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4058 Hwy 801Nv;K As _ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 4 ak *NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a Sanitary SSrewage S stems PermitrNliimber Name Date _tea o7 S q_ N0 77/75 u_. Location 14 -r-: , Gd s` ; � ,. Z 70 ZoP' Subdivision Name Lot No. Sec. or Block No. Lot Size House ZerI'll Mobile Home T Business Industry No. Bedrooms No. Baths No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO Er Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES E NO ❑ r Type Water Supply t����� /1lff lCyG� c *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by�� *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed �Jd U Sa t ti Certificate of Completion `' �+... Date -17 *The signing of this certificate shall indicate that -the system described above has been installed in compliance with the standards set.forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. � %J n I S�� Il�� �" �Of�� GOC Yqaueste!dByv IF LICATION 1 �0 SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department .,�,, � Environmental Health SectionIM P. O. Box 665 U t,cksville, NC 27028MA�. 1 199�?Coll ell 1 6 1. ApplicAtion/Permit Rr C e- �� e- " - Mailing Address rRli- • 5' 6 X 3 3 �( Home Phone �� 1rY�oC K5 V ((1 i ("�(C Q2G 2 Business Phone 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business ❑ General Evaluation VSeptic Tank Installation Permit 2-frouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms 3 d No. of Bathrooms �Z Dwelling Dimensions 7� 5X a ❑ Other 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: ❑ Public .EkMivate 8. Property Dimensions Z 5 Sewage Disposal Contractor ❑ Unknown Section Lot # ❑ Basement/Plur,.ibing ❑ BasemenUlyS Plannbih ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes *o If yes, what type? ❑ Community '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. Effective October 1, 1989. Directions to Property: o� gol 91;�,.)l� U 014 -}0 $D 1S. I pproX . 1 M. 1 �. On. l.si . and er 0- V.. This is to certify that the information provided is correct to the best of my knowledge, and`I understand I am responsible for all charges incurred from this application.J11 n I DATE SIGNATURE t CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: Y1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. „ DATE // SIGNATURE DCHD (1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �S ADDRESS PROPOSED FACIILTY Water Supply: On -Site Well. DATE EVALUATED 1 00, �7 PROPERTY SIZE 115!4C, -LOCATION OF SITE B - Community Public Evaluation By: Auger Boring Pit Cut s- �a y FACTORS 1 2 3 4 Landscape position L L ,L L Slope % HORIZON I DEPTH Texture group L e'741 Consistence Structure Mineralogy HORIZON II DEPTH Texture group` c G Consistence ' Structure 14 R Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION off LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE MATE: • -4&;;,4— OTI REMARKS: — LEGEND DCHD(01-901 PRESENT: 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 ■..■■■■■.■■■■.■■..■.■SS...■...■..■■■■■■■.■■......■...■..■■ ©■■..P■ ■..e■■■..■.■■■■e■■■■■■■■■See.■ecce■n■■■■■ceeeee■■.■■.■e■■cee.��e■ ■■■ee■e��e■■eE■■c■■e■.eee■■.ee.■�ee■.■■.■■■■■■.■■■■■.■■■■■.■.■■■■ ■■e■■.■■.■■e■■.E■eeeeeeee■■eeee■ ■■eeee■e■■.e.cee■eee■■.■e■eee■ea ■.■e..■■e��e■.e■c■■.■■■ee.e.eee.eee■ccccee■■.■■■■.■■■e■■■.■■■e.■.■ ■■.e..■■■■■.■e■■■■■.eeeee.■■e■ee■■■■ecece..■■■■■■■■■■■■■■■■.■e.■■■ ■■e.■■..■■■■■..■■■■■■■■■■■e■e■eee■■■■■..■■■■..■.■.■■.■■..■■..■■■.■ ■■■■e■■■.e■eeeee■■eeeeeee■■■■c■■■■■■.■■...■�.■■■■■■■■■■.■■■■■.■■■■■ ■eee.■eeeeeece■■cceee■■ceee.eeececc■■■■e��e■■■■■■■■■■See■.■Oce.■■ ■ec.eec■■■■ecce■cceee■e■ecce.■e.�eeeceeSSSS■■.■■■■e■■■..■.■■e■.■■ ■.■See■■■■..eeceeceeeeecececcee■ ■eeceeeee■.■■■■■.■.■■■.eei�ee■.