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1535 Hwy 801Srlavip Cnunty NC ' TAY PArCPI Pinnnrt An `% M9,4 Warinaerinv CAnfamhar9R 9MR ,... _ Davie County, NC 'Parcetlnformation` °r� et Parcel Number: F800000084 Township: Shady Grove NCPIN Number: 5880064152 Municipality: Account Number: 51376000 Census Tract: 37059-803 Listed Owner 1: MOCK LAWRENCE L Voting Precinct: EAST SHADY GROVE Mailing Address 1: 131 GW MOCK WAY Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: 10.332 AC HWY 801 OFF Fire Response District: ADVANCE Assessed Acreage: 10.06 Elementary School Zone: SHADY GROVE Deed Date: 11/2008 Middle School Zone: WILLIAM ELLIS Deed Book f Page: 007750001 Soil Types: WeC,WeB,PcB2,PcC2,MsD Plat Book: Flood Zone: X Plat Page: Watershed Overlay: - Building Value: 78540.00 Outbuilding & Extra 6450.00 Freatures Value: Land Value: 139530.00 Total Market Value: 224520.00 Total Assessed Value: 224520.00 `�� ° "" a Davie County, NC All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or °r� et causes of action due to or arising out of the use or inability to use the GIS data provided by this website. Perauttee's • / DAVIE COUNTY HEALTH DEPARTMENT 0 Name: L '{ * �'��f �! r �'�'� Environmental Health Section PROPERTY INFORMATION J , P.O. Box 848 Directions to property: `f(� /' �`� /� Mocksville, NC 27028 Subdivision Name: r' Phone #: 336-751-8760 Section: Lot: / AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - SYSTEM CONSTRUCTION AUTHORIZATION NO: t A Road Name: '" Zip: .� : r✓"( ' **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 �� 1 ✓ ' s -f ._-.l�%s'' ! b G _ % IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE H # BEDROOMS -3 # BATHS .'_ # OCCUPANTS *).- GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes orNo LOT SIZE 70" TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 36J NEW SITE REPAIR SITE V �r � LINEAR SYSTEM SPECIFICATIONS: TANK SIZE 5Y ")k/ PUMP TANKGAL. TRENCH WIDTH .� ROCK DEPTH / LINEAR FT. OTHER A r Cj REQUIRED SITE MODIFICATIONS/CONDITIONS: 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BFTWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT l \ , ' SYSTEM INSTALLED BY: AUTHORIZATION NO. ��l 7 "OPERATION PERMIT BY: DATE: Lo —Oz2 — O "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 01102 (Revised) 1.f'�E`" �. r ' Perrnittee's s�/� a z DAVIE COUNTY HEALTH DEPARTMENT�o er �. Environmental Healtt>\Section PROPERTY INFORMATION R P.O. Box 848 t1�'ti -D1recSiotlsTo. property: Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 �,, :� - ., r• Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - SYSTEM CONSTRUCTION AUTHORIZATION NO: 002778 A Road Name l Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior tolssuance 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 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE COMMERCIAL SPECIFICATION: FACILITY TYPE # BEDROOMS -3 # BATHS # OCCUPANTS ��+ GARBAGE DISPOSAL: Yes or No # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE e, TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 36Q NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. !PUMP TANK fv /GAL. TRENCH WIDTHROCK DEPTH LINEAR FT. OTHER A f- REQUIRED SITE MODIFICATIONS/CONDITIONS: 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE C_4Lt P4TWEF�t 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT SYSTEM INSTALLED BY: a �CCJ r m / r AUTHORIZATION NO. I�'7 7 ��PERATION PERMIT BY: /' r� �� DATE: / 6 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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 07102 (Revised) • AVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 2 PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760��`�^� ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ Number: / `g ` M'7" (Home) nv ' 6- r3 a (Work) Property Address: h535-! i v v y o V j Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under: �-" Q Na etc Type Of Dwelling: i1a US lb>,NGk Date System Installed(Month/Day/Year): �g f0 Number Of Bedrooms:L-9_Number Of People: Is The Dwelling Currently Vacant? Yes No U- If Yes, For How Long? Any Known Problems? Yes ❑ N&Z;1 If Yes, Explain: Please Fill In The Following Information About The New Dwelling. Type Of Dwelling: %6111 Number Of Bedrooms: / Number Of People: Requested By: NDate Requested- (Signature) For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Environmental Health Specialist Date *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ Date: Paid By: Received By: Account #: Invoice #: LoG�c G 3 APPLICANT INFORMATION L ,e -e /V�,o C, V, Water Supply: Evaluation By: On -Site Well Auger Boring DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Community Pit PROPERTY INFORMATION Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH G —41 Texture group Consistence xz2- Structure Q -C/ Mineralogy At HORIZON H DEPTH —4 40 Texture group G Consistence Structure d Z-41 Mineralogy HORIZON III DEPTH Texture groupC L 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: O; Z REMARKS: LEGEND EVALUATION B Y: OTHER(S)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 a' dq VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Mjd 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 05105 (Revised)