S'�Z 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 Mois 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 Mineralog 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) ■ME■MEM■■E■E■M■ ■EMMEMEM■■M■■M■ ■■MEMO■■■■■MEM■ ■MME■■■■■■■MM■■ ■■Mee■■■■■■■EMM ■■■M■■■■S■■■■■■ ■■■■■■■Ms■■Me■e■■■EMM■■■■■■ Mee■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■see■■■■■ ■■■■■■Mr-i►a■■■■�■■M■■■■Mee■■■ MEMO ■■ONE ■■■■■■■■■■■■■■■■■■ ■■E■■■■O■■i■■■M■■E■M■e■■■e■■■MME■■■■ ■■M■■■■■■■■■M■■■■■■Mee■■■■E■MMM■�■ ■M■■M■■M■■■■■■■■■■■■■■■Mee■■■■■■ ■ ■■■■■■■■■s■■■■■■■■■■■■■■■■■SMS■■■■■ ■■■■■■■■■Mee■M■■■■■■■■■■■■■■■■■■�■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■Ms■■■■s■■■■■Mee■■M■e■■■M■■MM■■E■ MEMNON EMEMEM MEMEME iicai i m ■■■■■■■■■■■■■■Mee■■■■i■■■■■■■■■■■e■■■■■■■■■■■■■►■■■■■■ ■■■■■M■■M■■■■■■■■■►.■M■■■■■■E■■MM■■E■■MME■■■■■■■■S►�tM■■ ■s■■■■■E■■■■■■s■■i■■■■■■■■■■■Mee■■■■s■■■■M■■■■■■■■■■��■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■MOs■■■■■■■■s■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■MMM■E■■■O■■■■��■■■■■E■■O■M■■■■■M■■■■e■MM■■■�■■■■ ■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■Mee■■■■■■■■■■■M■■■�■■■■■ ■■■ MEN MEN ■■■ ■■■ ■■■ i ■■■■■■■■■■■■■■■■■■S■a■■■■■■Mee■■■ ■■■■SMS■■■■■■■■■■■■■■■■■■■■S■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ DAME COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 December 8, 1999 Timothy F. Ruiz 588 Main Church Road Mocksville, NC 27028 Re: Site Evaluation/US Hwy. 601 N. Tax Office PIN: #5813-89-7885.02 Dear Mr. Ruiz: As requested, a representative from this office visited the aforementioned site on December 8, 1999. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, X04".A vs. o4aA. Robert B. Hall, Jr., R.S. Environmental Health Specialist Enclosure(s) Parcel #: B30000000610 Davie County, NC - Basic Estate Search .Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: B30000000610 Account #:82515714 Property Values Tax Codes Owner Information HAUSER CHARLES RANDALL& HAUSER MARCIA 0 ADVLTAX - COUNTY T 26,470 5332 HIGHWAY 601 NORTH 81,790 FIREADVLTAX - FIRE TAX 81,790 OCKSVILLE NC 27028 0 Property Information Township Land (Units/Type): 2.090 AC CLARKSVILLE ddress: 5332 N US HWY 601 Deed Information Local Zoning Date: 11/2000 Book: 00351 Page: 0135 -- Plat Book: Page: Le al Description PIN 2.091 AC HWY 601 N 5814805182 Property Values Building: 55,32 BXF: 0 Land: 26,470 Market: 81,790 ssessed: 81,790 Deferred: 0 Sales Information lo. Book Page Month Year Instrument Qual/UnQual Improved Price 00196 0661 08 1997 WD Unqualified Vacant 15,000 00351 0135 11 2000 WD Qualified Vacant 15,000 Page 1 of 1 oP�t1 00 OU0 Davie County Web Site View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 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=1475922 8/16/2016