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4166 Hwy 801Nr t,. .;,.; ;,>^v.titi�% t:'�,w^�xf�p.e�f".�+,�.fa3 r'. ,yw,...� .,,-a�'k,'s�.,� �c.� r:,��r .r "Cp 4 „`2 r'��2`�..�;?��„m,�H,�,r`i�-�t �e a.i�,C �`�r�a$�'�,�,��,�'%,a�"a�. ;:`y�i '�' �`3��/"1% x,~'�� , , . , . T ,Fd°�cer' . , �'t�`'i+ epa�ck7`�wr'tv�''i4: ?N' �'g;�'��"w£a� .s.r,C". t� �.-S`�;� '^[t'i�?f'�"� .p�. e1� , .'3, t�� ... . - . , . . . .. . . . . . � .. . . �, -au�r�ioi�izAT1oN No: O �$ �.' . DAVIE COUNTY HEALTH DEPARTMENT •-. .'�., "' x" Environmental Health Section PROPERTY INFORMATION -:Permittee's ` . P:O. Box 848 : ' ' �ona � ��� . ,�Name:-- � i ,� , Mocksville, NC 27028 Subdivision Name: _ c� �`� Phone #: 704-634-8760 Directions to property: r3"G`� %``�C�OJ?aP'.Y� . Section: Lot: , � : AUTHORIZATION FOR ': �} � SYSTEM CONSTRUCTION. Tax Office PIN:#�a��- `� � =� - -Road Name: ����j Zip: �f Q ci" **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Forn�/Authorization Number.should be presented to the Davie County Building Inspections : Office when applying for Building Perriuts. ` (In compliance with Article ll of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) /` r� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION � .S� ~ � r� I . ,` • ' ' , IS VALID FOR A PERIOD OF FIVE YEARS. ; . ENVIRONMENTAI. HEALTH SPECIALIST DATE ISSUED i. ., . . _ . . , j v ,-a�'d PF. „ ar:.'; ab,v^c ", �F } s _�_ ,.�• a "y'e.:- tR:'w. i s.•.-.,ywa.r"'�"-b�r )`atgI L,j' r,,,.y�: - i ♦r:,sr pix �� I ,s 1s d€ i�j "�@ t .: �r+A `dam DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION rmSit c �� tatriB:-r0 i?Subdivision Name: -w ,',Directions to property: t `°1 ; , Y Section: Lot: 4; IMPROVEMENT 8 PERMITTax Office PIN:# ' h�� ►Z_ Road Name: Zip **NOTE*This Improvement Permit DOES NOT authorize the constriction or installation 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) % f a ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE DiTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING TBE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE A94C TYPE WATER SUPPLY Ari DESIGN WASTEWATER FLOW (GPD) l Q NEW SITE REPAIR SITE 011 SYSTEM SPECIFICATIONS: TANK SIZE ,/d0 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH? LINEAR FT. 1415,11) OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: "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 (704) 634-8760. OPERATION PERMIT AS �w SYSTEM INSTALLED BY: Pi r )Vd i �. II G `tai IV" IV � ✓ `fD taco AUTHORIZATION NO.y 6 OPERATION PERMIT BY: _�� DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM 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 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEM ENT.re ATC �NJL . Davie County Health Department B U E ,�� Environmental Health Section 5 P.O. Box 848 MAR Mocksville, NC 27028 ��7 (704) 634-8760 ! ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed, A6/ 4&/n /,/LAtk- Mailing Address 12-ff AoirM4 4CIA City/State/Zip 7426� 2. Name on Permit/ATC if Different than Above Contact Person Jdhk lx"" A611)— . Home Phone (g/") F q% - yZ y Z Business Phone F/ 17 yy1 Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluatio [M Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [obile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # Peopled_ # Bedrooms 3 # Bathrooms Z [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats EstimatedW ter Usage (gallons per day) 7. Type of