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6210 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002501 Tax PIN/EH #: 5756-44-7426 Billed To: John Link Subdivision Info: Reference Name: Location/Address: 801 S-27028 t-aciuty: Kesiaence ATC Number: 3318 vroperty Size: see 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 Form/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 WASTEWAT ONSTRU—CTTIIO/N IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: '-9 { % �ZC ��- Date: 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 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. -01-n S� Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) . rn Account #: 990002501 Billed To: John Link Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5756-44-7426 Subdivision Info: Location/Address: 801 S-27028 Property Size: see map ATC Number: 3318 **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 A 22 #People I #Bedrooms /-/ #Baths Dishwasher: f21"" Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type /I #People #People/Shift #Seats Industrial Waste: ❑ Lot Size PtP C Type Water Supply Design Wastewater Flow (GPD) Site: New ❑ Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width�W�l � Rock Depthj�� Linear Ft. a0d Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative 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 1:30 p.m. on the day of instal tion. Telephone # is (336)751-8760.**** '4- aLr Ld Environmental Health Specialist's Signature: J1 Date: DCHD 05/99 (Revised) 0 O lot, A PLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC /J Davie County Health Department EnvironmentaiHeaith Section // ` P.O. Box 848/210 Hospital Street C�` Mocksville, NC 27028 1 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed v O 4 /( �1 Contact Person Mailing Address 6 r v e- Ila G % y S-0 Zf Home Phone�f�e�� City/state/ZIP-z% /�: fr �l_r1/ /e- iu � Q 2- iness Phone �/jj .2 ` 2. Name on Permit/ATC if Different than Above Mailing Address _City/State/Zip / 3. Application For: B site Evaluation ❑ Improvement Permit/ATC oth 4. system to service: a - ,(Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms �% # Bathrooms' a LTDishwasher IJ Garbage Disposal Lkliashing Machine O Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: bounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C- If yes, what type? 'IMPORTANT'* CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI7TED by the client with THIS APPLICA'T'ION. Property Dimensions: / F ` _ WRITE DIRECTIONS (from Mocksville) to PROP ;RTY: Tax Office PIN: # -V Wil. Cga 1a AGI SoNf h Property Address: Road Name �� p a SS C ��G�l�l L/ j%/✓✓� City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. 1 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 ant responsible for all charges incurred faun this application. I, hereby, give consent to the Authorized Representative of the Davie County I-icalth Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE O `- d�._ SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). c,3 �.�c7 Account No. Revised DCHD (07/99) ~ C<_1 Invoice No. �-� /\ Wt. r, rr O,F 4�s03, { t oa. /,� r' r 2 1. 70l T co 03 Cl ro 70 r o , 3 r r r \ N W ` 1 rq r. Om r W.<A p 's - 0 0` f .o 205.46' ; Now Lot �^° s 04°26'39"W 233.39' Totat i a�N�.�•`./�('\ { DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002501 Tax PIN/EH #: 5756-44-7426 Billed To: John Link Subdivision Info: Reference Name: Location/Address: 801 S-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: Evaluation By: On -Site Well Community Auger Boring// Pit Public Cut /� FACTORS 1 2 3 4 5 6 7 Landscape position Slope HORIZON I DEPTH (� Texture group rA Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure <h /1 /G Mineralogy• / . ` l 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: 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 ois 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 Mineraloev 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 05/99 (Revised) ■MEMMEMMEM■■E■ ■■MES■■■E■e■S■ ■■■■■■■■O■■■■■ ■■■E■■■■■■■■■■ ■SS■■E■■■E■e■■ ■■■■■■SEE■■E■■ ■■■■■■■■■■■■■■ ■■■e■■E■■■■■■■ ■■O■■■■■■■■■E■ ■■■■■■■■■■E■■■ ■■■e■■■■■■■■■■ ■■E■■■■■■■■■■■ ■■.■■■E■■.■■■■ ■■■■■■■■■■■■■■ ■e■■■e■■■Se■S■ ■M■■■■■■e■E■■■ ■■■■■■■■■■■■■■ ■■■MENEEME■E■■ ■■■■■■■■■E■■■■ ■■■e■■■■■E■E■■ ■EEE■EEE■■■■■■ ■■■■EEE■■■E■S■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ NOME ■■MEMO■■■■■■EO■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■ ■■■E■■■■■■■M■■■■ ■O■E�ii■O■■■■OO■■■■■E■■ ■ONO■■■■■■■■■■s■■■E■■■ ■■■■ ■■■■MMMENEE■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■N■ ■■■■■■■■■■e■■M■■ MEMO MEMEEN- EMEMME�i ■■■■■■■ ■■■■■■R Noon aONE ■■►No■■■■■■■■■■■■■E■■■■■■■■■■■ ■Nook■■■■��■■■■►�■■■■■■■■■■■■■■■■■■■■■■ ■■■■\,1■■■■e,l■ee.