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1718 Hwy 64E
, ° _. , DAVIE COUNTY HEALTH DEPARTMENT ,, 0 3 . --- Environmental Health Section �GL y�� • - � ' P.O.Boz 848/Z10 Hospital Street Mocksville,NC 27028 (33G)7.5]-87C►0 , IMPROVEMENT/OPERATION PERMIT . Account #: 990002619 Tax PIN/EH#: 5757-38-2338 , : �� Billed To: Andy Lipscomb Subdivision Info: /'7�� � f/W!� (yLf t'i Reference Name: Location/Address: Highway 64 East-27028 Proposed Facility: Residence Property Size: see map � ATC Number: 3381 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION FOR WASTEWAT'ER 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 PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type /� #People `� #Bedrooms 'y #Baths D�.� Dishwasher:� Garbage Disposal: ❑ Washing Machine;,� Basement w/Plumbing:la Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size Type Water Supply �✓8/I Design Wastewater Flow(GPD)_'�_ Site: New Ja Repair 0 System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Width3(e,� Rock Depth�_ Linear Ft. .06� Other: ; Required Site Modifications/Conditions: IMPROVEMEIYT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER R�SER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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. Telephone#is(336)751-87G0.**** �or��^P��'� �C �c u�� . �.-� �y� ��°�''� �' �' ��u�6 �' F Environmental Health S ecialist's Si ature: " / Date: LT �� `� P � �L,3 DCHD OS/99(Revised) � � ' � : DAVIE COUNTY HEALTH DEPARTMENT � h ` Environmentai Health Section P.O.Boa 848/210 Hospital Street � Mocksville,NC 27028 (336)751-8760 Account #: 990002619 Tax PIN/EH#: 5757-38-2338 . Billed To: Andy Lipscomb Subdivision info: Reference Name: Location/Address: Highway 64 East-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3381 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION ` **NOTE** This Authorization for Wastewater System Construction MLTST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/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 CO STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: Date: ��S��� t ERTIFICATE OF COMPLETION **NOTE** The issuance ofthi Cert cate o Completion shall indicate the system described on Improvement/Operation Permit has been installed' com iance 'th icle 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," ut sh 1 in N W be taken as a guarantee that the system will function satisfactorily for any given period of t' =� � � �4� � � lJ r� � '"' � l_ r`"�-"v� � t_'-_I�� �� � �Dvs�.� .�-�r-►�� - 1_l r�� �� .- - -. - _ �$ ,�'�'c��� � �nS i � '�'{��1L�.� �'j . �c� ��T '3 L t J� �JC3 Septic System Installed By: �Z-'� Environmental Health Specialist's Signature: Date: � �� DCHD OS/99(Revised) � Jan 07 03 02: 6p davie county envhealth 336 751 8786 p.2 al.. ,.�:. �' ' , , � � '��1� `� Q � � 'j � APPUCAIIGN FQR BRE EVALUAiION/IMPRdVfMEF(f PFRMIT b ATC �� -�� � Oavie Courtty Heafth Departrnen! � p„ � �� ' Eav/ronme/ttdl Nealth S�i/on �' , j�� � { , �,J3 � r.o. sox ete/210 xoep�t.l sera.t '�';. � `M� � Hoctaville. NC 2T028 2 (335)751-8760 � ZO �,.,, ��' i t -�" a1 • +* xxss avPs.xcATxotv caamTos aa paoacss�n v�sas xi,z r� z � , � :,����Q!��� iGN IS P1tOVIDED. R�er to the INFOti1�ATI0N BULLB'P�i for iIIstxua �/ , � �� Q��:. �,�, ' � K�N to D�Billad � ConLUCt Y�tean � � � �r,'`n-'.. . :�Q v►��„�a.e ���t� �s � t��t� �. �. G9 k-1 y�s�o ✓�trier..wz=p �Mc��!C-S�;\\� Y�C—�-7c�.�.. �„«,. ,�Gt�e� 710-�"011� �e.1 5-3ylt� �/�x.n. en r.ra�t/sxc a:a�tr.r�ue rhan xbm,. ltailiaq addsaaa ciLy/stat�/[ip ,�`�pplication 7br: py�it� 8valuation � Smpzovam�nt parmit/ATC �th . ��1�svse.m Lo s�r►ico: [�onsa 0 Mobils Hom� ❑ Snainasr ❑ Isiduatty fl Oth�r .�� 2l,A�aidanwi � Pooplo `. � aodrooms �_ e�athroo�eu��' . . ��h.a�.: n ca.'baqo as.yo�u r�V,►..hi„Q x.�rsn. . ti�i...w�rJrlunt�nq r�aaawr�r./�w vl�b.inv " � 6. z!au+S.w.s/SndwtcY/Oth•r: Sy�ej.Ly!� � ♦ a�op1• ! eisucs . . � f Camodei i 9howcs � nrinsl� � � /1rat�r aaele=e . I1 YOODSEAVICL: B 8�ats �stiss�iad 7Pater Usaya �qulo.w p�r day) �� sYpa of wat�r aupply: 0 Ccuaty/City �We21 [7 r•aanalty �a, Do yon autEclpate additloos or c:paosioos oTthe facillty thls system is iateaded to serve? ❑Yes �tvo Ifyes,w6st type? J' ,/,. ••�LSfPORTANT*" IEN7S GUMPLEfE THE REQUIRED PROPEATY INFORMATION REQUESTED ��� '�°" BEIAW. Elt� a P W E P2.AN UST BESIlBd!liTED 6y the cllnt wilb THIS APPLICATION. V Aroperty D'ua¢�stons:��.