water supply: [ ] County/City [ell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [—'J'No If yes, what type? EITHER A PLAT OR SITE PLAN D PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AGIOF THE PROPERTY MUST BE SUBMITTED WITHTHIS APPLICATION. Property Dimensions. Rio WRITE DIRECTIONS (from ocksville) TO PROPERTY - Tax Office PIN:#QZ ROPERTY:TaxOfficePIN:#QZ 1-- %J �p0[ TU�n►�' 1'rndk;nv;ll� Q.? Property Address: Road Name g a 1 SS o t 9 A "'Iks rnJA City/Zip 1m0GYsu;l lL 22c z V ; /VCw d e*rvcuao If in Subdivision provide information, as follows: Name: Section: Lot #• 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 DATE SIGNATURE Revised DCHD (06-96) to conduct all testing procedures as necessary to determine the site suitability. THIS AREA MAY $E USEb FOR I)RA WI NC YOUR SITE PLAN: 00 a APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE r% C1 �T`�G�'" D� 0�2 Davie County Health Department c�1A�� $ Environmental Health Section " qty P. O. Box 665, Mocksville, NC 27028 dl w� i - 1. Application/Permit Requested By -TO n CL r"I /?;►cher ` Mailing Address At, Z 13o,r las Moe c ilc, A/.C. 27Dz8 Home Phone 17TY - 3 Z'/2 Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: 4. System to Serve: ❑ Business "ouse ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms Lf General Evaluation ❑ Mobile Home ❑ Other No. of Bathrooms �!Z Dwelling Dimensions 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 m Private 8. Property Dimensions 0 atA.cd Sewage Disposal Contractor ❑ Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No 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: Imo L46%4,awd To goy ic4rZv r Fnopu� iS Apr"A a'fn & on 1e fE Tures aE stax6 nth 8141t9-'Le6&% owe it, 16 Aupwsr I5 Apprdx. 3QiFT. OFF tr1� Raav This is to certify that the information provided is correct to the incurred from this application. DATE of my knowledge, end I understand I am responsible for all charges SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fanddisposal ECK ONE: ❑ 1. 1 OWN the property. Z�-rI DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative Sof the D vie County Health Department to enter upon above described cated in Davie County and owned by ; 0S 6 o all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. .Cyd DATE SIGNATURE DCHD (12-90) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME A "ADDRESS PROPOSED FACIILTY ,�Aq e� e DATE EVALUATED —m -9* PROPERTY SIZE E LOCATION OF SITE Water Supply: On -Site Well r/ Community Public Evaluation By: Auger Boringy Pit Cut FACTORS 1 2 3 4 Landscape position L Slope Z HORIZON I DEPTH " 8 " Texture group Consistence Structure Mineralogy HORIZON II DEPTH D' 15Q 41 A Texture group Consistence , Structure 101 Mineralogy HORIZON III DEPTH - Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 773 LONG-TERM ACCEPTANCE RATE _ SITE CLASSIFICATION: , S�iP q'o A' a� EVALUATED BY: 29�af/ LONG-TERM ACCEP�'AI�CE DATE: 7I OTHER(S) PRESENT: REMARKS: r�'.i� 'Ie, Gt //- 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 3C -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(01-9ot ■■■.■■...■...■.■■11.■n�1�.l��i...■moon■■N■■...e.as.■n■.■■.....■■..eve■ ■■■■■■■■■■■■■■■■■11■■�,i/.�f1R':til■■■■■■■y■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■■■■■■■■■■■■■■■■■■.■.■■■■■■■■■■■■■■.ecce■■.........i■■n.ee■ ■■.■.■...■.....■■■■.■■■■■■...■ee■■e.ee..e■.cif■:111...■■■■■.e...i�...■ ■■.e■■e■.■■■.eee.eee.