1235 Hwy 64WDAVIE COUNTY HEALTH DEPARTMENT 1w
Environmental Health Section
P. O. Bos 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002347 Tax PIN/EH M 5728-66-6446.RK
Billed To: Ronald Knight Subdivision Info:
Reference Name: Location/Address: US Highway 64 West -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3193
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type ii Sw— #People / #Bedrooms 1,? #Baths 2
Dishwasher: lam' Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply,/,'/G/l Design Wastewater Flow (GPD) Cbl Site: Newjn '..'Repair ❑
System Specifications: Tank Size/
& GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width S ��l Rock Depth Linear Ft.o�oU
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
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)751-8760.****
Environmental'Health Specialist's Signature: Date: �� �✓
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Bog 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002347 Tax PIN/EH #: 5728-66-6446.RK
Billed To: Ronald Knight
Reference Name:
Subdivision Info:
fd Y -to -o3
Location/Address: US Highway 64 West -27028
Pro osed Facility: Residence Property Size: see map
ATC Number: 3193
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST 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 WASTEWAT Aky,08?:
ONSTRUCTION IS VALLID FOR A PERIOD OF�FIVE YEARS.
Environmental Health Specialist's Signature: ,Y7- Date: 1r7— 3 —t/,y
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance 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.
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
�D
10 ZYJ
Date:
APPLICATION FOR SITE EVALUATIONAMPROVEMENT P
Davie County Health DepartmentAx :
Environmental Health Section D
C� P.O. Box 848NOV 1
Mocksville, NC 27028
704 634-8760 ''
yl
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed LA h 1qV /b A41 G
Mailing Address 3 y 3 m t I din
City/State/Zip� j T;� , �1�,e • :2 M7
2. Name on Permit/ATC if Different than Above
Contact Person ecN w og LimpA KiyL(if/
Home Phone X70 ^ 2 7A . 4 J 3 t----,e-d_7
Business Phone ^�%D� - 27S-
Mailing Address '%i'� City/State/Zip
3. Application For: U Site Evaluation { improvement Permit & ATC
NW!�'_IlrTi
[ ] Both
4. System to Serve:
D4 House [ ] Mobile Home [ ] Business [ ] Industry .
[ ] Other
5. If Residence:
# People --L— # BedrooAL� # Bathrooms_
�(J DishwasherKJ Garbage Disposal
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: [ ] County/City KWell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes N No
If yes, what type?
.�iir
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***.T OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax Office PIN: # 5 72 $ - 66,_ -L _ ; 7,4148 US loo (ASr FRbM M ockSV IT, Q6
Property Address: Road lame 11.,q, 6q (dl � l hmp)�' WE M ilE 4o / a Ml, t Ar'", ZA Ori0R
Citymp ' Oc i(Sv,ll . l'(C �� Ac�icl.r�,r MAOts�N t cif. m4i
If in Subdivision provide information, as follows: a oag 1(2d &A A .SMAu Rogs-e i.s oN Le{l• Nfl1 h 1 AE
N&
; /u
Name: N & '
Section: .-dot#- r r Fie
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 County Health Department to enter upon above described property located in Davie County and owned
by `A& LOU 02-4 1'435 t conduct all testing rocedur as necessary to determine the site suitability.
DATE I /— 9 SIGNATURE 6.�
Revised DCHD (06-96)
THIS AREA MAY $E USED FOR DRAWING JOU ITE P i %
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t , DAVIE COUNTY HEALTH DEPARTMENT
� Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME 7 P4
PROPOSED FACILITY
SUBDIVISION
Water Supply:
Evaluation By:
On -Site Well 1-�% Community
Auger Boring v Pit
DATE EVALUATED
PROPERTY SIZE
ROAD NAME 6.3
Public _
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
j� /
Texture group
Consistence
i
Structure
/
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (0I-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
Nott
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
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•. Davie County Health Department
and Home Health agency
Environmenta(Health Section
P.O. BOX 848 / 21 O HOSPITAL STREET
COURIER 509-4-06
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-8760,
Ronald David Knight
343 Millsaps Rd.
Statesville, HC 28677
November 26, 1997
Re: 2 Site Evaluations/200 Acres
U. S. Highway 64 West
Tar. PIN: *5728-66-6446
Dear Client(s):
As requested, a representative from this office visited the aforementioned
sites on November 25, 1997. Based upon the information provided on the
application(s) for site evaluation(s).,and after the evaluations were completed,
the sites were found to be provisionally suitable for the installation of an
on-site sewage disposal system on each site.
Before any permit(s) can be issued the appropriate application(s) must be
filled out and the house/mobile home,location(s) staked off.
If you have any questions, please feel free to contact this office.
RH/wd
Enclosure(s)
cc: Zoning Office
Sincerely,
I
�0'�,j� gyp, �a''rl��j• pdBD
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
M
Parcel #: I400000001
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search . Sales Search 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:I400000001
Account #:82530236
Owner Information
Building:
Tax Codes
BXF:
HELTON PEGGY O& OWINGS DAVID L
Land:
ADVLTAX - COUNTY T
Market:
1257 US HWY 64 WEST
assessed:
FIREADVLTAX -FIRE TAX
Deferred:
OCKSVILLE NC 27028
00777 0559
12 2008 QC
Property Information
Improved
Township
�Lan�d(Un;7itsFrype): 184.160 AC
2008E 0128
MOCKSVILLE
dress:35 W US HWY 64
Improved
0
Deed Information
Local tonin
Pate: 12/2008 Book: 00777 Page: 0559
Plat Book: Page:
Legal Description
PIN
186.71 AC HWY 64
5728666446
Property Values
Building:
24172
BXF:
9 00
Land:
744,80C
Market:
995 52
assessed:
398,32C
Deferred:
597-20C
Sales Information
No.
Book Page
Month Year Instrument
Qual/UnQual
Improved
Price
1
00081 0331
07 1969 WD
Unqualified
Improved
0
2
00777 0559
12 2008 QC
Unqualified
Improved
0
3
2008E 0128
03 2008 WL
Unqualified
Improved
0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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
htty://maps.daviecountync.gov/itsneWiew.asi)x?grid=1474831 7/12/2016