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300 County Line RdDavie Countv. NC Tax Parcel Report Wednesdav, October 12, 2016 WAK1V11V(�: '1'Hl� 15 1VU'1' A �UKVL+'Y . _ _ __ Parcel Information Parcel Number: 1100000053 Township: NCPIN Number: 4799901233 Municipality: Account Number: 28508000 Census Tract: Listed Owner 1: GAITHER GORDON W Voting Precinct: Mailing Address 1: 3622 US HIGHWAY 64 WEST Planning Jurisdiction: City: MOCKSVILLE Zoning Class: State: NC Zoning Overiay: Zip Code: 27028-8454 Voluntary Ag. District: Legal Description: 4.970AC TRACT 1 GAITHER Fire Response District: Assessed Acreage: 4.68 Elementary School Zone: Deed Date: 4/1993 Middle School Zone: Deed Book / Page: 001680075 Soil Types: Plat Book: 0008 Flood Zone: Plat Page: 094 Watershed Overlay: Building Value: 6910.00 Outbuilding & Extra Freatures Value: Land Value: 41070.00 Total Market Value: Total Assessed Value: 47980.00 9�16�� Davie County� �o�,N�' NC Calahaln 37059-801 NORTH CALAHALN Davie County DAVIE COUNTY R-A Yes COUNTY LINE WILLIAM R DAVIE NORTH DAVIE PaD,PcC2,Ce62 DAVIE COUNTY 0.00 47980.00 All data is provided as fs without warranty or guarantee of any kind either expressed or implied Including but not Ilmited to the implied warranties of inerchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due tc or arising out of tho use or inability to use the GIS data provided by this website. �w.... ., :. . ::-.:--. ..,.�,r .,-t�-; r � , . , . , ,; -. - . r , - � •� ._ �� ' �� Aj�iTHOR�ZATION NO: �� DAVIE COUNTY HEALTH DEPARTMENT �`� • Environmental Health Section PROPERTY INFORMATION Permittee's . � � /f . �/ P.O. Box 848 � Name:` � G�� 'n✓1 (�G-� f�'✓� Mocksville, NC 27028 Subdivision Name: // L Phone # 336-751-8760 Directions to property: �/'1 �� . ��7 Section: "� Lot: � , /7 � AUTHORIZATION FOR �,� p �.�r'?L ��i;�'. �� . 1'�''e .� i S � WASTEWATER Tax Of�ce PIN:# �/ !J - l � - c�i�J � SYSTF.M CONSTRUCTION � � , � � �� Z� �y r�. � . /� r., % � .,-�, Road Name �;�,�;,�-� �— p: G'`�%L,� , �_ **NOTE** This Authorization for Wastewater System Const�vction 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. (ln compliance with Artide 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) � � ,.� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ..c=�.�1�:,�.— .: !i'�%1'`�� `3� ` IS VALm FOR A PERIOD OF FIVE YEARS. , EN ONMENTvaL,.kf�ALTH SPECIALIST DATE ISSUED � -.- ' . � . {' �Y3�, �� -, � , , r � -_ ., . . : � _ , l DAVIE GOUNTY HEALTH DEPARTMENT / ��'� J� , A' � �y �,.` .. . . r N . . �� Y�� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION �,Permittee's. ,� i �f� - �m� - '"' �t; � �s �; r � t `> _ , r ;�� ;:.r" Subdivision Name: """ ,,. -.. , �.� �, . - "Directions to property� r%�' � '� �� -'� �- Section: "' Lot: � IlVIPROVEMENT -,-. ,�.,,, •,_ . /',� �� / `�. � i � ;�3:', � � � PERMIT Tax Office PIN:#��%`t'`� - �'j�C.� _ ��y-�'�.: � ; 1 �. � j°��y. �r.�, �.,:>r �7 '? I , � � � � Road Name � '�d �-• I�.�l Zip: .� �` _ � �" � **NOTE** This Improvement Pemut DOES NOT authorize the construction or installation of a sepdc tank system or any wastewater system. An ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained from this Department prior to the construction/installation of a system or the issuance of a building pernut (In compliance with Article 11 of G:S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ., �f` f�xf "'�� ***NOTTCE*** THLS PERNIIT LS SUBJECT TO REVOCATION IF SITE �;,�, :...? ��`ti;-;J jz- �;,..r-� �-�� -� PLANS OR Ti� INTENDED USE CHANGE. YOUR WASTEWATER EIVVITtONMENTAL_HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TiIIS PERMIT BEFORE _ INSTALLING T'HE SYSTEM. . RESIDENTIAL SPECIFICATION: BUILDING TYPE �# BEllROOMS _� # BATHS _� # OCCUPANTS �_ GARBAGE DISPOSAL: Yes or� f COMMERCIAL SPECIFICATION: FACILT['Y 7'YPE # PEOPLE # PEOPLFJSHIFI' # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE S� TYPE WATER SUPPLY ��;/�-// DESIGN WASTEWATER FLOW (GPD) � NEW SITE_ /'� REPAIR SITE �j, �� // / SYSTEM SPECIFICATIONS: TANK SIZE Ob0 GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH �_ LINEAR Ff.