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3805 Hwy 601S' � �: ra''` aai�;� .ai.=bgi.b.S `Tsj rsb1 a.1' 4 .+7 e.t''• '.0 eN:-.. 3y i;rs .fdrti'�'\. Y. ..:'� .,ir..ta.��w' rrt: �- t^i y, _ `..h{ �. -":t, � .'qw k •,, *'� r ;.b �.k r,: ;; s�:; j�• .n��.•<a+sT3- 1� ,3 a z=;�i'{*�F ny �sr-1€ " `� + tit f ,g s . � '�/ AUTHORIZATION NO: 0941 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Pee nittee ; ` . P.O. Box 848 ;. a. Name: (�;', Mocksville, NC 27028 Subdivision Name: y �,�, Phone #: 704-634-8760 Directions. to property: �'ITSection: Lot: AUTHORIZATION FOR R WASTEWATER' Tax Office PIN:4.1 - SYSTEM CONSTRUCTION Road Name: In 4 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 1 l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �f IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTALIEALTH SPSP C� DATE ISSUED ' F � i Y`'�F ib-'rlri+F ,�.ryiy} ty �• .NY + ��.\ 7tA .... _ R '- ,�IC"YY`5ti 1 9 ai.!-,r t} •l 4'•Y:.1'.` ...�.'`[YAt ���i+7- }/O <}wDAVIE COUNTY HEALTH DEPARTMENT r� IMPROVEMENT AND. OPERATION PERMITS : PROPERTY INFORMATION Subdivision Name: Directions to property: (1f_ J Section: Lot: k f IMPROVEMENT r PERMIT Tax Office PIN:# r Road Name:1061 S Zip: **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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF.SITE - ; tom{ 1.::;• t,� , ,- } _,i: , �,° PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE Ali # BEDROOMS mss? # 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. �r� ROCK DEPTH ?V I/ LINEAR Fr.. LJO 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 (704) 6348760. OPERATION PERMIT s SYSTEM INSTALLED BY: " AUTHORIZATION NO. OPERATION PERMIT BY: DATE: l V "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCT" 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. DCHD 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMLTE Davie County Health Department Q i1 Environmental Health Section P.O. Box 848 1997 Mocksville, NC 27028 1 (704) 634-8760 I ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed0VI1T�G� I (9 . sol a e -S Contact Person -FGI rn' z P - Tics + Mailing Address c� �6 Jr 14wy W1 S. Home Phone�S'c1�� City/State/Zip Mockso,',e aldaq Business Phone 70`4 - iD3Ci ' 6`l1 2. Name on Permit/ATC if Different than Above Mailing Address H wyy d L 5� City/State/Zip 1 V1�/1 3. Application For: [41Slie Evaluation [ ] Improvement Permit & ATC 4. System to Serve: [ ] House [1,40bile Home [ ] Business [ ] Industry [ ] Other 4- 1C.11 CkSVIII-c N/Both 5. If Residence: # People J #Bedrooms # Bathrooms_Q []'Dishwasher [ ] Garbage Disposal [,4 Washing 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: L4'county/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [of Ro If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE SUBMITTED WITH TJIIIS APPLICATION. Property Dimensions: �X �.X r/a �XI a``�'y� ', WRITE DIRECT ONS (from ocksville) TO PRZZ Tax Office PIN: ` #575z( - 37 - d 3 y ' (0o� herr 41 I ! Property Address: Road Name S0:5 Rwh 061 ►' `016, Se CIA City/Zip I Vi M l lie IV, G a`L7Oag 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 ounty Health Department to enter upon above described property located in Davie County and owned by14arvev G 4I 67 to conduct all tes7-0 rce res as necessary to determine the site suitability. DATE rT ' l ' 7 SIGNATURE r6' r lil d't Revised DCHD (06-96) THIS AREA MAY 13E USED FOR DRAWINC7 YOUR SITE PLAN: t ::yS F v � .� - ��� - dr� .�.�}. r - ,� 1 ♦' f __e . y "�.Y. �-�� �"' x'i`I}R �t• ^,`�s eta ;r T A a I j 199 �qpc25- G O N 265 O�6/ �d F R 3 G3'd61 i b£ZE p- •pL� �i �+ ��� �'� .* 6 8. �bZj7�£� z li co r'� L 55 co ro t6s5sl j f £9z Z9'9i�- `�° O(�+ s her#si s'oa �b�,..XoiL�C DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY s//'! PROPERTY SIZE SUBDIVISION ROAD NAME101� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring i/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position ,L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 1 r Texture group Consistence i Structure !G S Mineralogy, HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) EVALUATION BY: 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 ■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEN ■■■■■■■■■■■■■■■■■■■■ MEMO ■e■■■W►■■■■■■■■e■■■■■■■■■■■■■■ ■■ee■e■■■■ee■■e■e■ee■■e■■e■■■■■■ ■e■■■e■■ee■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■e■■■eee■■■■■■■■e■■■■■■■e■■■■■■■■e■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■L7i�1■■■■■■■■■■■■■■■■■■■■■��■ e■e■■■■■■ee■■■■■■■ee■■■se■■■e■■eeeeeee■ei�e■e■■■■��■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■e■■e■■■■ee■e■■■■e■■e■e■■e■■■e■seeese■e■■e■■■ ■■■■■■■■■e■■ecce■■■e■■■■■■e■■■■■ ■■■eeeee■eeeee■eeeeeeeeeeee■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■eee■■■■■■■■■■■e■■■■■■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■eee■■eee■■■■■■■■■■e■■■■■■■■■■ ■e■■■e■■■■■■■■■■■■■ecce■eee■■■■■ ■■■e■■■■■■■e ■■■■■■■■e■■■ ■■■e■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■e■■■■■■■■ ■■■■■■■■■■■■ ■■■e■■■■■■■■ ■■e■■■■■■■e■ ■■■■■■■■■■e■ ■■■■■■■■■■■■ ■■ee■■■■■■■■ ■■■■■■■■■■e■ ■■e■■■■■■■■■ ■■■■■■e■■■■■ ■■■e■■■■■■■■ ■■■■■■■■■■■■ Parcel #: N600000065 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 #: N600000065 Account #: 41356870 Owner Information Buildin : Tax Codes BXF• ONES MIKAEL& JONES TALMADGE P nd: ADVLTAX - COUNTY T Market: 807 US HIGHWAY 601 SOUTH ssessed: FIREADVLTAX - FIRE TAX Deferred MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 0.870 AC JERUSALEM Address: 3805 S US HWY 601 Deed Information Local Zoning Date: 01/2000 Book: 00323 Page: 0657 Plat Book: Pa e: Legal Description PIN 1 AC HWY 601 58944000 PropertV Values Buildin : 62,24 BXF• nd: 16,37 Market: 78 61 ssessed: 78,61 Deferred Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00323 0657 01 2000 WD Unqualified Improved 15,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 0 Page 1 of 1 ®rja--Is 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=1462835 8/2/2016