■■■...ee■.e..m.e■...r���.�i�lr�m■■�...■.■..■■..■■ ■.....■..■■■.■....■..eee..■e...■.._.■....e.n.ie.N■■s.■...�...■.■■.1� ■■..■.■..............me■..nee....■ ■.....�o.lao.■■■.I■■�.���i.■.■....■ ■.■.■■.......e.e.■■ee■..e.m■■..■■■..eee■��■■..■...■�:�■..:I..ee.=..■ ■.e..ee■..m■■.....■eee..■..■.m...■.u....■��■■.■..■■■_.■...■.■■■.■ ■e■■■.ee■.m...eee■...ecce.......■■■..a.e.me..me.■■..e.■..�1.■..m.e.■ ■■■■.■■■eee■■■■■eee■■■■■mee■■■■.e.em.■m,■■�e■■■..■...■ emme■.m■..■.. ■.■■..e■■...■■.....■ee.■.■■....■......■iso..■.■■■....■■..■..■.....■ �iiiiii�iiiiiii�iiiiii�iiiiiii�iiiiiii�iiiiii�iil■■iiii�iiiiii� ....................................... . ....... ....... ........ ■ .■..■.■■.■■■■■.......■e..me■■■a.m..a�!=il�i■i•• e■■.■■e...e mono �w■.■■■■•�e■�■■■e■N■■■■■■■.■■■.■■■■■.�. ■ ■ ■Nemo■ ...... ■ ■.►.e►i.....■......■■..■��ew■■.■.:�.►:-.■■■■■ ■■■M ■u .cow■.■■■■■■ ■..:^;,■■■■■■■.■■■■.■.■■.■■■.m�.■■.■■i■■■��.�.fl■■ ■ ■ ■■ ■■■■moon ........................�I..N■or`■.i �■ ■�.■■■.e■■■■■. ■1'IJ1►/e■....■■.nee..■■.eee■..eee.. /mono■H.■■i ■■ mono.■■■...e.■ iir'lii::■■■iiiiioiii� iii�iii=i■i■is'�■ ■■C'e■■■■'■'■'■.■ ■■ ■ ■■■ ■■■■■■■■ ■■■■■ : mmmom E::C::::::: ::::::::::::::::::�..... ...�.......�.�■■ ■■■■■■■me■■..■■■■■■■.■me■■■■m■■!I■.eeN mom ■■e■■.mmmm■ ■■■N ON ■ecce...m■■mmmmmm.m.m.e.m■■■mme\� m.m..e. ■...■...Nm■.■emmme ■m■■ ■.■....■.e..■......ee■■.■■e...■e�.noon.■_■■...■.e..■■.m.emme■■■.■ ■■■■..e■■.N■m.ee■nee■.■■.■me■■■\1..■ee■me N■.mN.ee■.■.■■■■.■■e.■ ■■■■..■Neeeemmmm■■■■■■e■.■■■■■e■1\■■■NN .Nm.ee■ee■eee■ ■■N.■■■ ■...■■.............e.....■■.....elle■.......m■■.....e...■.Ne■■■■e. ■■.■■..m....mmm■■mm■ m■ee■wri..■■��me.■.■e■■.e■gimme.■...e■..me■■.e■ ■■.em.....■■..■■m■■■■.■■■+ue■.e■ ■m■e■m■■■■■mmMOM■■■■■■■■■■■■■e■■ ■..■■■■■.me■■.■■■u■■■.dlll�e■■Neral l■....i.■■■....e.....■■.N......■ ■.■■■■■■■■■■■■m■■■■■■■■■■■■■■■■■■1/■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County NealtFr Department and .dome Nealtlr' ffyency 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 January 12, 1994 Jonathan Pilcher Rt. 2, Box 105 Mocksville, NC 27028 Re: Site Evaluation Highway 801 North Dear Mr. Pilcher: As requested, a representative from this office visited the aforementioned site on January 10, 1994. Based Upon the information provided on the application for a site evaluation and after an evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, ke4l'PLI-60 4�;Ioe4l�A7 Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure Parcel #: B30000007702 Davie County, NC Basic' Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: B30000007702 Account #:82520700 Owner Information uildin Tax Codes BXF• UMFORD ERVIN HECTOR nd• ADVLTAX - COUNTY T 166 HIGHWAY 801 NORTH FIREADVLTAX - FIRE TAX eferred• OCKSVILLE NC 27028 Property Information Township nd (Units%Type): 10.620 AC CLARKSVILLE ddress: 4166 N NC HWY 801 Deed Information Local Zoning ate: 04/2003 Book: 00474 Page: 0890 lat Book: age: Legal Description PIN 10.623 AC N OFF HWY 801 56974000 5823 -66 -1768 - Property Values uildin 97,82 BXF• 14,5601 nd• 1essed: d77arket• 1 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00164 0301 06 1992 WD Unqualified Vacant 0 2 00172 0247 01 1994 WD Qualified Vacant 25,000 3 00474 0890 04 2003 WD Qualified Improved 161,500 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information 1< Return to Basic Search Page 1 of 1 oA.r� 01-oriti--'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=1463633 9/22/2016