1139 Hwy 64EPermittee's 2 S _ ( -DAVIE COUNTY HEALTH DEPARTMENT
Name: £ I `�" Environmental Health Section PROPERTY INFORMATION
�f P.O. Box 848
Directi ns to property: vy�- Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
� Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION `f 3 '1 J '"
AUTHORIZATION NO: 002881 A Road Name: �l.[
**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)
7--09
**�TICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
.� IS VALID FOR A PERIOD OF FIVE YEARS.
AL HEALTH SPECIALIST DATE ISSUED
• �je .�•.0 1? `e i N" l' i` ,.. .. . a ,:'l•j ''4.,1 icy
. ,_.
Perrruuer�'s VIE COUNTY HEALTH DEPARTMENT
�� Environmental Health Section PROPERTY INFORMATION
_ P.O. Box 848
#;echo s fo property: �LG� ['` + Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot: _
AUTHORIZATION FOR
- (. v� �- WASTEWATER r
t`e. Cr Ta Office PIN:#
A 1 SYSTEM CONSTRUCTION f t G.
AUTHORIZATION NO: 002881 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)
OTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
E 'VIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 3 F # BEDROOMS J t # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
--e
-e - I co - ( Cly ~a (( U
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
11l� 3ro�
SYSTEM SPECIFICATIONS: TANK SIZEI�GAL. UMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
' 11TLiCD (1.I�
G.)L-75._
REQUIRED SITE MODIFICATIONS/CONDITIONS: Aly
l
I 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. A
OPERATION
SYSTEM INSTALLED BY:
I �+ f 6 j`'
J i
AUTHORIZATION NO. Pl OPERATION PERMIT BY: DATE: -7--//—,i
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATEAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGFE 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 07102 (Revised) fie er-#27As
- q :,.- _:yF - r: .,y a ' v,- ir."'i-ry-'•'.t rrrt Y` <- ,; k„,�y ..st'." s,r t i',sbs,,y, •'s,:: ,pr QA- m,.. n,r- � 'y,:,,.q,.;« •
Per rnqttms ,DAVIE COUNTY HEALTH DEPARTMENT
U., �.-% � ` � Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
,I- fA0k;ch ns to property:. Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
L WASTEWATER Tax Office PIN:# - i T -
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002881 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)
-`a �i " *** OTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
%F ''r �`,• t:I~-'" f ~ /(i IS VALID FOR A PERIOD OF FIVE YEARS.
-'
AL HEALTH SPECIALIST DATE ISSUED l� ,
RESIDENTIAL SPECIFICATION: BUILDING TYPE �r # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
QG/{'� Li
LOT SIZE TYPE WATER SUPPLY CIO DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE'GAL. PUMP TANK AJ/ GAL.
TRENCH WIDTH & It ROCK DEPTH _ -7'7" LINEAR FT.
G.
I 5—
REQUIRED
—
REQUIRED SITE MODIFICATIONS/CONDITIONS,:
IMPROVEMENT PERMIT LAYOUT
• Y �i
II 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
I1
� S4
a 3
SYSTEM INSTALLED BY:
L
i+3 1VCl.J-
C
G ik 1,i,( k1liGI
AUTHORIZATION NO. �I OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL IN[ ICATE3 T THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAG 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) Q
i
APPLICANT INFORMATION
^ to S h -e NC9 Yi
Water Supply:
Evaluation By:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
On -Site Well / Community _
Auger Boring Pit
PROPERTY INFORMATION
(� f( (Al
OC k5Ut,�
')
Public /
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
l
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
/V-
CMineralo
Mineralog
HORIZON II DEPTH
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
5
LONG-TERM ACCEPTANCE RATE
66. D.-7 i
SITE CLASSIFICATION: 12 J
LONG-TERM ACCEPTANCE RATE: 7
REMARKS:
EVALUATION BY: 4 Uj '1� J Cc r ct U�
OTHER(S) PRESENT: to y tz7" L
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
ONSISTENCE
Moist
VFR - Very friable FR - Friable FI Firm VFI - Very firm EFI - Extremely firm
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
LYQt�
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 05/05 (Revised)
Appraisal Card
Page 1 of 1
Previous Card
Owner: SHELTON PEGGY O Per.[: I4-000-00-001
�CLTON PEGOY O OVVINGS DAVID L
R4turn/Appwl Notes: MwN IF540-05-N3
139 W US HWY 64
FCDYNTYTAX
PLAT: / UNIQ ID 14934
530336
D226 -PI ID NO: 9728666446
(100), FIRE TAX (100)
CMD NO. 5 of 5
YwY. 2013Tw Y-2016
186.71 AC NWY 64
1MAW AC SPC. Iwpemen
nMRd 59 en 09/2W9/2M8060051ERICNO
TW -06 CI- FR -02 EX- AT- LASTAC"M 20t21114
CONSTRUCTION DUAIL M VALUE
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uMAWn-3
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24.9
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24,92
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995,52
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39B,3z
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AL TAXABLE VALUE -PARCEL
$97,
398,32
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256,
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9,72
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744,
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613,52
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HEATED AREA 3,152
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NOTES
4....... 35 ........
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UNIT O% ANNDEP % W/XF DEM I.L0611 FACT A
% CS462
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2,039 92,31
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http://maps.daviecountync.govlitsnetlAppraisalCard.asox?idP=1474831 &Action=Auto 7/13/2016