2162 Hwy 601S (2)44
Penfiittee'ir DAVIE COUNTY HEALTH DEPARTMENT 1
Name: Q Environmental Health Section PROPERTY INFORMA I N
P.O. Box 848 Q
Directions to prope�ty: �nr`�� !'' Mocksville, NC 27028 Subdivision Name: P61,
Phone #: 336-751-8760
AUTHORIZATION NO: 002711 A
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
Road Name (� rp I. Zip:
**NOTE** 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 Building Inspections
Office when applying for -Build irrg'Pegnits.
(In compliance with -Article I 1 oflCi.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
,xel IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRON E AKH H SPECIIAJI ISDATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE r� �� # BEDROOMS 25 # BATHS -# OCCUPANTS ;-- GARBAGE DISPOSAL: Yes or No
COMMERCIAL
//SPECIFICATION: FACILITY TYPPEE� # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes
or No
LOT SIZE � ` 02CTYPE WATER SUPPLY `'�"��DESIGN WASTEWATER FLOW (GPD) D NEW SITE REPAIR SITE r
SYSTEM SPECIFICATIONS: TANK SIZE] GAL. PUMP
/TANK
' GAL. TRENCH WIDTH )t-^.-.� ROCK DEPTH �JIA LINEARFTS." 2Z�S[/��
V J 5)-p eo 10-J&
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
N•►a:
t'`751
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1 VIA%
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: Beak,
1�
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AUTHORIZATION NO.71/OPERATION PERMIT BY: DATE: `, 1.2-3 --,V9
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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 07/02 (Revised) �(il/I W• .-Q 1 U" " 75'0
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r 0-10guthttee s"r` DAVIE COUNTY HEALTH DEPARTMENT (� ✓V
Environmental Health Section PROPERTY INFORMATI N
- / P.O. Box 848 _f t�/Q
T- Directions to property: ” r'I - '� -� Mocksville, NC 27028 Subdivisi n.Name: l I r
h�� Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
s WASTEWATER Tax Office PIN:# - �-
SYSTEM CONSTRUCTION
r AUTHORIZATION NO: 002711 A Road Name: /(-
**NOTE** 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 Building Inspections
Office when applying for Building-Perinits.
(In compliance with Articlejl I o G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
t ,
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
11 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTA!< HEA H SPECIALIST, -`')DATE ISSUED'
RESIDENTIAL SPECIFICATION: BUILDING TYPE f 1-12U)[l # BEDROOMS _ # BATHS # OCCUPANTS -' GARBAGE DISPOSAL: Yes or No
s
COMMERCIAL SPECIFICATION: FACILITY TYPE-# PEOPLE # PEOPLE/SHIFT1 # SEATS INDUSTRIAL WASTE: Yes or No
�r
LOT SIZE �% " "`I YPE WATER SUPPLY ���t DESIGN WASTEWATER FLOW (GPD)NEW SITE REPAIR SITE
r I
SYSTEM SPECIFICATIONS: TANK SIZEj� ______GAL. PUMP TANK GAL. TRENCH WIDTH' JROCK DEPTH t ;A LINEAR FT. 2 Z'S
REQUIRED SITE MODIFICATIONS/CONDITIONS:
1 D
IMPROVEMENT PERMIT LAYOUT
t
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tj
x,Flj
N,
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: , IBJ P &C k
AUTHORIZATION NO. --OPERATION PERMIT BY: ° DATE: /sr 23 'a5r-
**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 TIME SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
r•
DCHD 02/02 (Revised).Aee7 .1f ,.. .. �,
NAM
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION, j� ��L� ?7L--q&0�
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
93 PHONE NUMBER`S
ADDRESS_ Cg/&Z IIS &WV &101S, V� OIIe SUBDIVISION NAME
LOT 0f Le- 0, &6-46
DIRECTIONS TO
w.r n,. 1
DATE SYSTEM INSTALLED&O t AlWNAME SYSTEM INSTALLED UNDER
TYPE FACILITY O S& NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY (:OC(ifi SPECIFY PROBLEM OCCURRING JW
/v 1AJ Ad,). bum e xoly -
DATE REQUESTED /A INFORMATION TAKEN BY,
0.
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. 1193
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APPLICANT INFORMATION
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
PROPERTY INFORMATION
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Public J
Cut
FACTORS
1 2 3 4 5 6 7
Landscape. position
L
Slope %
HORIZON I DEPTH
Texture group(�
Consistence
Structure
Mineralogy
HORIZON 11 DEPTH
Texture group
Consistence
Structure
G
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture groupC�
Consistence
Structure .
Mineralogy
SOIL WETNESS
^-
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
fl
SITE CLASSIFICATION: 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
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3y -d
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
Mineralogy
1:1, 2:1, Mixed
]�te�
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 DCHD95/05 (Revised)
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Parcel #: L510OA0033
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: L510OA0033
Account #. 41248250
Owner Information
BXF•
Tax Codes
Land:
ONES LARRY W& JONES ANGELA K
EMOCKSVILLE
Market:
ADVLTAX - COUNTY T
ssessed•
162 US HIGHWAY 601 SOUTH
Deferred:
FIREADVLTAX - FIRE TAX
Unqualified
NC 27028
11,500
2
Property Information
0597
Township
[Land (Units/Type): 0.350 AC
Unqualified
JERUSALEM
ddress: 2162 S US HWY 601
3
00197
Deed Information
08
r— Local Zoning
Date: 08/1997 Book: 00197 Page: 0062
Vacant
85,500
Plat Book: 0002 Page: 084
00157
0597
Le al Description
1991 WD
PIN
OTS 3-6 R L FOSTER
33,000
5746154372
Property Values
uildin
48 56
BXF•
129
Land:
8,55
Market:
58 40
ssessed•
58,4001
Deferred:
1989 WD
Sales Information
No.
Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
L
00146
0883
01
1989 WD
Unqualified
Improved
11,500
2
00191
0597
12
1996 WD
Unqualified
Improved
25,500
3
00197
0062
08
1997
Unqualified
Vacant
85,500
$
00157
0597
01
1991 WD
Qualified
Improved
33,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Page 1 of 1
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=1459372 8/2/2016