� I / / � . / ./ w / ♦ . /1 i ' � REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENTPERMITLAYOUT ��,pp�g•JEi� EFFLUEi�i CiII.T�I2� �I�d��FliS} I � : l ;,� �� ,�1� E _ �.,oj�� /� 30 -9� �x,�-�� . � �-°�'" � � 1 .�� b., i� �ar, r�r' ► � '� � � j"lo+iCl�ik�� iS�i� q� �'C' � � � � ��'�� ,�' � E � � a _ `r' r �. - � •• EEL(3:t F ��j// Si o r 1 1�� po�� ["it?1►�'i ;: �� -- //� �S � `n � � �1��'�! �r�\� �' �o�z �6� X la jt5� / 9'�,C, *"`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. OPERATION PERMIT � � v SYSTEM INSTALLED BY: ;`��''`— I� I,Jl�,� ��L�e r � �� IS..�-�� ' , � AUTHORIZATION NO. �r� OP RATION PERMIT BY: � DATE: �' *"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS SCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPUSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCfiD OS/96 (Revised) % � � �� • /., PLICAiION FOR SITE EVAWATION/IMPROVEMEM PEAMIi h ATC Davie County Health Oepardnent - Environmental Hea11fi Secdon P.O. Box 8�8/210 Hospital 3treet tsoo]caville, Nc 27028 � � �336)751-8760 � I3 APPLZCATION GANNOT BE PROCESSED LTNLE33 ALL TEiE REQI)IRED ,, 3 PRWIDED. R�efer to the INFORMATION BULLETIN for instrnctions. be $�llea �� T�O� O t-1 7�% �� +� conr.aot rerson li a 1-�'� r> 1laiiinq 11cldreaa �(� c� vZ 7�" UJ L/ !D � 1.{1(�J � 8ome phane �-1 �—..7 � d / City/8tate/SIP �'��tS �U f 1 �� %V.l.�� Business ?hone �"I `�. — / 0 � SJ 2. Name on Peanit/1►TC i! biflerent than Abave 1lailing Addresa City/Btate/Eip 3. Appl.icatioa Sor: L�"Site Evaluation �Impravement Permit/ATC �Soth t. sy.tem to servtce: U Honse L9'Mobile Home � Bnsineas 0 Industry 0 Other a. If itesideace: # People � � Bedrooms c� / 8ath�tooms .�. 0 Dishwasher 0 Oatbagn Disposai B"ttashinq Hachine 0 Bas�t/Dlnatslnq 0 BasemenE/No Pluabing 6. i! Bnsiness/ineustsy/othes: SpecilY typa � Peapie # Sinlcs • Ccm�odea � 8hawers * Uridals / Nater Coolers IS FOOD3ERVICS: � 3eats Estimated Nater tlsage (Qallons per aay� 7. Tp� of water supplp: 0 Conaty/Cfty D 11 0 Comnunity e. Do you wnticipate additiona or e:panaiona of the facility this syatem ia intended to aervei 0 Yea � No � lf yea, wb�t type' """IMAORTANT'*' `CLIENTS lllUST Ci011tPLETE THE REQUIRED PROPERTY INFORMATION REQQESTED B�LOW. Eitber a PI.AT or SITE PI.AN MUST BESUBtlt1T7'ED by the dlent nith TH1S APPI1CATlON. Property Dlmenaiona: � J �� ' wR .�QQ Tai Oftice P[N: # `-� �� c�`�.,� �-(' _ Property Address: Road Name Ov� �� _ ctcyiuP _ if in a Subdfviaion provide informatioo, As follow�: Name: Section: Block:• l,ot: (fmm Mock:ville) to PROPERTY: /"�/�-E'J _ f'7`. 0 �� Date Pruperty Flagged: .� - i%o6� This i� to certify that the intormation provided is correct to the 6est of my knonicdga 1 understwd ihst awy permit(a) i�,sued hereafter are subject to su�pension or revocation, if t6e �ite plana or iatendcd nse c6ange, or if tbe informatton submitted ia t6is application is fAlsitied or ch�tnged I, also, anderst'and that I ant responsible jor a/1 chwga fncurred fronr this applicatio,r. I, 6ereby, give conaent to the AatLorized Repreaentative of f6e Davie County Bealt6 Department to eoter upon above desc�ibed property located in DAvie Coanty and owned b� to couduct all teriing procedures Aa nece�ry to determine t6e �ite anitabilih. � DATE ~�� SIGNATURE l.