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2131 Hwy 601S (2)DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROV NT PERMIT , **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) NAME /7 r O/ /yJi9.t� �/D 77 PROPERTY ADDRESS IyO I S A 170 ;2V..DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE . tll.,f� # BEDROOMS # BATHS # OCCUPANTS- GARBAGE DISPOSALp<fe)/No COMMERCIAL SPECIFICATION: FACILITY TYPE'' # PEOPLE # PEOPLE/SHIFT # SEATS- INDUSTRIAL WASTE: Yes/No LOT SIZE S TYPE WATER SUPPLY 41 DESIGN WASTEWATER FLOW (GPD) 4101d NEW SITE t/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE.ills GAL. PUMP TANK GAL. TRENCH WIDTH 'GROCK DEPTH )'-2 'LINEAR FT. Ga OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***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. .. ,� IMPROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT AUTHORIZATION NO. 0 LA' j(n e - APFRATION PERMIT BY '� ?...]� DATE -1 1 (10 **THE ISSUANCE OF THIS ORATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPI.IANCE WITH ARTICLE 11 OF G.S. CHAPTER 136A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE AS A GUARANTEE THAT THE SYSTEM WILL FICTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 ."0t g 1.>6 ]r .�, `5 <<�_.,�! �. v �t'rs K. •v. . yi` .� ,.l .,A'r ��/"O -, .. �� Davie CountyHealthDepartment ENVIRONMENTAL HEALTH SECTION `' P. Dr Box 665 1 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of i, G.S. Chapter IsOA, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issuedbythe Davie County Environmental Health Section prior to issuance of any Building Permits. This Fore/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** ��6 NU BER NAME P/ />i/1.✓ DATE % /.�'�L NAUTFgR1ZAT0 6 NATE ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE*H THIS AUTHORIZATION F WA TEWATER SYSTEM CONSTRUCTION IS VVA'LID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL ?H SPECIALIST DAM . DCHD,10/95 • APPLICATION FOR SITE EVALUATIONAMPROVEMENT ****IMPORTANT**** Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. . 1. Name to be Billed -S A t e-11� A? A- - /1?/07-/-'/,� Contact Personm�,s� Mailing Address 3 / 4,5, A4- ► d S°� `}"1 Home Phone s` 0 40, City/State/Zip a t) CSS iLl _ ��� - 2--20'2--2 Business Phone 25 -2- 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip Application For:ite Evaluation [ ] Improvement Permit & ATC [✓Both 4. System to Serve: [ ] House Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People_ # Bedrooms #Bathrooms 2— [ ishwasher [ ]Garbage Disposal [�shing 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: [ ] County/City Kell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes 11.1K0 If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE '14a4 SUBMITTED WITH THIS APPLICATION. i Property Dimensions: %>>/� �� 1, WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # d CA, d/V � � �% Property Address: Road Name a . s,, . d 6 O / S ouy 11 - ✓a" City/Zip If in Subdivision provide information, as follows: Name: Section:Lot #: ' 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 c n uct all testing procedures necessary to determine the site suitability. DATE SIGNATURE ��yI , 4!ca Revised DCHD (06-96) H180N « ro a v roa `yj , e . k 1 « 22 b ry_ k � s g 3' jf 6 a i r 8z r V 06'9 0 T AS At g y, ✓ �7 x r r t ' o , x{ I L si b z « t 4R,« . �'V c , .31 t a.: rt sx S rw 4 a n a u l9 C:)� O CA Cw 00 — g} Cb0)c vv zS'Z 0Z a oe-0 x s� Aw,� T —80 _ - -- _ 11 0- s` c liL'l-t ` o m -- — ZZ'6GI I )-081 �'S z85!z �� rn �__. ,�LU y8 I'` O � sfT i a 2oCn l W ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health -Section .r' Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY DATE EVALUATED `�1o2`7S fi PROPERTY SIZE %/1-C�+�> LOCATION OF SITE / IGz�GS Water Supply: On=Site Well, di'� �/ _ Community Public -- 'Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH �' t Texture group Consistence 7e,;,L. Mineralogy y n, HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure . Mineralogy SOIL WETNESS , RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION f LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: A5 EVALUATED 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 Aay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR-.V,..ry 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 ■.■..■■.....■...■■.■■...■.....■.N■..■.■■ on MEMO .■O■■■U■ MEM■MO■ ■■■■■■M■■■■■ M■■A■■■■■.■...■■■■■�CCCCCC""'CCCCCCiiiiiiiiiiiiCCC .................................■■.■ESUS.■.■C■■■■■..■■.■.■.■..■.■ ..........................■■.......■■....■uC.MEN■MEM■MMUMMMUSEEM■ .......................................\■■. ■■C ■.. .■■■■M■■■.... ■■..■■■e■.■Ns■A■■N....■■■..■■■■\.s■C.s■as\ ■■M CM■MCMMMM■M■EM■MS■ ■■■■.■■■■■/■■/.■■\■.■■.■..\■■■■■ ■ .■.■■:■\.CE ■■C ■.■■MMMMM■■.■ ■■■..■■..■■■■...■.■.■■.■■.■■■■■■ N■■■■■■ .e. .■■. ■.SUES■N■.\■■ ■.■■■■.■■■.■■.■■.■■.■■■■■■■ ■■■■■.\\\.Uq■■.■.■ ■.■■ ■■. .■■■■■.■ ■.■■■..■■.■■■■.■■.■■.■■■.■....■■■■.■\■q.■ ... ■SUES =11■.■.■■■■■ ■\■.■.■.\\..■.■.■■..■.■■\..■■■\■ MESS\■\■ No ■CCC■ ■ NEM ■■■■MINN ■■■■■..■■.■■■■......../■■...■■.■C..■...■■C■.■ C.■o■■■■■■■ ■. ■■■■■■./■■..■..■.■■.■■.■■.\.■\■ MUSEUMN.ONUNUM■.MMOMOO ■■■E■ ME a■■■■N■.■OMNM\NMENMOO\O■OM.00■MME■S■UOO■ C/Oq CNMCCCCECME mom MENUMME E\OMu\■C\UUOE ■■■■■MM■MHMM■MM■M■.MMMM..MMMME■MEC■�■■.NM� ■.■■.■■■■.O■U.0.O.■■E.O■\.O■N.N.■MM\M.■.N..■O.\.M■\\N.N.M.O■U.\■U■■.M■S■M.M■\■O■.M.■.qUH■N■■■.MM\.E//O..\.M■S0.■E0.■E0.■S.■.■�■M■■■.M■HM.■NO■/EHHMNH■ME■■�O■ ■■EC■. 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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=1479088 7/29/2016 Property Values Building: 42,28 BXF: 36,24( Land: 97,64( Market: 176,16( ssessed• 176 16 Deferred: cl Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00128 0285 04 1985 WD Unqualified Vacant 16,500 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 �O U tZ,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/itsnet/View.aspx?prid=1479088 7/29/2016