1778 Hwy 64EPerrnittee's , DAVIE COUNTY HEALTH DEPARTMENT
Name_:I-, . - y!1/1 A Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
{
Directions to property: '� Mocksville, NC 27028 Subdivision Nane: ,
'77— r� Phone #:.336-751-8760 '
Imo% t / y': ".Ws - .�t t� fj� j Section: Lot:
�� ij�� AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
„r SYSTEM CONSTRUCTION - -
rtM- O
AUTHORIZATION NO: 7 8 A .:, , . T ,� �;:�, 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.] 900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
Et4VIR&M- ENTAL ALT SPECMIST dy D
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS ___�7__# 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 v
i/ // ♦/
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1,-e' LINEAR M
OTHER i
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
t
"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.
DCHD 02102 (Revised)
// /(0
DAVIE COUNTY HEALTH DEPARTMENT
`IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems, f Permit Number
____
Name �I r / �G+,.% ii �fi;1,� Date N° 7 7 2 8
�9
Location —
�
Subdivision Name Lot No.--- Sec. or Block No.
Lot Size House House Mobile Home _ Business Industry
No. Bedrooms 1#5 —C No. Baths __6 2-- No. in Family �— Public Assembly �'` Other
Garbage Disposal ' YES ❑ NO 2r Specifications for System:
Auto Dish'Washer YES NO ❑
Auto Wash Ma ;hive YES NO ❑ ��`���i /�
Type Water Supply — --- cwb � it Jct r
`This permit Void if sewage system described below is not -installed within 5 years from date of issue. t
This permit is subject to revocation if site plans or the intended use change.
R
J:
C
Improvements permit by
,w I
'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
;–
Final Installation Diagram:
i
System Installed b,
Certificate of Completion t Date
'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 the system will function
satisfactorily for any given period of time.
•1N `��� �Y,q't
1
APPLICATION FOR SITE EVALUATION/IMPROVEMENT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
SEP 6 !-�'J'01
Application/Permit Requested By1�f3l,- Mn
Mailing Address O - S X ��� Home PhoneW - C l - h l
P C- ��� b Business Phone `�7N - Lo3(-f-0?7 2"
2. Name on Permit if Different than Above
3. Application for: ❑ General Evaluation /1R Septic Tank Installation Permit
4. System to Serve: ❑ House Mobile Home ❑ .Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision l J A n � —",0 bc.K• Qa � PAC"- Section Lot #
(kc -e(-1, Wxh r\6 (MobA
❑ Basement/Plumbing
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: Public ❑ Private
8. Property Dimensions 3(0 RC S Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? Yes ❑ No
If yes, what type? )[)Lk-, N A, hou5 e'
❑ Basement/No Plumbing
Washing Machine
Dishwasher
❑ Garbage Disposal
❑ Community
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
.� (-Oy C
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
-1b--9L/ I ( �
DATE SIGNATUFW
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie 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 said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATUR
DCHD (1/93)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME W
ADDRESS w1
. PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
Sloe9..
FACTORS
1
2
3
4
Landscape position
Sloe9..
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC'
C
Consistence
r
r
-7071—c--
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texturegroup
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S
S
LONG-TERM ACCEPTANCE RATE
r
r
,
SITE CLASSIFICATION: /S EVALUATED BY:iG�
LONG-TERM ACCEPTANCE RATE: r
REMARKS:
DCHD(01-901
Landscane Position
OTHER(S) PRESENT:
LEGEND
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 -Film 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
■■E!E■E■
■ENEEME■
■OMMEME■
■OMMEME■
■■■MENN■
Parcel #: J600000090
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
'View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bill Information
P%rcel #:1600000090
Owner Information
ORGAN HARRISON B III& MORGAN MARY SIBLEY
1778 US HWY 64 EAST
MOCKSVILLE NC 27028
Account #:51896000
Tax Codes
ADVLTAX - COUNTY T
READVLTAX - FIRE TAX
Property Information
Township
nd (Units/Type): 37.820 AC
ddress: 1778 E US HWY 64
MOCKSVILLE
Land:
207,17
Market:
Deed Information
Local Zoning
ate: 05/1994 Book: 00174 Page: 0353
Plat Book: 0002 Page: 009
eferred:
165,671
Legal Description
PIN
6.40 AC HWY 64 THOMAS JAMES
5757484198
Property Values
Building:
513
BXF•
Land:
207,17
Market:
258 5
ssessed:
92,83
eferred:
165,671
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00174 0353 05 1994 WD Unqualified Improved 85,000
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
« Return to Basic Search
Page 1 of 1
oY
�rj`
11
Davie County Web Site
All Information on this site is prepared for the inventory of real property found within Davie County. All data Is complied 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=1491050 6/29/2016