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3693 Hwy 601S (2)'7�;� t'?�`G+, a+�L,f Ysi?j[�{"a �`y`"yr ra,.v,w.r:��y'.'+3�.d-1/.�^"'i.�./lt r~ I4 ��,Ia�,i �v %aiiyP p , ° 1� .>y�,a rf `. +1.'it`J :.�,. '7�+'..si...u-.di-•h'^'*'/rs. ".k.: �;�'i�.'.+Z� :Y•'a`r`+r+tE�l''is"'i y. 3 AUTHORIZATION NO: 1 5 4 2 DAVIE OUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Perm�tiree ti " P.O. Box 848 Mocksville, NC 2702a Name.., Subdivision Name: Phone # 336-751-8760 Directions to.pmperty: ^ � Section: Lot: AUTHORIZATION FOR � �+ WASTEWATER Tax Office PIN;#.Sy.►p- SYSTEM CONSTRUCTION Road Name: a / 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,.] 900 Sewage Treatment and Disposal Systems) } ',,' `' j ti�, j f/ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SP CIALIST DATE ISSUED DCHD 05/96 (Revised) i ')J�j� T"APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI 00;. Davie County Health Department A( pr 0.+ Environmental Health Section Jj et P. O. Box 848 l�ti6 Mocksville, NC27� ((3�1-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed v �' �' Contact Person / Mailing Addressy (a 9 5 601 J Home Phonnete��— A 7C/O City/State/Zip ! V •C A Business Phone� l &/I� bl✓ C'► /%• 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 4. System to Serve: 5. If Residence: ❑ Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: ❑ Site Evaluation ❑ House K Mobile Home # People 'Z-3 ❑ Garbage Disposal Specify type _ # Showers # Seats City/State/Zip ❑ Improvement Permit & ATC ❑ Business ❑ Industry ❑ Other # Bedrooms 2 # Bathrooms & Both UL Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 7. Type of water supply: R County/City # People # Sinks # Urinals Estimated Water Usage (gallons per day) ❑ Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes W, No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PJO&W THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: � 1 WRITE DIRECTIONS (from . Tax Office PIN: # zi � '1 G 1 Mocksville) TO PROPERTY. � t' - a g - �G' b �' � i U f �. • G� Property Address: Road Name % s • 1 City/Zip MOcks o f r— N• G' 1 If in Subdivision provide information, as follows: Name: 1 1 Section: Lot #: 1 1 1 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 "14ofthe Davie County Health Department to enter upon above described property located in Davie County and owned by A? '+ ,1+��AV—e- J to conduct all testing procedures as necessary to determine the site suitability. DATE4/ 5 q9 SIGNATURE Revised DCHD (06-96) YOU MAY USE THE $ACK OF THIS FORM FOR DRAWING YOUR SITE PLAN. fice't. 61 �' 115 s \\\ ;•,�; _ ' ` . 'x.98 Acs 4p0 ' \ 74.8 16 N 4 012 0 20 u'. 55 400 17 2.83 Ac- CA S C R� n* 1 ° ` sw' yz to ` �NID 0A �� f �.. �' s•.. �,' 39 ;.66Ac o c .• , w �. # r.. r g • a 1.19 Ac,= � a� > . x 18 g 5.43 Ac-9- 19 ct19 "� LrJ�6fi. 4()5.4 41 "'3" LO 47 . `� � yam, .� - , • LO , 4701289.56 �� .• 1.96 44 330 — 1. 157 61 11 a r' l ', :' a •6, a,"�"•yJ ,-+,+ • -A`r - +' 2' Ac as o o�FF _ ,t.. 48.01 1 "o A . 3\6 4 53 -. *. °'� 1.04 Ac ,� a��t . , 24 ao •,�� 253 � x.. 6. 5\0 6 9.3 7 Ac sem' t 015 . (1.5) �' N .. o• \ 9. � i �� , ^_.� . s �;� 361.2 0 7 13 r=, r. 6 AC 7.10 * •' N` r 7. 6,lk r 331.78 �� _y ti:.� alk 12► ,rod 71,0% 44 d ;574 s •N� �. ` , � 50 � �r�� " � 69.26. �,�g� a 259 — � ,� Zg5 Da 1 ;7 ; • c h -,.�, i 1556,94 256 R s L Ile (6.2 2 A„) 55 — �. 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DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT, Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY 'SUBDIVISION Water Supply: On -Site Well Community, Evaluation By: Auger Boring Le-' Pit DATE EVALUATED PROPERTY SIZE yG� ROAD NAME 4;;��5 ' Public !,` Cut FACTORS 1 2 3 4 5 6 7 Landscape position. 4 L Sloe % 6 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH' 4010 Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE i - SITE CLASSIFICATION: Y Y LONG-TERM ACCEPTANCE RATE REMARKS: irrf / —<--a r DCHD (01-90) EVALUATION BY:�'t/l OTHER(S) PRESENT: / Av tl�Vryer/ 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■mss■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■r.■■u■■■■EEE■■■�■■■■■■■■■■■■■■■■■■E■■■E■■■■■EE■■/Ee■M■ ■■■■■►■■■■ren:�■■■■■■■■■■■�n■■■■■►�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■CG'!/[1■■X19■■■■/■■■■■■■■■■■■■■■■■■\`■■■■■■■■■■■i1E�■■■■■■■■/■■■■■■■■ ■ENNENmMMMMM MEMNONEMMEMEMENNENEMEMEM ■■■■■�'■■■■■■■■■■/■■■■/■■■■■■■■■■ ■■■■■■■■■■��■■■■■■■■■■EEM■■■■■■■■ ■■■■■■■■►�■■r■■■■■■■■■■■■■ENI■■■/■■■�i■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■ ■NEEM■■■■■■ ■E■EEE■OME■ ■E■■E■E■E■■ ■e■■M■EM■■■ ■■EEE■■■■■■ ■■M■■■M■■M■ ■EM■MM■■■■■ ■MM■■■■■■■■ ■EMMEMENE■■ ■■E■■■■■■■■ ■■E■■■E■■E■ ■ Parcel #: N60000004901 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search Q View Property Record for this Parcel View Map for this Parcel View Tax Bill Information C Parcel #: N60000004901 Account #:64634500 Owner Information Building: Tax Codes BXF• HAVER ARTHUR C & SHAVER BONITA F Land: ADVLTAX - COUNTY TA Market: 693 US HWY. 601 SOUTH ssessed• READVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 4.510 AC JERUSALEM ddress: 3693 S US HWY 601 Deed Information Local Zoning Date: 03/1986 Book: 00130 Page: 0455 Plat Book: Page: Legal Description PIN 50 AC HWY 601 5754286869 Property Values Building: 01 BXF• 9,0001 Land: 41,7901 Market: 50,7901 ssessed• 50,7901 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00130 0455 03 1986 WD Qualified Vacant 11,500 View Property Record for this Parcel View Mao for this Parcel View Tax Bili Information « Return to Basic Search Page 1 of 1 oP.tF f t� °o U �,l 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=1466775 7/29/2016