2602 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990000868 Tax PIN/EH #: 5746-50-1749
Billed To: Carolina Finishing, Inc. Subdivision Info: ,
Reference Name: Steven James Location/Address: 2602 HWY 601 S-27028
Proposed Facility: Shop
ATC Number: 3635
Property Size: 4.23 Acres
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 Fonm/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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on I
has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900
Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will
given period of time.
;Pp 41
Septic System Installed By: -jfajL oxm) �) /1c �j
ient/Operation Permit
Treatment and
satisfactorily for any
Environmental Health Specialist's Signature : Date: „62 -/6 ',03
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000868
Billed To: Carolina Finishing, Inc.
Reference Name: Steven James
Proposed Facility: Shop
/,/• O 'Zovy
Tax PIN/EH #: 5746-50-1749
Subdivision Info:
Location/Address: 2602 HWY 601 S-27028
Property Size: 4.23 Acres
ATC Number: 3635
**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 A9 #People #Bedrooms #Baths
Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift �_ #Seats Industrial Waste: 13
Lot Size Type Water Supply a Design Wastewater Flow (GPD) Site: New -0 -Repair ❑
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.IC�747
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER ISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Dep ent 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. Teleph e # is (336)751-8760.****
Environmental Health Specialist's Signature: �' Date: _4d t`/61�
DCHD 05/99 (Revised)
EC BVE
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department .
Environmeota/flea/th Section D EC 5 2003
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 .
(336)751-8760 ENVIRONMENTAL HEA(
DAVIE COUNTY
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
• INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. frame to be Billed �+ PRXA)/0 /if '♦� ''y ' S �G�G �✓ f�: ,A a rj
y/si • Lti • Contact Person �
..Z(Q.L Cf5 L 6/ 5 T - o4
Mailing Address � �� /. /"�/�/' a Home Phone
City/State/ZIP /•w�'►$IJ� Ile �-+ X.7,0 Z'd Business Phone ,%T� ✓ 7 �/ ��
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: �te Evaluation .__ ;2ms
—rovement Permit/ATC Ki- —Bo
4. System to Service: 13 House El Mobile Home iness❑ Industry ❑ Other
5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People # Bedrooms # Bathrooms
❑Dishwasher []Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
0-11-
7.
) a,//��
7. If Business/Industry /Other: verify type �oD .47A 3,i # People # Sinks
# Commodes l # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated. Water Usage (gallons per day) Vv
8. Type of water supply: Li �County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes M - Ko
If yes, what type?
***IMPORTANT" CLIENTS MUST COMPLETE THE 'REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: _ �j� /�� 14"2-S q-C� WRITE DIRECTIONS (from Nlocksville) to PROPERTY:
Tax Office PIN: # � `-1 — 1
Property Address: Road Name � 4r� C+t/.SiGcr dtJ
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
Date home corners 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. I, also, understand that I ani responsible for all charges incurred, fi•oul
this application. I, hereby, give consent to the Authorized Representative of the Davic County Health Department
to enter upon above described property located in Davie County and owned by _
to conduct all testing procedures as necessary to determine the site suitability.
DATE �� Z D d SIGNATURE r
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).
Sign given
Revised DCHD (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No. r, t7
Invoice No. �pd
v
:
3143,
.0153-- ' : AoV
. 0153 - 1.624A
b 2
r .
y, 5059
80
hSZ)
.
�f s
(1.28A) = �s (2.48A) �6
8972 r 6971
NP
x 5030A00 3 987
�o `-� s ►'�
2so sem, = r 174 ' '�
° 8794
.` 7701
,����
v =
y f
s
M5030A000204 0 , � �
�� f (2.00A�
R
x
7692
602'
'Jtop
y� 8590
f r
r 9450
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #: 990000868
Billed To: Carolina Finishing, Inc.
Reference Name: Steven James
Proposed Facility: Shop
Property Size:
PROPERTY INFORMATION
Tax PIN/EH #: 5746-50-1749
Subdivision Info:
Location/Address: 2602 HWY 601 S-27028
4.23 Acres Date Evaluated: ja -!-5+
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Publicy
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position A�
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH _
Texture group
Consistence
Structure i
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE i
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: d
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY:�1
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
CONSISTENCE
Moist-
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
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 05/99 (Revised)
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i
A.