�" J.4-�►'�-' � G�.ti,�� TBIS AREA MAY BE USED FOR DRAWING YOUR S1TE PLAN (tnclude all of t6e fol:oaing: Eziating and pr�o{►c►sed property lina aad dimensloas, atructurYs, setb�tck�, and �eptic locadons). Reviaed DCHD (07/98; Account Na Invoice Na b J, � 1 � 0 Piet%E' �O � I '� .�c�1Lc� �1tc1 £��totj'�?' U �.� hJorm Carolina NW r� SW Click c:n the Map to: Q Zoomin Q ZoomOut Q Recenter Map Q Identify: Parcel SCALE 1 : 3268 � � � Zoom In oom O Full Extent Reset Map S Parcel Data • Parcel Number(P/N): 4799901250 • CountylD:01 N0000001701 • Property Address: 30D COUNTY LINE RD • Legal Desc.: 5.66 AC SR 1338 DB • Use Value: $0.00 • Building Value: $0.00 • Extra Features Value: $0.00 • Land Value: $22,320.00 Parcel Query a parcel by one (o�parts of one) of the following: St. # St. Name St. Type ress: � l-� � Last Name First Name �� Find Parcei • Total Value: $22,320.00 • Owner. GAITHER GORDON AND COLEEN • OwnerAddress: 3222 US HWY 64 W • Owne�City: MOCKSVILLE • Owner State: NC • OwnerZip:27028 Map Layers Draw se/ected layeis.� �E Transportation � Street Centerlines Interstate 40 � US Highways -- NC Highways — Other Streets -- E SE is map is prepared for the inventory of real property ind within this jurisdiction, and is compiled from orded deeds, plats, and other public records and a. Users of this map are hereby notified that the rementioned public primary information sources �uid be consulted for verification of the information �tained on this map. The county and the mapping i software companies assume no legal responsibility the information contained on this map or in this Date: 3/18/99 Time: 8:38:32 AM � Rail Lines Government � Cit�+ Boundaries � Townships � Census Tracts � School Districts Natural Resources � Hydrology � Soils Localities � Schools � Fire Departments Parcel Data � Parcels Draw Layers � � + • � �' ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT � ' SoiUSite Evaluation APPLICANT'S NAME �Or �'1 oT�r �� DATE EVALUATED �� ^O(� '-1 l PROPOSED FACILITY n1��/�'1�t PROPERTY SIZE ��/� � SUBDIVISION — Water Supply: On-Site Well Community Evaluation By: Auger Boring �� Pit ROAD NAME Public HORIZON I DEPTH Texture group Consistence Structure 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 SITE CLASSIFICATION: �J LONG-TERM ACCEPTANCE RATE: � REMARKS: DCHD (01-90) EVALUATION BY: OTHER(S) PRESEN s LEGEND _ • � •�l�iJ ��j� �� 51 � ' ;l ' / i R- Ridge S- Shoulder L- Linear slope FS - Foot slope N- Nose slope CC - Concave slope CV - Convex slope T- Tenace 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 Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky SP - Slightly plastic P- Plastic VP - Very plastic Structure SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangulaz blocky PL - Platy PR - Prismatic Mineraloev 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 Classiiication - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gaUday/ft2 -._ '—"'c: ,:�.. ,, ' .a Y'�iY'� . r ' .r „ f �. � , a � � � .�.a�' v ,- �, , r� � .: - .._.. -..., i: . . , . . , _ : ,,. , . ' .. . , .. 4 .. �.....-�. .-.. t , �.....��.._ y . . . . . ,'... . :'�>., . .i♦ . ,�„ . ��`�A�UTHORIZATION NO. ��j DAVIE COUNTY HEALTH DEPARTMENT I��'!/lUD , v�� "�`''` �.��. � � � A Environmental Health Section PROPERTY INFORMATInN Permittee's � .,j% P.O. Box 848 Name: __''�/��G �/" r;c'r; / " �i' � ,,. Mocksville, NC 27028 Subdivision Name: Directions to property: /� / ��'�' Tc' �' � � -: �,� Phone # 336-751-8760 ; AUTHORIZATION FOR �!