■ ■■■■■■■■■■■■.eeeee■eeeeeee■ ■■■■eee■ill■■eeeeeee ■.■■■■■.■%■MeSS■■■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii��ii■e.�i�iiiiiiii�Eiii■■ii ■..■■■■■.■■.■■■.■■■■■■.■e■SO■■.■■■■■■..■�■■.■■■...■■..II.■L'■■■MI.■ ■.■■cecctee■ecccccec■■■■■e.ee.c.eeeec�.E■eccc■cce■ �ee.■ctceeee■.■ EMEMEMiii =iii ■■.ee■■■eeec■c■e.■eeeeeeeee■■■c■■■■e....ceec■e�ceeeee MEN■■■eee■ ■e■■..■■■■■■■..t■■■■��ar..■■■■■■■■■■■SSSS.■■►.■■■■■■..■■......■.■■■■ iiiiiii ■..■..■■.■■.■■..■■■SS■■S��■.■.■..■■..■■.■It■............■'.■....■■e■ UMMMEMM ME■■EN MENNEN MEMNON iiiiij�iiiiii iiiii■�iiiiii ■■■■■■■■■■■t■SS■■■■■...■■■■.■....■■..■ ■■ ■■.... 0MMMM■MMMMMM.■■ ■■■■■■ee■■■eeeecccc■e■■eeeceece■■ee■ee seeeec ■ ■c■■c ■■M■■■■■ :.:::5:.■=11■■CSC■N EMEMMEM iiiiiiiiiiisiiiiiiii�.ieiseiiiii.iii■ iINEEMEMENNOMMEMEN ■nuE■ ■M.�E■M■ ......■■■.■....MEN..■■■■......■.■..■■ MERE ■■■■■■■C I ......■.............■..............�■.MMM■n MEN ■....■.■....■■..■■...■.■...■■�== ..■■�.��ME .■.IMMMEMEMEMEMN .■■EaN.O■.O. ...............■......■..�...■■.■.�:�. ��■ N■ �• . ■E ME■MOMME ■ecce■SOS■SSSOSSSSeeS■■I�OOSSS■SS� ■SE■. ■ .O ■■■■■■■.■■■■■■■.■■�■■■■■i�■■.■■■■. ■■■■■WI■ ----■■■■■■M■■■MEMEMEM ■.■.■n..■■■.■..■ ■...■i�.■■...■.■..._...��a�■■ ..■■■■.■.■S■.■.■■ iiiiiii Mii�iiiiiii=ii�MMM�:: iiiiMM=iiii ■i■ iiiiiiiiiiiii ■■■■Ee■eeeO.eeeeeeeee■eee■OMSei�ee■■■N/.■■ MUMMMUMEMMEN ■e■■e�.ee ■MOOS■eSSO.eOe.■eee■■■■....■■■S.�■See■■S�.SSS■■■■N■.■eeeeee ■■e■ ■e.eN■■■■■■■■■.■■■■■eeeee■■■■■e SOMEONE ■■■.■■■■■■.■SOO■.■SO■ee■ ■ecce■■■■■■eeeeeeeeeeeeeSee■■eMNeeeeeee. MSNSN■S■ONeS■■eee■■SS ■S■■SO■S■■N.■t■■■■■OO.00eMS■■■■MMSOO.SOO N■.S..SMS■■SSS■■eeeee■■ ■.■■■SSSO■.■■MSS■SES■■■.SSN.SSOE■■■■t.O■ MSUS�...S.S■SS■�SSSSSE.. ■■■OOOENOSSS■S.■.SSS■OOO SS■SSSOSSSeN■t N■ NMMMO■EM. ■MNSME■ ■e■e.■SNOe.OSSSOOSSeeee■ee.MSee ■O.■SOMeeOSO.S■■SSe■eM■SeeeeOOS■ .................................................................. .................................................................. ■Oe■ Oce■...e.eee.■..■■■■■eeeeee�■ee..ee■■.e...e..e■e..eeeene.e■ ii�eiiiiiiiiiiiiiiiiiiiiiiiiiiiu■iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii Dani? County NeallI De artment en and .lame .ilea l tii .. y cy 210 HOSPITAL STREET / P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 June 29, 1994 Tracey Sheets Rt. 5, Box 339 Mocksville, NC 27028 Re: Site Evaluation Highway 801 North & Essic Road Dear Mr. Sheets: As requested, a representative from this office visited the aforementioned site on May 18 & 31, 1994, to determine the soil/site suitability for the installation of a ground absorption sewage system. Unfortunately, due to the reason(s) noted below, we must classify this site unsuitable: 1) 2:1 clay. 2) Shallow soil to rock. We sincerely regret this classification and are more than willing to discuss this matter further upon your request. Sincerely, �64'le ,- Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure Parcel #: B400000007 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 #: 6400000007 Account #:64912000 Owner Information BXF• Tax Codes Land: [HETS LORETfA B & SHEETS TRACEY Market: ADVLTAX - COUNTYT ssessed: NC HIGWAY 801 NORTH [Deferred: READVLTAX - FIRE TAXKSVILLE NC 27028 Property Information Township nd (Units/Type): 12.300 AC CLARKSVILLE ddress: 4058 N NC HWY 801 Deed Information Local Zonin Pate: 05/1991 Book: 00159 Page: 0142 Plat Book: Page: Legal Description PIN 13 AC HWY 801 5823768333 Property Values Building: 22419 BXF• 5,27C Land: 107 30 Market: 336 76 ssessed: 252,15C [Deferred: 84,6101 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00159 0142 05 1991 WD Qualified Vacant 41,500 View Property Record for this Parcel View Map for this Parcel View Tax Bili Information « Return to Basic Search Page 1 of 1 qA-j� 01-orjl�ls 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=1478164 9/22/2016