�J� X 7���/ �D[RECPION9(tran l►loctaville)to PROPERTY: TAxOfticePlN: 5,��i��Jy �u�E- �T�m�crcc�c, 1y3c�-�-Sm��es �ro��y�aa,�: xoaa iw��� _(��f E oc� �� 3�� c�1m��}e� ����;� rn��.x-����`� ���„ -�.a. a��:���- �o�, ;� li is s Subdivisian provide leformation.as folinws: a?�� �Q�'�t,�c'e- 1�eh.c�� 12�� 1-�s e Name• � s�es: s�«k �r. v6.�p�rtr F�ca: I y o3 7Lis b to certff,y that the iaforowtbo prorided ts cornct to the be�t of roy kaa�sled�e. 1�mderstaad Ihaf aay permit(c) i�■ed 6ereafter sre subject to anspeasion or revceatkn,if tLc slte plaes or iateaded oso chan�e,o�if the inforoutivn cubmitted in thh applieatton is frlsified or ebsnged !,alao,rrurlersland fkat f am rnpo�ulble fos rt!/chargu incr�rrtrf j�ont r4Lr upplrcar�on. t,6ereby,givc coescst to the Autharizcd Reprosontstivo of the Davk Coa�fy Hcalth Dcpa�lmeof � to enter upoa above deeeribed property loceted in Devie Conely sad awaed by ta w�docl e[ t�stin proced�ns as aocessary tv determ3»c tha eite s bitily. `��SfATE � � � �/SlGNrt7'URB� � .?HIS AREA hIA HE US�b FOR DRAWING YO[JR SITE PLAN(Ia¢lrtle i of Ike folbaing: EzIsNnP eed propoud property Ura and d'uaeasioa:, strucwres, �etbacics, ■.d sepHc iocaHou). � � � 3ite Rcvisit Charge , � 3 aC� 3, Date(s): , /� Cllent Notittcadon Date: � '� � E�: v - ��Q ncC Accoaat 1�t0. � ,/ �� j [��a ncsn�o�rx�� m.��N0. -:.T��I t/ � T 3 � V __� �-�-,� - h �A. ����`*J` ' � . DAVIE COUNTY HEALTH DEPARTMENT =� '" �'� ' Environmental Health Section Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY IlVFORMATION Account #: 990002619 Tax PIN/EH#: 5757-38-2338 _ Billed To: Andy Lipscomb Subdivision Info: Reference Name: Location/Address: Highway 64 East-27028 - Proposed Facility: Residence Property Size: see map Date Evaluated: � ?l � Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo % HORIZON I DEPTH �c � Texture rou C Consistence Structure ' Mineralo HORIZON II DEPTH �"' " Texture rou Consistence r" SWcture �� Mineralo !,'/ HORIZON III DEPTH Texture rou Consistence Structure Mineralo ' HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � , SITE CLASSIFICATION: �� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: REMARKS: LEGEND � Landscape Position R-Ridge S-Shoulder L-Lineaz 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 ' Mineraloev 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-gaUday/ft2 DCHD OS/99(Revised) ■���o�s�as�■��■■�■�■��■■�■��■���■���■■■��■��������■■��■■�0�a�����■ ■����■���■�■��■■�■����s��o■���■��■��■■■■��■■������e■e�■�■��e�o���■ ■�a����ao���ov�■����■��■�■■�■a�����■■■a�■■e������m■��■■■o�■os���■ ■�����as�■���■o■����■��■�������■ ■����■■�■�������■■■os�■�e�a�o■�■ 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"��y g �y �„ � .�� �"��{�� � ;� ��aa'"�� +�� � 's ✓��; a�,�' � A, � �'"� �'�' �: Fr �3� ��. �� ; � �r,�a. r� � a� ��'. �� �,�� ���ro �� � � , � � ", g�a ,, y�� �.� ��`� � �}�� �. .�� '-+ � t, "�� ,a. �;�sarg �.'4��'` '�_„ �� r�� � p� Parcel#:J60000009502 Page 1 of 1 qa�t� Davie County, NC - Basic Estate Search o�U�'� • Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search � View Prooertv Record for thfs Parcel View Ma�for this Parcel View Tax Bill Infgrmation Parcel#:J60000009502 Account#:82520391 Owner Information Tax Codes PSCOMB JAMES ANTHONY&LIPSCOMB SANDRA ADVITAX-COUNTY T 1718 HIGHWAY 64 EAST READVLTAX-FIRE TAX MOCKSVILLE NC 27028 Pro e Information Townshi Land(Units/Type): 3.000 AC MOCKSVILLE ddress: 1718 E US HWY 64 Deed Information Local 2onin Date: 03/2003 Book: 00469 Page: 0502 lat Book: Pa e: Le al Descri tion PIN .000 AC OFF HWY 64 5757393055 Pro e Values . Buildin : 31135 BXF: 2 65 Land: 20 59 Market: 334 59 ssessed• 334 59 Deferred: Sales Information No. Book Paqe Month Year Instrument Qual/UnQual Improved Price 1 00469 0502 03 2003 WD Un ualified Vacant 0 View Pro�ertv Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search 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 herefn 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 inerchantability 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. 1.5A http://maps.daviecountync.gov/itsnetlView.aspx?prid=1460002 6/28/2016