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2280 Hwy 64WDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 �1 IMPROVEMENT/OPERATION PERMIT Account M 990001089 Tax PIN/EH #: 5719-65-3267 Billed To: James Ward Subdivision Info: Reference Name: James Ward Location/Address: N.C. Hwy. 64 W.-27028 Proposed Facility Church Property Size: 3.5 Acres ATC Number: 2407 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type Wt-)" #People = #People/Shift #Seats Industrial Waste: ❑ Lot Size 5, 5 k94> Type Water Supply �� Design Wastewater Flow (GPD) Site: New Repair ❑ c System Specifications: Tank Size .koo GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. 1969(5) Other: .1�� [� I nc) Q� As € ed 1n tem15A NCAC alsISAo be used ��-,( acc�ted Systems may al'so-^be�used-_rc Q� Re.nnired Site. MMifinatinnc/C'nnditinnc- 'fSSuw— &-j t✓B,� mop'. �, � N -)ILD) �o- 1�' 10,0 1 ' �' , ---z----- ---- -------- ---- --- ---- ---- -- - L1.J IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) 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.**** Z - �� N r Environmental I ec i 's Signa ate: r-71 2s-h�� A �. DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001089 Tax PIN/EH #: 5719-65-3267 Billed To: James Ward Subdivision Info: Reference Name: James Ward Location/Address: N.C. Hwy. 64 W.-27028 Proposed Facility Church Property Size: 3.5 Acres ATC Number: 2407 As stated In 15A NCAC 18A.1969(5� ampted Systems may also be use 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 Formuthorization Number should be presented to the Davie County Building Inspections Office when applying for b d g permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .19 ea a sposal Systems). THIS AUTHORIZATION FOR WASTEW N TION VALID FORA P RIOD OF FIVE YEARS. Environmental Health Specialist's Signature: r Date: I &1o,!g- 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 I 1 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. Environmental Health Specialist's Signature: DCHD 05/99 (Revised) -fAW 41-11 Owl 5-M& -lyp OW N Date• ,Z S l� Z T Ito, J (vo i p LNl�ti Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) -fAW 41-11 Owl 5-M& -lyp OW N Date• APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERM Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760, ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billedc:gf09'5 �,$ -�i✓D4� D, Contact Person J� V_'jo' oq^- J Mailing Address S % % JE:' )�kgu o. /� Home Phone 7,7a— City/State/ZIP ) Dr, k Si/, /tee d�L' 7DnZ?S Business Phone 2 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ErImprovement Permit/ATC ❑ Both 4. System to Service: ❑ House ❑ Mobile Home Er Business ❑ Industry ❑ Other ��rA 5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative pacCepted 6. If itesidence: # People # Bedrooms # Bathrooms ❑Dishwasher ❑Garbage Disposal ❑Washing Machine— ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type # People lj # Sinks 3 # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: #1 Seats Estimated Water Usage (gallons per day) B. Type of water supply: Er County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? 1'**I11P0RTAN7*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client witli THIS APPLICATION. Property Dimensions: 0y FOG f-e,S Tax Office PIN: # 9712tso 9-32 Property Address: Road Name 7 / LlX- (a -We S I city/zip )-nag-ksti;)ie- z.,2' )ca If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY:' y -i�, ,7 r 15 IV S- t) k/ '�q<A--( % h e Koh Section: Block: Lot: Date home corners flagged: 4/- / —O C) 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 ain responsible for all charges incurred fron: this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suf ability. DATE )- 9 - e 5" SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE, PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given " Revised DCHD (05/03 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Q Invoice No.3 DAVIE COUNTY HEALTH DEPARTMENT --Z/��/ • Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001089 Tax PIN/EH M 5719-65-3267 Billed