+, i C- f[��. fc`�l. �..��,.;�f �r"�`i'�,�' /`j WASTEWATER � . SYSTF,M CONSTRUCTION �• ' A% �C. / �rl f t. Section: Lot: Tax Office PIN:#� �/f - � � -%,c��.3 C7 Road Nam�f :; :,� f y%�i.i� '/�t�rl Zi �.��c=.'? C. P **NOT'E** 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. (ln compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) X� � ��'� / �, ^. ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION f'L`�----- ��` �.��::� '�-%C`� IS VALID FOR A PERIOD OF FIVE YEARS. TH SPECIALIST DATE ISSUED . . , , ..., .: .. ; . . . ._.. ..; . . : ... . . , �, , .. (�� t � � �} ' t. .'. � �i1 �J �l ��U d / �li ., � j��,� � DAVIE COUNTY HEALTH DEPARTMENT I�' '� - � TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permiftee's' i " , ,: _ �„ } � _:Name: � ' �` � F'" ° �" r > ," : �'f , ,� �� Subdivision Name: � ._ Directions to property: f: ��'�:' '' i ' f�i Section: Lot: IMPROVEMENT , f'�'=(, , � 1� ,� ��"�� PERMIT T�OfficePIN:# %��'.� `%�,' - P"� J'! r ; f �-1� Road Name: �, ,��r i' Zjp; r �. **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Department prior to the construction/installation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, W�stewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ,' f' , , ***NOTICE*** THLS PERMIT IS SUBJECT TO REVOCATION IF STl'E '�: �` , " . . . .. ---.__ �. £ '"; �� r , ,: PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER , � ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE/�' �# BEDROOMS �# BATHS �_ # OCCUPANTS � GARBAGE DISPOSAL: Yes or �oi COMMERCIAL SPECIFICATION: FACILITY 1'YPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No V. � LOT SIZE � A� ' TYPE WATER SUPPLY� <I DESIGN WASTEWATER FLOW (GPD) - �� NEW SITE REPAIR SITE 1�� „f �j�� /Q �l r- � SYSTEM SPECIFICATIONS: TANK SIZE y�GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH /�J LINEAR Ff. � REQUIRED SITE MODIFICATIONS/CONDITIONS: � ��l�.f' �� P�X / �/y � IMPROVEMENTPERMITLAYOLLTa�`r�ROVED EFFL[1E�1T FI�.TEI�� RIS�R(S> IF 6" ��L0.3 FItJIS�l�r1 GnF3D�i: �'�' '• `, UN`c ="`� �GiG�' / .��k: G-n(� %5� -'i a � � i nl � ----�------___ �.,,� � � � r�' V ' **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 # j�y(�(l,r}};C�; 4-�"�60. � t�;c,)7 91—R7Fti I OPERATION PERMIT �t SYSTEM INSTALLED BY: �Y I n 01 I / AUTHORIZATION NO. � DATE: /` �� *"`THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T�iE�S-Y-&��IvI DESCRIBED ABOVE 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. -� DCHD OS/96 (Revised) "'�.,^*�'°�` F � F . ; ` �% 'i . . , • . .. ' .�-✓! ,J i J` "'.�} �-% t�+,� ` • �:� ,,,,� w , � � ,� „� � : DAVIE COUNTY HEALTH DEPARTMENT � � IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ' ,Permittee's= . Z ,'' ,;Name: � ' � ^ � - ' Subdivision Name: r Directions to property: '' t Section: Lot: � Il17PROVEMENT PE�T Tax Office PIN:# � . - - Road Name: � Zip: **NOTE** This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained from this Department prior to the construction/installation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) . ***NOTICE*** THLS PERNIIT IS SUBJECT TO REVOCATION IF STI'E PLANS OR THE IIVTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TI-IIS PERMTf BEFORE INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE.M• f�. # BEDROOMS j # BATHS �� # OCCUPANTS �_� GARBAGE DISPOSAL: Yes or �o� �r COMMERCIAL SPECIFTCATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL W�4STE: Yes or No �.._ , i .j • .:. LOT SIZE=-� % i' TYPE WATER SUPPLY� �(, DESIGN WASTEWATER FLOW (GPD) ��='-,- NEW SITE REPAIR SITE �r''� {�:� ��` �., t� f SYSTEM SPECIFICATIONS: TANK SIZE `! GAL. PUMP TANK ��GAL. TRENCH WIDTH �`�`�� ROCK DEPTH �� LINEAR FT. � �: ��/ REQUIRED SITE MODIFICATIONS/CONDITIONS: "( /��r�' { L:.