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1222 Hwy 801Nr, U DAME COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boa 848/210 Hospital Street Mockisville, NC 27028 (336)751-8760 Account #: 990001526 Tax PIN/EH #: 5862-09-6068.ff Billed To: Frederick Fisher Subdivision Info: /222 NC H W_1/ g61 N6 Reference Name: Location/Address: -AM 801 N-27006" Proposed Facility: Residence ATC Number: 2673 Property Size: 150x250 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: T�(`r� Date: / L., —ev 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: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street • Mocksville, NC 27028 'D Z) (336)751-8760 IMPROVEMENT/OPERATION PERMIT 1222 N& ifwq goiN Account #: 990001526 Billed To: Frederick Fisher Reference Name: Proposed Facility: Residence Tax PIN/EH M 5862-09-6068.ff Subdivision Info: Location/Address: 1240 801 N-27006 Property Size: 150x250 **NOTEC * 'I i bfmprovement/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 S Dishwasher: Garbage Disposal: ❑ Washing Machine: ®'�- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial111, Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size XC Type Water Supply �� Design Wastewater Flow (GPD) `,w Site: Newt Repair ❑ System Specifications: Tank Size/ 0 GAL. Pump Tank GAL. Trench Width L�Rock Depth 0 Linear Ft.G Other: V, &��' &dA�101jw_ Required Site Modifications/Conditions: 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:�0 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** /I( l/I Environmental Health Specialist's Signature: Date: _/6 W DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/MPROVEhIFNi PER&IlY & AYC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 JAM y 4 Z001 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed f-r.eCLCv z,4 A/rllt�t f ,,tL� Contact Perso((nq? Mailing Address 11 Q c Home Pho.Q3'-)p7 City/State/ZIP Pr. %, t fn• Business Phone ,r 0) y 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ";',Site Evaluation ❑ Improvement Permit/ATC 'fd Both 4. system to Service: P House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms q # Bathrooms S Dishwasher O Garbage Disposal ZWashing Machine ❑ Basement/Plumbing U Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: �( County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes CX10 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. � t^/ Property Dimensions: 150 X a S WRITE DIRECTIONS (from Mocks�ville) to PROPERTY: Tax Office PIN: # aL;P0 J 600 OCd 1 C(.o 00600 1613 (n o i b 4D Property i - Property Address: Road Name Id `Io 5'0 10$ 14 City/Zip AdV,-ti d 100 ( 0 C i-� ,p o.✓o�yoX If in in a Subdivision provide information, as follows: I.- �� r op Name: / 1 Section: Block: Lot: Date Property Flagged: �— to " O 1 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 �i�c. ,cL �s�r• to conduct all testing procedures as necessary to determine the site suitability. DATE %- 6S o 1 __ 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). 