To: James Ward Subdivision Info: Reference Name: James Ward Location/Address: N.C. Hwy. 64 K-27028 Proposed Facility: Church . IiCA&*.BoaiJD' Property Size: 3.5 Acres ATC Nu�pb?r: 2407 **NOTE** This mprovement/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 - _ #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ /'&,- -76 A4Lo SOaoky Commercial Specification: Facility TypeCA#yOC-44 #People #People/Shift #Seats 200 Industrial Waste: ❑ Lot Size �3, 5/AC &ype Water Supply!t7OA&)' ' Design Wastewater Flow (GPD) 3DO Site: New 11Repair ❑ System Specifications: Tank Size 15C(bAL. Pump Tank GAL. Trench Width M Rock Depth Linear Ft.O Other: I P STU60TIOf� EP`jCSTXU, c,),jVI 10.0-. 1AA% i' , Required Site Modifications/Conditions: %)-'�hL-L o -J cIE-31-0)9- J �=� *,gFF /-JG, 44 -P IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 K 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.**** �Q$I? L_t�J.y i CNoWt4 fl s 45' E 'ronmental Health Specialist's Signature: Date: 300 DCHD 05/99 (R vie '' O� DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001089 Tax PIN/EH #: 5719-65-3267 Billed To: James Ward Subdivision Info: Reference Name: James Ward Location/Address: N.C. Hwy. 64 W.-27028 Proposed Facility: Church Property Size: 3.5 Acres ATC Number. 2407 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS VCTION IS V FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature- te: G CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: APPLICATION FOR SITE EVALUATION/IMPROVEMIENT PERMIT do ATC Davie County Health Depatttnent d Envltonmenftf flew/th Sexftn P.O. Box 868/210 Hospital street APR 5 2000 Mooksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***XWCRTXM** THIS APPLICATION Calow BB PROCHBBRD UNLESS ALL THE R$Q INPORMhTION 18 PROVIDED. Refer �t10 the nOrORMl1TICH BULLETIN for instructions. 1. name to be Ruled JCL m (e S W ai r ci Contact "roan -Ty+)/1/) Hailing Address 1 9 1 I'i"a Ir' �` I e �1 `�� name Phone q 98 — 6 City/sats/:z9 a O Lts �- V 1 1 i,'e ' . %b 2 g sasiness Phone C.0 Z. hauls on Posit/ASC it Different than Above ming meets city/sate/ria 1. Apr-lization Trot: df Site Evaluation n Inproveaent Permit/ATC / Both s. systen to servicer 0 House - 0 Mobile Home 0 Business 0 Industry 6' Other OUR s. If Residence: I People i Bedrooms s Bathrooms 0 Dishwasher 0 Garbage Disposal O washing mufti" 0 sasestant/Plvabing O sasesant/Ko Plumbing 6. Sf suainess/Industcr/Other: specify type (/, /7 U,4 c 14 i People%DQ I sinks 2- i Commodes 2 i showers f Urinals f wear Coolers , I! It`OODSERVICM: # Seats Estimated (later Usage (gallons per da r) 7. Type of water supply: alc-ounty/City 0 well 0 Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes ®'No If yes, what type? ***IMPORTANT*** CWENTS MUST COMPLEWTHE REQUIRED PROPERTY INFORMATION REgUESTED BELAW. Either a PLAT or SITE PLAN MUST BESUBM IM by the client with TIAs APPLICATIO . l Property Dimensions: 3 5 It re WRITE DIREC11ONS (Brom MockrAe) to PROPERTY: Tax Office PIN: #-f % J 9U f :3 2 6 7 lAk s/ ' Property Address: Road Name 1411'y- by - WeSr z)N Ayy -7�f a A O tyZi/'" � C.1'�V l 1 i e 2 8�'t�LLt Ci/ p - M If is a Subdivision provide information, as follows: Name: i rl Section:: Block: Lot: Date Property Flagged: / L100 . 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 we change, or If the Information submitted In this application is falsified or changed I, also, understand that I ane responsible for aU charges lncamd front this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departmey)ti , Ro to enter upon above described property located In Davie County and owned by //EX1/E/V FoO/z D Gjf� to conduct sR testing procedures as necessary to determine the site wi)Wlity. -01 'I IRS AREA MAY BE USED FOR DRAWING YOUR 81717E FI A�l (I)efciude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic Idetflons). �; _ono m 6 '50� 411-- . 