��/ �Ji! ' c; � f �j%�C` •'�'i IMPROVEMENTPERMITLAYOiJ��f��r�� L�w��-�- F��,F�� ..n�r.�r�{�) Iw C�+� �' L��L��•� hzr�r�� t ��. , `_ �i�, �� .:�C�.�' � / �= ?;' :..,i^.: i� ..� �" �;f �;�� . r4P�i: --"""".r..�+-�' , "--». � > + C `"r V ✓ � **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 930 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE #�4-j1Q¢1;634-�760• !;?.�s� ) 7y.i _.,�17'f�f3 I OPERATION PERMIT SYSTEM INSTALLED BY: �,� ��, , � �� ,, �..,�� -_, � I� 7r- r 8 n �� /- _ . �,/_ � AUTHORIZATION NO. �Ir /� i � OPERATION PERMIT BY: / '�••��!'�. `` / �,Z�.�"„�.�. — DATE: I I / � � r **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE�SYS DESCRIBED ABOVE 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. I DCHD OS/96 (Revised) ' :,ti. r . � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ ' Name: �U�� r�� "' �� Phone Number: �/ � �� (Home) Mailing Address: c��-2� !�� Y Gy� ��2 — ��J`�� (Work) ��OG-d�.S Lsll� /�"�c�! .� �� Detailed Directions To Property Address: F �� Z '�- ,�� %� "�UG. � Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under:�U/s G �''� �G < !�� Type Of Dwelling: / � � -- / � Date System Installed(Month/Day/Year): 02 ��'� Number Of Bedrooms: c� Number Of Peopl� Is The Dwelling Currently Vacant? Yes f1V No ❑ If Yes, Far How Long? ///��' C/��Ol� ��i <%t�- � Any Known Problems? Yes ❑ No fY lf Yes, Explain: --- Please Fill In The Following Information About The New Dwelling. Type Of Dwelling: �� f� . Number Of Bedrooms: � Number Of People: � Requested By:� � " ''�"`'�— � Date Requested• /� 3 — � � ' �'o �� (Signature) For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Comments: �" I" � � � T" ��Lr �7 � Environmental Health 'YThe signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a Quarantee(extended or limitedl that the on-site wastewater svstem will function properlv for any �iven period of time. Payment: Cash ❑ Check 0 Money Order ❑# Amount: $ Date: Paid By: Received By: /�/ Account #: / Invoice #: y_��. j . - .-... . , . ae'�`�. 's-. � a;F' ,�. � � i3',. .:'`�l . ,- � s i � .,�a �..� � ..�- �` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ># :�� PO Box 848/210 Hospital Street , ` -` Mocksville, NC 27028 .' t Phone: (336)751-8760 3� . � ' . , � i ON-STTE WASTEWATEI� CERTIFICATION FOR DWELLING (Check'One) REPLACEMENT o ' REMODELING ❑ RECONNECTION ❑ Name: �G�'G�oy� C.a �' ��'�''' Phone Number: �/ � rJ(~lG � (Home) Mailing Address• �_.��2�- `� �-'l� �y� GI�� ~ / ��7 (Work) /f�a� �!fS �.�//C /�'� ;l �G:�.-� Detailed Directions To Property �" ,r. -/�l� /h '` � , ; ;'` � � ,- Please"Fill In The Following Information About The Existing Dwelling:t � I ,; t � '�' � �.� ' / . � . j yr . Name System Installed Under:�i /' �G� � L� G i�f''1 �'-" Type Of Dwelling: ��- `� j Date System Installed(Month/Day/Year): �'-G� Number Of Bedrooms: a2 Number Of People:-�� ' Is T'he Dwelling Currently Vacant? Yes f�Y No ❑:' If Yes, For �How Long? /� �%��' ��, ��"In l� �'G� �/2- � Any Known Problems? Yes 0 No ��If Yes, Explain: — ' �..�,....� ...,,,.�..., . �.. Please Fill Yn The,Follo .{'_- ` .�..�;� ..::� Type Of Dwelling:' �� F Requested By: � �'} {. � j� S -�,�QQ�. •°k , � , , ♦ ' . f Approved ❑ � Environmental Health Information About The New Dwelling: ',.�.::�..-,._-.p�a '� � ..