7� g -�- L) Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: ERS: Account No. a;O Invoice• No. 1212 DAVIE COUNTY 1H EALTH DEPARTMENT Environmental Health Section ` Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001526 Tax PIN/EH #: 5862-09-6068.000EP Billed To: Frederick Fisher Subdivision Info: Reference Name: Location/Address: 1240 801 N-27006 I� Proposed Facility: Residence Property Size: _159x25(3— Date Evaluated: /`�✓ tic, Water Supply: Evaluation By: On -Site Well Community Auger Boring ✓ Pit Public V Cut FACTORS 1 2 3 4 5 6 7 Landscape position T Slope % vim— 2 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence / l - 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: L'�L aD �G EVALUATION BY: 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) ■ ■■MEMS■■■ MEMMEMEME ■■MMN■■M■ ■M■■■Mee■ ■NM■■■■OM ■■■■■■■■■ ■E■■■■■■■ ■■■■■■■■■ ■■MEMO■■■ ■E■■■■■■■ ■E■■■■■■■ ■■■■■■■■■ ■■■■■■■E■ ■E■■■■■■■ ■■■■O■■E■ ■■M■■■O■M ■EES■■E■■ ■OMEN■■■■ ■■ME■■E■■ ■■■■■■■■■ ■E■■■■■■■ ■■N■■E■■■ ■E■■M■■■■ ■■■■EEE■■ ■M■■E■E■■ ■■M■■■■■■ ■■■■■■■■■ ■■■■■ME■■ ■■■■■■■■■ ■EN■■■■■■ ■■■■■■e■■ ■■■■■■■M■ ■■■■E■■■■ ■■■■■■■■■ ■■■■■■■■■ ■■N■■■■■■ ■■N■■■■■■ ■■■■■■■■■ ■E■E■E■E■ ■e■■M■■■■ ■■■■■■■■■ ■■N■■■■■■ ■■■■■■U■ ■■■■■■ ■ ■■■■■■■E■ ■■■■E■■■■ ■■■■■■■■■ ■■■■■■■■■ ■■■■■E■E■ ■■■■Mee■■ ■O■■■E■■■ ME■■ME■■■ ■E■■ME■■■ ■■■■■■■■■ ■■■■■■■E■ ■■ME■■■■■ ■■■EEMME■ ■■■Mee■■■ ■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■EME■E■ MIME■■■ ■ ■■■E■ ■E■■■■■ ■■N■■■■ ■E■■M■■ ■■■E■■■ EMEME■■ ■ME■e■■ M■M■M■■ ■■■M■■■■■E■■E■■■■ ■■■MEOENME■E■■■■■ ■■■MO■E■■E■■■■■■■ ■■■E■■■■■E■EE■■■■ ■■■■■■■■■E■E■■■E■ ■E■E■E■■MEMO■■■■■ ■■e■■■■■■■■■■■■■■ ■E■■■E■■■■■■■■■■■ ■■NOME■■■■■ME■■■■ ■■N■■■■■E■■■E■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■M■■ ■■M■■■■■■■■MM■■■■ ■■■■E■■■■■■■■■E■■ ■EM■■■EO■■■■MME■■ ■■■■■■■■■■E■■■■■■ ■■■■■■E■■■■■E■■E■ ■■■■O■■■■■■■■E■E■ ■■■■■■■■■■■■■e■■■ ■■■■■■■■■■■MEMME■ ■■■■■■■E■■■■■E■■■ ■■M■■MMM■■M■MMM■■ ■■■■M■■■■EEE■■ME■ ■■■M■■E■■EMEM■■■■ ■E■■■ME■■■■■■■■■■ ■■ENO■■■■■M■MMM■■ ■■■■■■■■■■■■■■■■■ ■■e■■■O■■EMMOMMEN ■■■■■■■■■■■■■■■■■ ■O■■U■■■■■■U■M■ ■■e■ ■■E■■■ ■■■ ■■■EMM■■MMM■■■M■■ ■■■■■■■■N■■■■■■E■ ■■M■■■■MMM■■MM■■■ ■■■■EO■■■■■■■EEE■ ■■■■■■EE■E■M■■■E■ ■■■■MM■MMM■■■■M■■ ■■■M■■■■E■■■■■■■■ MO■■■MMM■■■O■■■M■ ■■■■M■MM■MMMM■■■■ ■■MMEMENM■M■MMME■ ■■■■M■■E■■■■■MME■ ■■O■■■MMM■■■■■M■■ ■■■■M■MMM■M■■■■M■ ■■MM■■■MM■MME■EN■ ■■■■■■■■■■■■■■M■■ ■■MMM■■■■■E■■■M■■ ■■M■■■■■■■■■■■■■■ ■■M■■■M■■M■MM■■■■ ■■E■■■■■N■■■■■■M■ Mee■■■■■■■■■■■■■■e■■EMMN■■■■■ ■■■■■O■■OE■■E■■E■■EE■■■■Mee■■ ■M■Ee■■eee■■■■■■■Mee■Mee■■■■■ ■eMN■E■M■■eMee■■■e■■■M■■■eee■ ■■■■■M■■■■■■■■■M■■■■■e■■Mee■■ ■■E■■S■■■e■■■■■EN■■■■N■■■eee■ ■■■■■■E■■EN■■E■■eee■■■■■■■■■■ ■E■■SEN■■■■■■■■Mee■■E■■■ecce■ ■E■■EMEMMEO■■EMM■■■M■■■■■Mee■ ■��■■■e■■Mee■■■■■■■■■■■■■■e■ Parcel #: C600000128 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information . Parcel #: C600000128 Account #:8302165 Owner Information Tax Codes Building: ELL ANDREW LEONARD & BELL 3ESSICA LINDSEY ADVLTAX -COUNTY T 3,5401 1222 NC HIGHWAY 801 NORTH READVLTAX - FIRE TAX Market: ADVANCE, NC 27028 essed: Property Information eferred: Township nd (Units/Type): 0.780 AC 2012 TO FARMINGTON ddress: 1222 N NC HWY 801 0 Deed Information 2013 WD Local Zoning ate: 05/2013 Book: 00925 Page: 0118 0 5 00646 0857 02 Plat Book: Pa e: Qualified Le al Description 289,500 PIN 10.820 AC HWY 801 5862089759 Property Values Qual/UnQual Building: 234,2901 BXF: 3,5401 Land: 26,7401 Market: 264,5701 essed: 2645701 eferred: 0 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00540 0436 03 2004 WD Unqualified Improved 180,000. 2 00731 0873 10 2007 QC Unqualified Improved 0 3 00890 0546 05 2012 TO Unqualified Improved 0 4 00925 0118 05 2013 WD Unqualified Improved 0 5 00646 0857 02 2006 WD Qualified Improved 289,500 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP, Mtn wri"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=1461969 9/1/2016