931 Hwy 801NAccount #: 990002817
Billed To: Daniel Kenney
Reference Name:
Proposed Facility: Residence
ATC Number: 3494
IX----
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5862-47-4108
Subdivision Info:
Location/Address: 931 NCHwy 801 N-27006
Property Size: see map
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 Fonm/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 CONST UC ION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
3
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 v'th Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall . � WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time. 1
Septic System Installed By:
Environmental Health Specialist's Signature: ZZ Date: lo
DCHD 05/99 (Revised)
DAME COUNTY HEALTH DEPARTMENT
• Environmental Health Section
,. P. O. Bog 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002817 Tax PIN/EH #: 5862-47-4108
Billed To: Daniel Kenney Subdivision Info:
Reference Name: Location/Address: 931 NCHwy 801 N-27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3494
**NOTE** This Improvement/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 J #Bedrooms #Baths
Dishwasher Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: � Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water SupplyC-' _ Design Wastewater Flow (GPD)<.Site: New2r""'Repair ❑
System Specifications: Tank SizVO4&_ GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width Rock Depth Linear Ft 160
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPRO FILTER. RISER(S) IF 6 « BELOW
FINISHED GRADE. ****NOTICE: Contact a represent of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to . 0 P.
a io . Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature:—Z Date: 4e
DCHD 05/99 (Revised)
Oct 28 02 11!23&
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Noalaville, HC 27025
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—*IN PO ILPrt-THE M4UIRAD PROPERTY INFORMATION RCQUF3TED
DELA aPI.ATtrSFrtP QS7ZUSU8bl MDb ttadleat w4x4T1HISAPPUGT30Pi
✓ Property Di W stony �� �'" �jj�� ` ,wttr!X DIR6Y:RONS (Gose Motk.Qk) to PROP ARTY:
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to eater opou abore described propeM foaled is Dsvta Coaaty sad oamed
to eaadoetan testing prooedates as neeKsary to defarsdae dw sift so ity U
DATE /!� G� �SICNATL i
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APPLICANT INFORMATION
Account #: 990002817
Billed To: Daniel kenney
Reference Name:
Proposed Facility: Residence
Water Supply:
Evaluation By:
rnvr�n i r uv r vnivin i ivix
Tax PIN/EH #: 586247-4108
Subdivision Info:
Location/Address: 931 NCHwy 801 N-27006
Property Size: see map Date Evaluated:
On -Site Well Community
Auger Boring Pit
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
I --
Slope % .
HORIZON I DEPTH
�L
Texture groupCL
��
Consistence
Structure
Mineralogy
1J
HORIZON II DEPTH
'� v
Texture group
Consistence
Classification - S(suitable PS( rovisiona suitable , U(unsuitable)
Structure
S'
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
LONG-TERM ACCEPTANCE RATE:
REMARKS:
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 - Angul ocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralogy
1:1, 2:1, Mixed
Note
Horizon depth - In inches
Depth of fill - In inches
1J
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches fromla d su ace to free water or inches from land surface to soil colors with chroma 2 or less
Classification - S(suitable PS( rovisiona suitable , U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft
DCHD 05/99 (Revised)
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Parcel #: C700000054
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search Q
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: C700000054
Account #:42596000
Owner Information
uildin
Tax Codes
BXF:
ENNEY DANIEL CHRISTOPHER
nd:
ADVLTAX - COUNTY T
arket:
31 NC HIGHWAY 801 NORTH
ssessed•
FIREADVLTAX - FIRE TAX
eferred•
DVANCE NC 27006
Property Information
Township
nd (Units/Type): 1.080 AC
FARMINGTON
ddress: 931 N NC HWY 801
Deed Information
Local tonin
ate: 10/1978 Book: 00106 Page: 0119
lat Book: Page:
Le al Description
PIN
1.081 AC HWY 801
5862474108
Property Values
uildin
68,64
BXF:
nd:
37,50
arket:
106,14
ssessed•
106,14
eferred•
CI
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00106 0119 10 1978 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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Page 1 of 1
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01-0
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=1459409 9/8/2016
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DAVIE COUNTY HEALTH DEPARTMENTr � .