�. . �, mber Of Bedrooms: � Number Of People: �� f�� ;, J l t�� s . :'r ' Date Requested: � � _ `''� ) " d c � >> For Environmental Health Office Use Only ❑� (i F �' —� �r�i�r�i � � � .� . �- *The signing of this form by the Environm�n'tal Health Staff is in no way intezlded;'`nor `shoulcl_be vtaken as a guazantee(extended or limited) that the on-site wastewater system will function proper�ly for any given period of time. Cash ❑ Check ❑ Money Order ❑# Amount: $ Date: �_ � sy: 4 Y `� E '�� h/^ / �� fi «� I� "ti:,.� ��.1 J � t �� i + 1' �,�.f. � ., �-r_"'^'—"�`"'"""'--".. . . . By: � Invoice #' ` ,/c.l � '"^''��'.f � �ll. � <.t ,V ,. . f / /� � � . . . .,.,. . _.,....... . . : . ,.-..�, �_..� -� , --� . , - - . ., _ -- - . T _._.. , ` . . . i ' A T � ZATION NO: � '� / � �� % , �, ._ O,� 3 DAVIE CnUNTY HEALTH DEPARTMENT � �Environmental Health Section PROPERTY INFORMATION ! Permittee's � � /'j . // P.O. Box 848 Name: � L/ o� (S��'t�7� Mocksville, NC 27028 Subdivision Name: "" ' �! L Phone # 336-751-8760 Directions to property: �J/ �%✓ � [ �-�T � � ��. ) , •► . f► �' �' , ,�.'. / � � , < /� • • /.r O r - /!kh7, � 0 Section: `+ Lot: � AUTHORIZATION FOR '/ p WASTEWATER Tax Office PIN:# 7�- !�� -� J�� SYSTEM CONSTRUCTION Road Name: . � r• � �1�1C Zip: ��"�� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Counry Environmentai Health Section prior to issuance of any Building PermiGs. This FormlAuthorization Number should be presented to the Davie Counry Building Inspections O�ce when applying for Building Permits. (ln compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) /// #**NOTiCE*•• TH1S'AUTHORIZATION FOR WASTEWATER CONSTRUCTION ��. �/'�"�� ',3t� IS VALID FOR A PERIOD OF FIVE YEARS. �Ei V 20NMEN'1101,.kF�ALTH SPECfALIST DATE ISSUED .' � KESiDEM'[AL SPBCIFlCATION: HUILDMG TYPE M BEDi?^�"+.S '�? ?A': i?S _ q OCCL!PAIB'i'S GARrAGE p1�PGSAL:': es or e COMMERCIAL SPECIFiCATION: FACILiTY 1YPE M PEOPLE # PEOPLEJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIIE...7 �7Ci , TYPE WATER SUPPLY��L� DESIGN WASTEWATER FLOW (GPD) ,�r� NEW SITE_� REPAIR STfE �� N / SYSTEM SPECIFlCATIONS: TANK SIZE �� GAL. PUMP TANK GAL. TRENCH WIDTFi � ROCK DEP'fH � LiNEAR FT.��_ REQUIRED SITE IMPROVEMENT PERMIT LAYOUT �;��P s�LppRpVED EPFLUEItT FILTER• j�,�� w�j /1-30 -9� �x;�� , � � �� a� � �oh o��+ � ti ', � � 3(o��Xln�� X'•�� ! � . i � 9' U.C. � � , , ., —s � � — O _ •RISERIS! Ii ; P• / L-�� ' ' BE[J]M �I 1 �HED GRAD � r ,( ��/ISio f...�' \ �L Pa�E . ��• �� r� _-�� _ r � S� ,,�, /f o "�(�C .-�� " J/'�' �"L � �o.�Z 3b'x�� q'.a � C. ••CONTACT A REPRESENTATIVE OF THE DAVIE GOUNTY NEALTH DEPARTMENT FOR FlNAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE �1 IS (336)751-8760. OPERATION PERMIT� SYSTEM INSTALLED BY: ��,��..�.-�,�� 1 �� --��o �� _ �� , A[TI'FiORTLATION NO. ,�r� =W-�— OP RATION PERMIT BY: DA'TE: '"'['HE 1SSUANCE OF THIS OPERATION PERMR SHALL INDICATE THAT TNE SYS CRIBED ABOVE HAS BEEN INSTALLED iN COMPLIANCE I WITH ARITQ,E 11 OF G.S. CHAPTER 130A, SECfION .I900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A I GUARAN7EE THAT THE SYSTEM WII.L FUNCIION SATISFAGTORILY iaOR ANY GIVEN PERIOD OF TiME. DCFiD 03/96 (Reviad) �,.- �. IMPROVEI�NT �RMIT DAVIE CDUNTY HEALTH DEPARTMENT IMPROVEMENT PEAMIT and �ERATION PERMIT ��NOTE+�* This i�prove�ent per�it DDES NOT authorize the construction or installation of a septic tank syste� or any Naste►+ater ✓�'�� 5yste�. RN RUTHDRIZATIDN fOR WflSTEWATER 5Y5TEM CDNSTRl�TION wst be obtained fra� this Depart�ent prior to the �� construction/installation af a syste� or the is3uance of a building per�it, iIn co�pliance with Rrticle 11 of 6.5. Chapter 130A, Nastewater Syste�s, 5ection .19@0 5ewage Treat�ent and Disposal 5yste�s) " �'"^ ( C� D 0 Ec?