0 00- T�-- / Revised DCHD (07/99) Site Revisit Charge iDate(s): I Client Notiliation Date: EHS: t Account No. A0�`� _ Invoice No. / i/ '�� INDEXED ON 5719.02 (1764) (1.84A) 5456 (6.51A) 9361 (2.74A)171 (3.45A) 2217 3267 �V1 Sa 765 Z N � j i1 INDEXED ON INDEXED INDEXED ON 5719.02 a 265 ON 5719.02 5719.02 265 243 8807 266 66 c'j Lo (o if (2.16A) 7820 5737 8707 �00 --,k 8627 70o IS � 'a \ (4.65A) 6189 o CLEMENT GROVE CHURCH OF GOD DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PRO Property Size PERTY INFORMATION Tax PIN/EH #: 5719-65-3267 Subdivision Info: Location/Address: N.C. Hwy. 64 W-21028 3.5 Acres Date Evaluated: Water Supply: On -Site Well APPLICANT INFORMATION Account #: 990001089 ' Billed To: James Ward Reference Name: James Ward . Proposed Facility: Church DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PRO Property Size PERTY INFORMATION Tax PIN/EH #: 5719-65-3267 Subdivision Info: Location/Address: N.C. Hwy. 64 W-21028 3.5 Acres Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1; 2 3 4 5 6 7 Landscape position Slope % io HORIZON I DEPTH 0- 77 - 7 - Texture Texture roup ZE L' L Consistence P S Structure, Mineralogy,. HORIZON II'DEPTH -2 2 - Texture r'ou Texture ! Consistence ' Structure C3k f k MineralogyI t_ HORIZON III DEPTH Texture group Ct S Consistence Structure MineralogyI 1 i HORIZON IV DEPTH Z+ Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: 'Ey- LONG-TERM ACCEPTANCE RATE: �• OTHER(S) PRESENT: REMARKS: 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 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 DCHD 05/99 (Revised) ON ii ■■■■■■■■■■■■e■■Nei■■■■a■■■■■■■e■■■■■■■� ■■■■■E■■a■■■■■E■■■■■■■■■m■■E■■E■■e■■rug ■■■■■■■■■■■■■■■■��■■■■■■■■■■■inn ■■E■■■■� ■E■■■■■■■■■■■■■■■I■■■■■■■■■■■Nei■■■■■■■I ■■■■■■■■E■■■■■■MEI■■■■m■■■■e■Nei■■■■;a�■I ■■■■■■■■■■■M■■■■■IM■■■■■■Nee■■ ■0�.�■� ■■■■■■■■■■■■■■■■■I■■■■■■■■■e■■■i■Nae=��■� ■■■■Nee■■e■■■■■EII■■■■■e■■■■■Mai■■■■■■■� SEMENEMEMMEmiloomm MEMENS wm:wiii ■■■■■■■■■■■■■M■■I■■■■■■Neese■■■■■■sO■■� ■■■■■■a ■E■■■a■■E■■■■■■Secy■■■� ■WEE■■EM■■EN■■ iAMMMMM■m■M■MM■ i■■■■■■■■Nee■■■ Ise■■■■■■■■■■■■ ■■■■■■■■i ■M■■■■E■i ■M■■■■■■ ■■■■n■■■ ■■■I IAME■i .,■.ft►geeim, um■■■■■., ■■S■■■■r,i ■■■■■■Mui ■■■■■■■■! ■E■■■■■ei nM■■■■■■i ammosommi ■■■■■■■■i ■E■■■■■■i ■■Nee■■■i ■■■■■■■■i ■■■■■■Nei ■■■■■■■■I ■■■■E■E■i ■■■■E■■■I ■■EEE■i■■ i ■■M■■■RMI MEMEMEMINI MOMMEMICNI ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■M■■■■ ■■■■■■S■■■■■E■■■■ ■■■■■■■■e■■■■■■■■ ■■■■E■■■,■■■■■■■■■ ■■■■■■S■Il■■SE■■E■ ■■■■■■■■■■■■■■■■■ ■■E■■■■■■■■■■ ■■■■■■■■■■■■■ No ME on so No ■■■■■E■ ■■■■■■■ ■■E■■■■ ■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■■EE■ ■■■■■■■ ■■■■■■■ ■■■■E■■ ■■NESE■ ■E■■E■■ NEEM■■■ ■■■m■■■ ■■■■■■■ ■■SOMME ■■■■■■■ ■■■MESE ■E■■M■■ ■■E■■■■ ■■■■■■■ NEMESES ■E■■■■■ ■■■■■■■ ■■E■■■■ ■■ENE■■ ■■■■E■■ ■■■■■■■ ■■■■E■■ M■■■■UI ■EN■■ ■■■■E■■ ■■■mems I■■■■■■■■■■■■■■E■ I■■■■■■■■■■■■■■■■ IM■■M■■MMEE■■MM■■ IM■■M■■ME■■■M■E■■ I■MEMEMME■■■■M■N■ IMMEMME■■■■■EM■■■ I■■■■■■■■■■■■■■■■ 1■■■■■■■■■■■■■■■■ I■■E■■■■■■■■■■■■■ I■■■■■■■■■■■■■■■■ I■■■S■■■■■■■N■E■■ I■■■■■■EM■■■■■■■■ 11■■■■E■■■■■■■■■■■ II■■■■■■■■■■■■■■■■ u■■■■■■■■■■■■■■■■ I'■■■S■■■■E■■E■■■■ Ie■■■■■■■■■■■■■■■ Parcel #: H300000015 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search Q View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: H300000015 Account #:34029400 Owner Information Tax Codes HEAVEN BOUND FULL GOSPEL CHR ADVLTAX - COUNTY TA 181 HARTLEY ROAD FIREADVLTAX - FIRE TAX OCKSVILLE NC 27028 Market* Property Information Township Land (Units/Type): 3.450 AC CALAHALN ddress: 2280 W US HWY 64 Unqualified Deed Information Local tonin Pate: 12/1998 Book: 00207 Page: 0852 00203 Plat Book: Page: 07 Legal Description PIN 0.50 AC US HWY 64 W 5719653267 PropertV Values Buildin : 27159 BXF: Year Instrument nd• 31,85 Market* 303 44 ssessed:CC 303,44( eferred• 1990 WD Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00155 0085 07 1990 WD Unqualified Vacant 0 2 00203 0678 07 1998 WD Unqualified Vacant 23,000 3 00207 0853 12 1998 Unqualified Vacant 30,000 4 00207 0852 12 1998 WD Qualified Vacant 30,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oI .Ml� ot-orml-'s 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 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1458897 7/14/2016