Penru%ee's._ D VIE COUNTY HEALTH DEPARTMENT
Name:f• x. %~.':I" 4,s Environmental Health Section PROPERTY INFORMATION
P.O. Box 848,
Directions to property: ` cfit + t; . , , �Mocksville, NC 27028 Subdivision Name:
- Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO. 2203 A Road Name: 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 Building Pen -nits.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
✓� = ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIA ST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # 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 GAL. PUMP TANK GAL. TRENCH WIDTH 4�- ROCK DEPTH, LINEAR FT. "
%. OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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 (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: Zy
CG
�X
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 I1 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 02102 (Revised)
tre��r• D VIE COUNTY HEALTH DEPARTMENT
'Name Nf /' % . Environmental Health Section PROPERTY INFORMATION
P.O."BOX 84$
�tfectiotis o pr �perty:_:�,J` J J Mocksvtlle, NC 27028 Subdivision. Name:
Phone #: 336-751-8760
r , Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - - r
AUTHORIZATION NO: A Road Name: 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 Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
J111a tfv aI lPA"I'ti 11U1l %iff% ♦ Ilia l r1Yl H l J:R I,Ul1I3 I J(VI. i JUIN
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALtIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSALf'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
SYSITM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH tLl / ROCK DEPTH_:�� LINEAR FT -24
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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 (336)751-8760.
OPERATION PERMIT i 11
SYSTEM INSTALL$D BY: U l f J C _ /! �� 4f/ ( /
y ,
_E:G
le ell
F,
-J
AUTHORIZATION NO, OPERATION PERMIT BY: J G�/ DATE: /"-
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED INCOMPLIANCE
WITH ARTICLE 1 I 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 02/02 (Revised)
g
70
- -.. M'-;/ ,. ,tea ,_!. •♦-:.
a.'' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"NdTE• Issued in Compliance with G S of North Carolina Cha for 130 Article 13c
P
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968)/ Permit Number
Name 1?f.7 Allfir' Date, l� ^ R '...�1
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size �� House Mobile Home —! Business Speculation
No. Bedrooms =^ No. Baths--� > No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NOY
Auto Wash Machine YES NO
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by., %'`�3
*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
4 f/
i , t
f
I S)
Certificate of Completion �� DateU T7
r �C
"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 tffd system,wjll function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT G
Davie County Health Department
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 99IF f, 93 f
1. Permit Requested By S Te V e qaAA e 5 Business Phone 9M 999 9
2. Address 1720,1 e V 7' /1/1/) r- a V N / L_,_ Al, C. ;70ZF
3. Property Owner if Different than AboveEy9�'/1!1!_e e & N & rT—
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Z Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc. —
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes % urinals_
lavatory showers
dishwasher sinks _
garbage disposal
washing machine
8. a) Type water supply: Public JZ Private Community
b) Has the water supply system been approved? Yes–ZNo
9. a) Property Dimensions :Li-' 6
b) Land area designated to building site fod X D
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
% Ddte I owner S4ature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: &0 /- f0& 1j To �frPCvsy iforlver– a60 o�
/
JaMc5 V. Burr oN
�erus�/enn
rowNsb p Fare bep7
APF rdx • �L A
76'
DCHD (6-82)
STrkes are ��►,tor T�%s buAty CISO
rsde y A,v',
ErdsLS'coa,d
Hawe// ham - socw a_s `oss;.ila plewse
`.� DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. B¢x 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name— Date /&FZ k
Address Lot Size C��q d?
FAr.TnRc
ARFA 1 ARFA 9 ARFA 3 ARFA 4
Topography/ Landscape Position
S
SS
PS
S
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
PS
S
PS
U
U
I) Soil Structure (12-36 in.)
Clayey Soils
P
PS
S
PS
S
PS
U
U
U
Soil Depth (inches)
p
PS
S
PS
U
S
PS
U
Soil Drainage: Internal
$P)
-'" (PSS
S
PS
U
S
PS
U
External
(P
( PSS
S
PS
U
S
PS
U
�) Restrictive Horizons
Available Space
ns
PS
PS
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
►) Site Classification
-
-
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE / PS—Provisionally Suitable
Described by - Title
SITE DIAGRAM
� h
i
DCHD (6.82)
Date ll•?3�- o
Parcel #: M503OA000203
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search G
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: M5030A000203
Account #: 39819500
Owner Information
Building:
Tax Codes
BXF•
AMES STEVEN G& JAMES SHARON T
Land:
ADVLTAX - COUNTY T
Market:
169 TURRENTINE CHURCH ROAD
ssessed:
FIREADVLTAX - FIRE TAX
Deferred
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 4.230 AC
JERUSALEM
ddress: 2602 S US HWY 601
Deed Information
Local Zoning
Date: 10/1987 Book: 00140 Page: 0396
Plat Book: Page:
Le al Description
PIN
K.00 AC HWY 801
5746501749
Property Values
Building:
201,71CI
BXF•
6,16
Land:
184 26
Market:
392 13
ssessed:
39213
Deferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00140 0396 10 1987 WD Unqualified Improved 0
2 00130 0515 03 1986 WD Qualified Vacant 4,500
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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.daviecountyne.gov/itsnetfView.aspx?prid=1473989 7/14/2016