� 'Gt' NAMIE �L�' •"�/ ///%!'P,7 i /Of//�'1i�fi PRDRERTY ADDRE55 �OZt�'i`�j �.../ •�. � . `� 7O DA� 9 �� . _G'�� L�ATIDN � !J./,�'r, Q�<� /'i .�v, �.' ��✓ e? l Y , �/� � �`? �/`"� • v SUBDIVISIDN NAME LDT Nl�4BER RESIDENTAL SPECIFICATION: BUILDING TYPE _�� BEDROOMS � # BATHS .� SEC. /AL�K NUMBER # OCCUF'ANTS � 6ARBAGE DISPOSRL: Yes/ to COMMERCIAL 5PECIFICATION: FACILITY TYPE # PEDPLE # PEOF�LE/SHIFT # SEflT5 IhIDUSTRI� V1A5TE: YeslNo LOT SIZE �3 TYPE WATER SUPPLY � DESI6td V�STEWATER FLOW l6PD) �� NEN SITE l./' REPAIR SITE 5YSTEM 5PECIFICATI�IS: TANK SIZE /��%6 6AL. GUMR TRh�( 6AL. TRENCH WIDTH �"'� R�K DEPTH /...� �� LINEAR FT, c,�T�J ' OTHER REQUIRED SITE MODIFICATIINJS/CONDITIONS: *�*THI5 PERMIT IS 5lIBJECT TO REVOCATIOW IF SITE Pt.ANS OR THE INTENDED USE CHANGE, YDUR WASTERWATER SYSTEM CDNTRACTOR h�1ST SEE THI5 PERMIT BEFORE INSTALLING THE SYSTEM. �_ � � s 3 y'1 _ �`'a.r�w, � 4 L �� IMPROVEMENT PERMIT BY r' /� �*CONTACT A REPRESENTATIUE � THE DAVIE C�JTY HEALTH DEPAATI�NT FOR FItJAI INSPECTION � THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:�-1:30 P.M. ON THE DAY OF IN5TAL.LATION. TELEPHONE # I5 t7Q4) 634-87E@. OPEAATI�N PERMIt AUTHORIZATION N0. SYSTEM INSTALLED BY �1C�%sS�x`��'� � �,��a� b'� �� DPERATIDN PEfUtIT BY DATE `I� " �P f*THE ISS�NCE OF THI5 OPERATIOPI RERMIT SHALL INDICATE THAT THE SY5TEM DESCRIBED ABOUE HAS BEEN INSTt�lED IN C�IFWCE WITH AATICLE 11 � G.S. CHAPTER 13@A, SECTIOM .1900 "�I�E TREATP�NT AND DI�OSAL SYSTEMS°, BUT SHALL IN ND WAY 6E TAKE�I AS A 6'UARAMTEE THAT TF� SYSTEM 41ILL FL�TI�I 5ATISFACTO�ILY FOR R�lY 6IVEN PERIDD � TIME. DCHD 10/95 . . . , ., . � • , �,..�� :,, � �i� r , .+ ;. .. _ ,. � ..:.1:'.. / �. ..� • . . � v��. ::�: >, . . . ::-� .�„ , . , ,' - _ ., {� _ -,,,; �.� r � . . ,., : � � � _ _ ,. j .,, . . Davie County Health Depart�ent ENVIR�JMENT�L HEALTH 5EC7IDN P.O. Box 665 Mocksville, N.C. 27Q�28 .' � , " ' AUiFIOHIZATION FOR WASTE�WIER SYSTDI C�ISTRUCTION tIssued in co�pliance with Article 11 of G.S. Chapter 130A, Wastewater 5yste�s) _. , � * � � ��+�+�This Ruthorizatian For Wastewater 5yste� Construction •ust be issued by the Davie County Environ�ental Nealth Section prior to ' issuance of any 9uilding Per�its. This For�/Authorization Nu�ber should be presented to the Davie County Building Inspections Office when applying for Building F'ereits.+�+ % _,,! �AllT}IORI.ZATION N.l�ER � � NRME . ;Y/�f',.;1�, i' �'!rt' ! , DATE � ' � ��f^ �t� ° i,; ^ ;��a � NAME ON IIPROVElQIT PERNIT (If different than above) �_�l%i�if"/iI ��ri!!./,�9�i'J �. 5I7E LOCATION r CO!l�NT5/COhNITI0N5 ON AU'TNORIZpTI�I TD CONSTRl1CT WASTEWATER 5YSTEM }t�TICE++� THIS AUTF�RIZATIDN FDR WR5TEWA7ER 5Y5TEM CDN5TAUCTIDN I5 VALID FOR A PERIDD OF FIVE (5) VEARS. f , � � �� ;�� ENVIROM�ENTAL FEAI. IflLIST DA7E DCI�ID 10/95 ��+�� J° ��,` s�� -' � �d � o-�.�`� �'� �`�'�� s,��r� C� C� C� D � . '\ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI I� L� � � � � Davie County Health Department �(,�� J� J �� J� // � Environmental Health Section n /,�� P. O. Box 665 G�r� n� /' �` n 6 � �� Mocksville, NC 27028 o�, �1� , � � / 1. Application/Permit Requested; By ' o�� • T��'" Mailing Address -3 �� N wy � s� Cr�cS �- Home Phone '�i�9� — S�� 7 l/cu • r� �.e �� C� � 7 fl-�'� Business Phone ��d j� 2. Name on Permit if Different than Above � I 1 Yn n '�f� o' I rna n ,i 3. Application for: 4. System to Seroe ❑ eusiness ❑ General Evaluation p House ❑ Industry 5. If house, mobile home: Subdivision D"Septic Tank Installation Permit Mobile Home O