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905 Hwy 801N,»rv', �s�:s'*. ,;Y:3"Y"'.*.'��?i$%�;cS;t isi'a%w��:� .p tt".:`};`r«a's^'^.r .�`-r's «k"1 cY'r�`,'y V�.i 1 }�a"'�S �}.,��g. 3� .G7 �sr a.+a ,}.;, w5t.5u f.f�r a i`�1',>ij'.r.,iY1*r, �`.r.•'>_ AUTHORIZATION NO: 0673, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION - ;Perin�tee' j;, P.O. Box 848. `: Name./S'i��/��/'� Mocksville, NG 27028 Subdivision Name: // Phone #: 704-634-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office IN:#a6A — '4 .' _gb4 SYSTEM CONSTRUCTION A ,/}D RoadName:-- ---D � � �, �.. �- 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 11, of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,.. rr' ./ r*'1' / x-7 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEAL H.SPECIALIST `r°' DATE ISSUED 1. y.—k�'y., .�r.w�^c� i�t.yik.aaw.yw'^ i�4,`"i „'�hr `i`°v'roe!'";'"�.r.t+'w'�r ""';fir., w�s,<r FiP'l+.iicy;at'`,r'�di� JA DAVIE COUNTY HEALTH DEPARTMENT,_ [f 2, = IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION F l4ame: j C,�j/�1���A Le�1j- Subdivision Name: Dire 'tions io property: Section: Lot: EWPROVEMENT PERMIT Tax Office PIN:# -q5 6.► -;4 - -5o 46 Roadame: tl /Y + Zin. f 1 r . ;' ✓'. ' ' -' / X' ::' 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 :: # BEDROOM # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SUE �tTYPE WATER SUPPLY / O DESIGN WASTEWATER FLOW (GPD) SE NEW SITE ��� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH —',� ROCK DEPTH 7 LINEAR FT. 3c�e 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) 6348760. OPERATION PERMIT SYSTEM INST D BY: V �o Ll AUTHORIZATION NO. OPERATION PERMIT BY: /r� 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 EVALUATIONAMPROVEMENT PERMIT [E OW Davie County Health Department i Environmental Health Section FEB , , 4199T . P. O. Box 848 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS KA / ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed t „/ KA �`d � 1- �*� Contact Person J/% L'. 5 rT-AE) Mailing Address 7 �Di-dO N Ph, Home Phone J City/State/Zip AvA_ c 97-00C Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: & Site Evaluation City/State/Zip UY Improvement Permit & ATC 4. System to Serve: W House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People .3 # Bedrooms # Bathrooms ;?— "I--. Dishwasher Q Garbage Disposal O Washing Machine Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify typefi# People 1_ # Sinks 'abm Cob # Commodes JdL- # Showers_ # Urinals # Water Coolers If Foodservice: # Seats, Estimated Water Usage (gallons-- sppeer day) 7. Type of water supply: lof County/City Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes © No If yes, what type? PROPERTY A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 4 l ; 6AI /qc r 1 WRITE DIRECTIONS (from 1 Tax Office PIN: # Mocksville) TO PROPERTY - C) ���� 2-� = � 1 Property Address: Road 710m-e-5"Alcv,11wo�z 10 1- /Y e 1 If in Subdivision provide information, as follows: Name: Section: Lot #: 1 1 1 1 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 r and owned by 2RLb y' d 24 L �-�-' `7 to conduct all testing procedures as