6 A p 9 9
-� IMPROVEMENT AND OPERATION PERMITS 1 PxOPERTY INFORMATION
Perinitti=e'S.
r�. -14ame: �` h', sl r" Subdivision Name:
'Directions to property:-�y c'" f,r: �1v/ Section: Lot:
r +'IMPROVEMENT
'��� t Cd Z nfi bcria, 1 PERMTf Tax Office PIN:#
- -
4 h of LL ,1M /Vt /f W,. �U� � Road Name:
**NOTE**.Tbis 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 from'this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1 I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
r , ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
` ..a.,.Xr�, 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 No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFr #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE
w, TEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK G
�,4ySAL. TRENCH WIDTH—IZI ROCK DEPTH_zc LINEAR Fr,:P� .:
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMITLAYou-I*RPPROVED EFFLUENT FILTE ii ,*RIeS.ER(S) IF b" BELL FINISHED GRADE*
**CONTACT A REPRESENTATIVE OF THE DAVIE COU EALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.O TH DAY OF INSTALLATION.TELEPHONE#
(336)751-8760
OPERATION PERMIT
S STE INSTALLED BY:
a a�,
r-
AUTHORIZATION NO: ' 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) >
+�,"7'P`'"'{�""`�"�v!'S`�•"r/i'�ri%y>"�C-�"`"'FrfilsFv+•�{�Gr�`'t,w+.�vr,, i1 j ! w11 :'�„1��si.b`..y..a �.;�_•, a t,wrt;'-�. .��.C�ynri' "f S�,Y+�'`}•«i''� ,.+
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�' s •-- , ., { + r A DAVIE COUNTY HEALTH DEPARTMENTj�d
IMPROVEMENT AND OPERATION PERMITS t PROPERTY INFORMATION
Per itteee,s. v '
J, } = Subdivision Name:
F DNections,to property: Section: Lot:
IlNP f%
PERMIT Tax Office PIN:# -
Road Name: 2D/ 'Zip.
**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 from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE. ,
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 # OCCUPANTSGARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
^^..AA».� is SPECIFICATIONS: TANK SIZE GAL. PUMP TANK cr", TRENCH WIDTH ' ROCK DEPTH LINEAR --
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
' !%!tel -�; fy`(� .�: �1 �•• f.: J �, �.� ��.. �1t�/J -"�:1t, f" r / `,
IMPROVEMENTPERMITLAYOU71*APPROVED EFFLUENT FILTE *RIS (S) IF 69-1 BELOW FIHISHEED GRADE*
r t
**CONTACT A REPRESENTATIVE OF THE DAVIE CO E4TH DEPARTME FORS f
I�NA4 INSPECTION OF THIS SYSTEM
BETWEEN 8:30- 9:30 A.M. OR 100 - 1:30 P.M. 0 THEDAY OR. STALLA N. TEL PHONE # IMA Im.
(336)Z51-876941
r
OPERATION PERMIT
STE INSTALLhPrBY•• f '`
r
AUTHORIZATION NO. OPERATION PERMIT BY: l 1 ` DATE: �I
mr
**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 NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
•
s
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
�J
WORKSHEET FORSEPTIC SYSTEM REPAIJ3 PERMIT
NAME Pall if I01 fil%fff 16- 11.1 PHONE NUMBERfl �- J�oZ�2 � 2—/J 90
ADDRESS 9yl 41G ZIwV 7011'tl_ SUBDIVISION NAME
L SUBDIVISION LOT #
DIRECTIONS TO SITE -y� �= �,�iT 1��� / u �''� 'C✓ G}� G �'���'
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER AW
SPECIFY PROBLEMS OCCURRING IA�
'DATE REQUESTED ����' i INFORMATION TAKEN BY �l'