4141 Hwy 64E � DAVIE COUNTY HEALTH DEPARTMENT
�� ' � • Environmental Health Section ,���`�
. P.o.Boa 848/210 Hospital Street ��
' Mocksville,NC 27028
(336)751-8760.
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IMPROVEMENT/OPERATION PERMIT
Account #: 990001252 Tax PIN/EH#: 5787-34-3391
' _ Billed To: Ken Bingham � Subdivision Info: L����
Reference Name: Ken Bingham Location/Address: U.S. wy.64 E.-27006
Proposed Facility: Residence Property Size: 372 Acres
ATC Number: 2489
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An ALJTHORIZATION 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type 1"l���C #People 2- #Bedrooms � #Baths �
Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: � BasementlNo Plumbing: �
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size 72 �T'ype Water Supply� Design Wastewater Flow(GPD) 2�� Site: New� Repair❑
r� � r� r
System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Width� Rock Depth $ Linear Ft.�
oth�: � �ST���c��-.��� . �,�1A�-t- Lt�� �'1�o.C. �M.t�J.
,
Required Site Modifications/Conditions: ��AU- 0^� ��� ' � � FQ� (—A1L�.{��%1' �D�F�.O�`^���
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IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(336)751-8760.****
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Environmental Health Specialist s Signature: Date: 20 � �
DCHD OS/99(Revised)
, DAVIE COUNI'Y HEALTH DEPARTMENT
' Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990001252 Tax PIN/EH#: 5787-34-3391
- Billed To: Ken Birtgham Subdivision Info:
Reference Name: Ken Bingham Location/Address: U.S. Hwy. 64 E-27006
Proposed Facility: Residence Property Size: 372 Acres
ATC Number: 24$9
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MLTST BE ISSLTED 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 CTIO IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signatur . Date: � � �
CERTIFICATE OF COMPLETION
**NOTE** The issuance of is ertifi e of Completion shall indicate the system descri n per tion Permit
has been install in ompli ce with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Trea nt and
Disposal Syst s," ut shal in NO WAY be taken as a guarantee that the system will function satis ctorily for any
given period o tim .
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��Septic System Installed By: � � �
Environmental Health Specialist's Signature: /y�//� Date: �O�2� �l /
DCHD OS/99(Revised)
�; R C�/ � 3:�s
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�� � — °���'fi�, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMR&AT D L� � � O U �
���� - Davie County Health Department
�� _� _ � o�G,, O��� Envirvnmenta/Hea/t�i Se�clion
���y - p.o. Bo� 848/210 Hospita7. 3treet � 2 6 �o�
„. � ; Mocksnille, NC 27028
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' �i�_i� ' (336)751-8760 �,4 ',,,ENVIF�O tE � j
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***T1�ORTANT*** THIS APPLZCATION CANNI�T BE PROCESSED UNLLSS ALL THE REQOIRED
INFORMATION IS PROVIDED. Refer to the INFORI�TION BULLETIN for instructions.
i. H� co � siiiea �F A/ �:�h 17I.� Contact Paraoa .��hl Q�n j�H..
Mailinq Addreae (G�0() (r:i �S Som6 Phone �'7 ^ (p���
CitY/Stata/ZI8 �.�lflCCj_ �.�'. �.'�C��n Busin�eaa Phonn �l !�"(D �J /
2. Namw on Permit/ATC if Difforent thaa Above
Mailiaq ]�cldress City/State/Zip
3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC 'f]�Both
a. syratem to sa=,►i�e: �ouse ❑ Mobile Home O Business ❑ Industry ❑ Other
s. �f Residence: � People 2 �i Sedrooms � # Bathrooms �_
❑ Dishwasher ❑ Garbaqa Dispoaal ❑ Waehing Ldachin� O Baeamei►t/Plumbinq ❑ Baaemnnt/No Plumb3nq
6. I! Huaineaa/Induatry/Other: Specify type # People A Sinka
� Commodea � Shonara # Vrinala � Fiater Coolera
IF FOODSERVICE: # Seats EStimAted WSte= Usaqe (galione per day)
�. Type of water supply: 0 County/City �Well ❑ Community
e. Do you anticipate additions or eapansions of the facility this system is intended to serve? ❑Yes �'No
If yes,what type?