Place of Public Assembly ❑ Other No. of People 3 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 Sinks No. of Commodes � No. of Lavatories J No. of Showers � No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: �J Public ' O Private 8. Property Dimensions �� a-�a��L`--�—� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Unknown Section Lot # O BasemenUPlumbing ❑ BasemenUNo Plumbing [�Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes p'No ❑ Community i '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. Efiective October 1, 1989. IDirections to Property: This is to certify that the -�-a �� . � d U%G�-�' �Of/L/r� a � � � `� i � �� M -�- .��. �-�--- � (�.��--_ ,�'-�� -f�� 9 Ta•r. Office PTr1 �� /�% %�`f y-�j�i �• 1�.5"� �: i f Road Name C. l�r »-�i� � � �i � Box �� (if available) city M n�i�K�, %l� /�lC � �7 0 ��3 � �� e-n. C� �. �-�, u� u� correct to the best of my knowledge, and I understand I am responsible for all charges 51GNATURE ALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY ��. I OWN the property. ❑ 2. I DO NOT OWN the property. MUST be completed by the owner or a person authorized by.the owner: ,:sentative of the Davie County Health Department to enter upon above described �-,y � ry to determine said site's suitability for a ground absorption sewage treatment SIGNATURE _ _ _ ,i � ,' � � -. � � � ` �°rBJ (6 . 13A) �T 19'0 3)6 � J �305 � � 5 . 93A �� ( ) � I lqq1J 1250 �� ti Q �L �j9 O� INDEXEO ON 4798 . 02 I INDEXED ON 4799 INDEXED ON I 4 7 99 �� 2�� - � � DAVIE COUNTY HEALTH DEPARTMENT y� � Environmental Health Section ` Soil/Site Evaluation NAME • �/l%/�Aa� DATE EVALUATED o� FJ �� ADDRESS PROPERTY SIZE �t� PROPOSED FACIILTY ,�J� LOCATION OF SITE �d`t�� .�h� Water Supply: On-Site Well _ Community Public s� Evaluation By: AugerBoring r/ Pit Cut SITE CLASSIFICATION: EVALUATED BY: ��.n,:G/ LDNG-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-Silt,y �:lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR- Vc.-y 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 ,iC-•5in�le grain M-Massive CR-Crumb GR-Granular ABK-M¢ular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�cy 1:1, 2:1, Mixed Notes Fiorizon 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 wate�' or inches from land surface to soil colors with chroma 2 or less Classification - S(snitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD (01-90� ■��■��■��■��u��u��n�n . ■�� ■ ■��■��■ ■��■�■■��■��■N�■��■■��■�� o��t��n�� iiiiiiiiiiiii�ir�iiiiii�iiiiiiiiiiiiiiiiiiiiiii�iii�iiiiii�i=�i�i��ii�iiii�iiiiiiiiii ................C..................................C........ . ._. ..�....... .. ■��■■■��■��■�■��N�■■■\■ �� ■�■ ■■ �■ ■ ■ ��■ ■■■��■��■�� ■�■��=��■n�i==■�■� ■ _ ��■��■ ��■��u�� n��N ■�■�■��■� �� ■ �� ■ ■ ■�■ ■�■�� n��■ ��v��vu�� vvd�W��■ �� ■�■��■■ ■■��■■�■�■�� u■■��■ ��■��■�a■�� ■ �� ■ ��■■■ ��■■■�■ ��■■��■��■■■� ■�� ■�� ■ ■ � �■��H■��■��■� ■��■�� ■��■ ��■��■� ■ � �� ■� ■ ��■■■��■ ■�■�r■��■�■■��N��v�� ■ �� ■ ��■�■��■■ ■�■�■�■��■H��■■��\�� v� ■ ■�M �� ■ ��■\�■ ��■ ■��■��Nn��\■�� ■�� ■ ■�l��■■��■u�u��\�� ■ ■ ■ ��/��■�� u��N��N��h�� NW �� ■ ■ ■ ��■��■ ��■��n�l�u■�� ■�� ■�� ■��■��\�■��n��■��n■ ■ �N�� ■ ��■��■■ ��■��■��■n��■�■ ■ ��■■ ��■ ■ ■ ��■��■ ........................C.�-�.. ...5... ............ �� ■��■��■��■■�i ��■ ��o�� = H�� ■N��v��■■��■ ■N��\�� ■��/��■��\■��■■ ��■ i�■■�� ■_ ■�� ■■ ��N��■��■�■■��'1�� ■ i��■�� ■��■■ �� ■e��■��A ■ ��H�■ ■��■ ■�� ■�� ■ �� ■ ■ ■ ■■ ■��■■��■■■■ ■�■�� ■ N��■ ��■��■��■��■�� ■ ■ ��n �� N�� ■��■■��■��■ ■ ■�■��■��■�■��■��■ ■�■��! 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