3468 Hwy 64Ws
Permittee' DAVIE COUNTY HEALTH DEPARTMENT
Name:
P-0—dcI1 ,L Lows,
r `5 Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property: E '- =7 i ;' C Mocksville, NC 27028 Subdivision Name:
Y + 1C. 1 '' 1 .• C Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
.AUTHORIZATION NO: 002968 A Road Name: 11s a WV W 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
-) • ,/ / ___; ., _ I ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
d +•' :, .d� �i i U' ' Zoo IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE IS9 UED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS (i GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE Sk�z TYPE WATER SUPPLY V4 (' DESIGN WASTEWATER FLOW (GPD) �t 0 NEW SITE REPAIR SITE /✓
SYSTEM SPECIFICATIONS: TANK SIZE Er ; GAL PUMP TANK GAL. TRENCH WIDTH JI ROCK DEPTH 2 ' LINEAR FT.
OTHER ( 7 ! 1
REQUIRED SITE MODIFICATIONS/CONDITIONS: \.-U� �'l�� G �G10 �V�C�1�CY'� 2 (4 ` of
IMPROVEMENT PERMIT LAYOUT
- k v\)
Check 1oV-kV i ice- - –
Yi(��GU t� VAC(,CSSG+Y��
�( t �('Ykl( 1,A(S CSV E
y
I9C),
c` I �1fc+r Cf
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
5 l�n�S
'JZ�t
SYSTEM INSTALLED BY: __IJII�G� l/1ea�
J +gF i
... IV
0()p 0 U v UUP
0
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: r7j �71M
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE STEM DESCRIB ABOVE 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.
DCHD 02/02 (Revised) '71 iJ''.LI g3
,.., t ,; ya(.yV .,
,. � -._r`•
-s°. .. , ..",.:,.tx ,v3 �.,.�4
.. 8•R`.AM`W� .a"m`i't�
".r:it;•�,�.. ..4 Y'�"
?^'y.°♦ ... 4R �, ♦ ,.6.1 .. : •.�+.:.*.'y
,...
pywW�`�"Tp •v .,� a .r`
�
LOT SIZE >1 TYPE WATER SUPPLY
DESIGN WASTEWATER FLOW (GPD) O
NEW SITE REPAIR SITE ✓
-Permittefe'
' ' "
DAVIE COUNTY HEALTH DEPARTMENT 1
Name:
0 2e I'S
Environmental Health Section
1
PROPERTY INFORMATION0%
TANK
GAL. TRENCH WIDTH
P.O: Box 848
f ,
_ D_irectioris to property:
Mocksville, NC 2702E
Subdivision Name:
Phone #: 336-751-8760
AUT6I6RIZATION FOR
Section: Lot:
REQUIRED SITE MODIFICATIONS/CONDITIONS:
WASTEWATER
Tax Office PIN:# - -
SYSTEM CONSTRUCTION
)!f
AUTHORIZATION NO:
002968 A
' , /
Road Name: U S E1 VIV b -t�' WZip:
**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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
12� 0 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE +.. # BEDROOMS # BATHS # OCCUPANTS s GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
# PEOPLE
# PEOPLE/SHIFT
# SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE >1 TYPE WATER SUPPLY
DESIGN WASTEWATER FLOW (GPD) O
NEW SITE REPAIR SITE ✓
'
j
SYSTEM SPECIFICATIONS: TANK SIZE GAL PUMP
TANK
GAL. TRENCH WIDTH
ROCK DEPTH LINEAR FT. t"
f ,
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT-kRMIT LAYOUT !
- � �' . • � �. 'Ir c � a �-t. 1, t 1 �._ _.--�~�
w
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE '# IS (336) 751-8760.
OPERATION PERMIT
51,t�eS
4$'. I,yit k"
IVQ
3LS' 4\-t'1
SYSTEM INSTALLED BY: b/ � C�N� CI CAd 1
C y .� Sh��'- o ny-
-all �•1�,e •� (< ve �
I
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: 4
**THE ISSUANCE OF THIS JOPERATION PERMIT SHALL INDICATE THAT THE STEM DFSCRIRA ABOVE 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.
3 DMD 0=2 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION /
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) / 3c)
NAME P7`/•fr.C� 921&, . PHONE NUMBER ,fa 77'lk
ADDRESS Gtw SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE � - �aaa La%4� �Gu -_Glued-� 11tif.'k-Y
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER ! aQ,. C
TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY &ell SPECIFY PROBLEM OCCURRING u/.7�/!0� �,�r.: - /i/L//
DATE REQUESTEDIt Z3 ��f INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
f
APPLICANT INFORMATION
Water Supply:
Evaluation By:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
On -Site Welly Community
Auger Boring V/ Pit
f�� ' � �L;fi�i ►�'J�11��7�
3�G� NAY b� w
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture groupG
Consistence
Structure
5
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
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
IT I
SITE CLASSIFICATION: EVALUATION BY; 0)q IVA' ij\�
LONG-TERM ACCEPTANCE RATE: r OTHER(S) PRESENT: kOf X0,X
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
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
Mineralo�v
1:1, 2:1, Mixed
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 05105 (Revised)
Parcel #: I100000026
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #:I100000026
Account #:82513096
Owner Information
uiidin
Tax Codes
BXF:
ROGERS PATRICK CLYDE & ROGERS KATHY H
Land:
ADVLTAX - COUNTY T
Market:
O BOX 37
ssessed:
FIREADVLTAX - FIRE TAX
Deferred -
MOCKSVILLE NC 27028
Vacant
0
Property Information
09 1999 ED
Township
Land (Units/Type): 4.620 AC
0
CALAHALN
ddress: 3468 W US HWY 64
Deed Information
Local Zoning
Pate: 09/1999 Book: 00313 Page: 0510
Plat Book: Pa e:
Legal Description
PIN
62 AC HWY 64
62379000
Property Values
uiidin
87,09 0011
BXF:
4,13
Land:
40,41
Market:
131 63
ssessed:
131,63
Deferred -
Unqualified
Sales Information
No. Book Page
Month Year Instrument
Qual/UnQual
Improved
Price
L 00005 0624
05 1946 WD
Unqualified
Vacant
0
t 00045 0624
05 1946 WD
Unqualified
Vacant
0
3 00313 0510
09 1999 ED
Unqualified
Improved
0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
« Return to Basic Search
E
Page 1 of 1
oP�r�
oull
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
httv://maps.daviecountync.gov/itsnet/View.asvx?grid=1425608 7/12/2016