***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client witL THIS APPLICATION.
Property Dimensions: �7 2 �L WRITE DIRECfIONS(from Mocksville)to PROPERTY:
Taa O�ce PIN: # �78 7 �Y 33"l/ '�✓y �o� df}S� f}aOTJrv X
Property Address: Road Name Ir�u � �� �h1 i
_.... -.._ _... . � _.__ .._, _ --
City/Zip �7 Dd (o �An �
--, . _
�f a f �� ���
If in a Subdivision provide information,as follows: �"��'G - 6 5 5 7
Name:
Section: Block: Lot: Date Property Flagged: �a
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issaed hereafter are subject to suspension or revocation,if the site plans or intended ase c6ange,or if the information
submitted in this application is falsified or changed. I,also,undetstand that I ant respo»sible jor all charges IncurredJrom
this appllcatlon. I,hereby,give conseut to the Authorized Representative of the Davie County Health Department
to enter npon above described property located in Davie County and awned by
to conduct all testing procednres as necessary to determine the site suitability.
DATE �/?� �c-� SIGNATURE
THIS AREA MAY BE USED FOR DRAWING'YOUR SITE PI.AN(Include atl of the following: Ezisting and proposed
property lines and dimensions, stractures, setbucks, and septic locations).
—� ����f�g � � y Site Revisit Charge
` �, Date(s):
��
70
�D � Client Notification Date:
Zo f x�� S� EH&
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, . ' , DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
' ' ' • Soil/Site EvaluaHon +
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990001252 Tax PIN/EH#: 5787-34-3391 �
. Billed To: Ken Bingham Subdivision Info:
- Reference Name: Ken Bingham Location/Address: U.S. Hwy.64 E-27 06
Proposed Facility: Residence Property Size: 372 Acres Date Evaluated: "7 I �
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS . 1 2 3 4 5 6 7
Landsca e osition L
Slo % '�
HORIZON I DEPTH � 0 -
Texture rou SI�
Consistence NS
Structure cF,�L
Mineralo
HORIZON II DEPTH ( - D
Texture rou 5 � �
Consistence F,r
Swcture
Mineralo ` \ �t
HORIZON III DEPTH � � a-F
Texture rou S �
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: �-�F' ��N��►'��
�
LONG-TERM ACCEPTANCE RATE: O' . OTHER(S)PRESENT: I��C,�
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
MineralogX +
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
DC}-ID OS/99(Revised)
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1
Parcel#: K80000000109 Page 1 of 1
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Davie County, NC - Basic Estate Search �,ov���,
� Davie County Web Site
�Basic Search Real Estate 5earch Tax Bill Search Sales Search �
View Prouertv Record for this Parcel Yfew Mao for this Parcel Vfew Tax Bill Informatio�
Parcel#:K80000000109 Account#:6660500
Owner Information Tax Codes
INGHAM KEN CARTER&BINGHAM ELIZABETH CROWELL ADVLTAX-COUNTY T
00 NC HIGHWAY 801 SOUTH FIREADVLTAX-FIRE TAX
DVANCE NC 27006
Pro Information Townshi
nd(Units/Type); 221.53QAC FULTON
�
�dress."4i42'E•US FFWlY-64-•'-
Deed Information Local Zonin
ate: 04/2008 Book: 00752 Page: 0838
Plat Book: Pa e: .
Le al DescN tion PIN
21.520 AC HWY 64 5787343391
Pro e Values
uildin : 83 33
BXF•
nd: 941 06
Market: 1 024 39
ssessed: 195 97
Deferred• 828 42
Sales Informatlon
No. Book Paqe Month Year Instrument Qual/UnQual Improved Price
00752 0838 04 2008 WD Unqualified Improved 0
00174 0457 05 1994 WD ualified Vacant 330 000
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�eal property found within Davie County. All data is compiled from recorded deeds,
plats,and other pubtic records and data. Users of this data are hereby notified that the aforementloned public informatlon 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 Umitation 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.-
1.5.9
httn://maps.daviecountvnc.�ov/itsnetlView.aspx?nrid=1460803 6/21/2016