necessary to determine the site suitability. r , DATE � ^ � - SIGNATURE Revised DCHD (06-96) JAMES DAVID ELLIS u b ,.d D.B. 64 PG. 171;•' c s O N p J r S 05°19'5511 435.54' 6; 00 i y¢ it x� gp' EASEMENT � S 05°19'55"E 435.59' ' l 11 • 3.2632 ACRES+— N 01 °00'40"E 236.11' MARK C. MINOR D.B. 180 PG. 784 �F IRON FOUND's u O N p J F 00 i y¢ it I ho t4 l 11 �F IRON FOUND's DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED S PROPOSED FACILITY 22_ SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit DATE EVALUATED PROPERTY SIZE ROAD NAME Public L� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 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 CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01.90) EVALUATION BY: OTHER(S) PRESENT: 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 ■■■■■■■■■■■■■■ ■■■■■■■■■■■■E■ ■■■MEMO■E■■E■■ ■■■■■■■■■■■■■■ ■E■E■■■■■■EEE■ ■■■■■■■■■■■■■■ ■■EE■EEE■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■E■■E■■E■ ■■■■■■■■■■■■■■ ■■■■■EEE■■■■■■ ■■■■■■■■■■■■■■ NOMMEN■■■■EEE■ ■■■■E■■E■■■■E■ ■■E■■■■■■■■■■■ ■■■NEEM■■■■■E■ ■■■■■■■■E■■■■■ ■E■■E■■■■■■■E■ ■■■■■■■■■■■■■■ ■■■■■■■■■■m■■■ i ■ ■■■■ ■■■■ NONE SEEN ■MEMO■■■■■ ■M■EM■■EE■ ■■■MM■■E■■ ■■ME■■EE■■ ■■M■■■ME■■ ■ME■■■M■■■ ■■■■■■■■m■ ■E■■■M■■E■ ■■■■EM■■E■ ■ ■ NEON ■■■■ ■■■■ NONE ■■■■■■ ■■■■■■ ■■o■■■ ■■■■■■ ■■NEEM■■EN■EMW■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■E■■■■■■N■■■■■■■ ■■■■■N■■■■■■■■■■ ■■■■■■■■■E■■■■E■ ■■■■■■M■E■■■■M■■ ■■■■■■■■■■■■■■■■ ■■■■EEEEE■■■■■ ■E■EEMO■■■■E■■ ■■■■E■■■■■EEE■ ■■■■■MEMO■■■E■ ■EEE■■■■■■■■■■ ■■E■■E■■■E■■E■ ■■■■■■■n■■■o■ ■E■■E■■ NOME■ ■E■■E■E■■■■E■■ ■EEE■■■■■■■■■■ ■■■E■■■■■■■E■■ ■■■E■EEE■■EEE■ ■■EE■E■■■■■■■■ ■■E■E■■■■■E■E■ ■■■■■■■U■■■E■ ■■■■E■■ ■■E■■ ■■■■N■E■■■EE■■ ■■■■E■E■■■■■■■ ■■Mui■■■■■■■■■■■■■��■■■■■■■■ ■■■��■■■■■■■■■■■■■ism■■■■■■■ ■s■i�■■■s■■■■■■Moe■■■■■■Mee ■■■■■■ ■■■■■■ ■o■■■■ ■■■■■ ■■■■■ ■■■■■ MEMO NEON MEMO MEOW NONE OMEN ■E■■■MENN■■ ■■■E■M■■N■■ ■■MEMS■■■O■ ■■■■E■■■■E■ ■EME■■■EEM■ ■■■E■■■■■■■ ■M■■■■■■■■■ ■■■O■■■■■E■ ■E■■■■■■■■■ ■■■■■■■NEEM ■■■■■■■■N■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■NEEM■■■■ ■■■■■■E■■■■ ■■■■■■E■■■■ ■■■■■■■■■■■ ■■■mo■■■E■■ ■■■M■■■■■■■ ■NEEM■■■■■■ ■■E■■■■ ■■■■■■■ ■■NOME■ ■■OMEN■ MONSOON ON Parcel #: C700000056 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: C700000056 Account #:24204250 Owner Information uiidin : Tax Codes BXF: LLIS RICHARD D& ELLIS KIMBERLY L Land: ADVLTAX - COUNTY T Market: 05 HIGHWAY 801 NORTH ssessed• FIREADVLTAX - FIRE TAX [Deferred: DVANCE NC 27006 Property Information Township nd (Units/Type): 5.580.AG Ed-ressF-905N FARMINGTON NCHWY 801= v 3 Deed Information Local tonin ate: 02/1997 Book: 00192 Page: 0873 lat Book: age: Le al Description PIN 5.67 AC HWY 801 5862466841 Property Values uiidin : 205 46 BXF: Land: 72,92 Market: 278 38 ssessed• 278,38(l [Deferred: Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved Price 1 00170 0534 09 1993 WD Unqualified Improved 48,000 2 00185 0512 02 1996 WD Unqualified Vacant 0 3 00192 0873 02 1997 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP�rI riot 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/itsnetfView.aspx?prid=1467552 9/1/2016