�■■■■■Mee■■■■e■e■■Mee■ ■■■■��I■■■■■■■■■■■■■■■■■■e■■■■■■■■Mee■■ ■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■ ■■■■��uE■■■■■■■s■■■■■■■■■e■■■■■e■■Mee■■ ■■■■ui�■■■■■■■■■E■■■■■■■■■■■■■■■■Mee■■■ ■■■■o■■■■■■■■■Mee■e■■■■■■■■■■■■■E■e■■■ ■■■�i■■■■■■■■■■■■■■OO■■■■■■■Mee■■■■e■■■ ■■■N`■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■..■■■■■■■■■■■■■E■■■■■e■■■■■■■■■■■Mee■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■Mee■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ VO " APPLIOATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie. County Health Department � �0 Environmental Health Section i5 Q �a� r1 P.O. Box 848 ��a ,� cl�D epa",-l% aril � i I 6 '��I Mocksville, NC 27028 1 SEP 2 5 - i (704) 634-8760 ***IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS`AL'L----, THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed S- L t Contact Person JyZ ( el Mailing Address 0 o%Home Phone S / Y :7 City/State/Zip0� % (� �K . Business Phone 2. Name on Permit/ATC if Different than Above e� e, Mailing Address "so M -e- City/State/Zip 'K , 3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC �q Both 4. System to Serve: [ ] House Mobile Home [ ] Business [ ] Industry [ ] Other l 5. If Residence: # People—3—# Bedrooms_ # BathroomsC�Z_ [ ishwasher [ ] Garbage Disposal [XWashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [Count 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? Al\ EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***.DAT OF THE PROPERTY MUST BE / 1) / % SUBMITTED WITH THIS APPLICATION. Property Dimensions: /Z x >'y 7 / Z WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #ci 7J� - Property Address: RoadN�me10-216 4U-)1/ k1) I567«tld �!2± 1K 6 1 j�%er(s�ec�l M. /(10 `ftaf City/Zir) , l r' �7 DA l -�� Q" ( l t �� 1< SCI I `1 CSI 1' I ll / If in Subdivision provide information, as follows: rzni�`i 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 nece by.��—, �IC=�r to conduct all testing procedures s to determine the site suitability. ��0� . DATE -T-- L ') SIGNATURE Revised DCHD (06-96) T11IS AREA h1A1J 13E USED FOR IVAIVINC YOUR SITE PLAN: X ,% L rol N jw"i 34R 1, �:.& o?- _1 Ol gpg qt-, ; .41.1 1-' . :• . . . . . . . SRI ..... ----- _30 'J" hgy Iz- .4� 4F, J:, 411 N, 0, 5p *;.:Jl `7ij e kp A, .14, lie 6 .;A IL" WC M rr� srs T V` W, hill i io Wj. A P, A Y y r.. tv- 7 vp 4 W -W w jy 1 __x. 4 A k . 77 ".7.1'.." kp k N —4ry Ile, wo, . 1 AV 1.17 ,Lt h_lr&14%(ti. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED :T f PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME Water Supply: Evaluation By: On -Site Well Community Auger Boring t_--, Pit Public i Cut FACTORS 1 2 3 4 5 6 7 Landscape position ` S Slope % HORIZON I DEPTH Texture group Consistence Structure %) Mineralogyj 7V HORIZON II DEPTH Texture group; Consistence I J Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION i LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND EVALUATION BY: OTHER(S) PRESENT: Linear slope FS - Foot slope N - Nose slope nvex slone. T - Terrace FP - Flood plain H - Head slope �aP loam L - Loam SI - Silt 1191+0 o F ��"�D CL - Clay loam SCL - Sandy clay loam CC�) 60 M P S `^' 1-- 7 L VSISTENCE VFI - Very firm EFI - Extremely firm °� Sticky VS - Very Sticky A -Plastic VP -Very plastic t —'D4P AAAA. mb GR - Granular ABK - Angular blocky )J_Ju f_' - Prismatic `;y land surface •ater or inches from land surface to soil colors with chroma 2 or less :able), U(unsuitable) UCHD (01-90) Davie County Heafth Department and Home Health Agency Environmenta(Health Section P.O. Box 8413 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 November 5, 1997 John R. Link, Jr. 5280 Hwy. 8015. Kocksville, "NC 27026 Re: Site Evaluation 6210 Highway 601 South Tax PIN: 45756-44-9445 Dear Mr. Link: As requested through your application, Robert B. Hall, Jr., R.S., Environmental Health Specialist(s) with this office, visited the aforementioned site on November 3, 1997. The purpose of said evaluation(s) was to determine the soil/site suitability for the installation of an on-site sewage system. The result(s) of the evaluation(s), a copy of which is attached, indicate,,,that the site is unsuitable for the installation of an on-site sewage system for the following reason(s): Rule .1940 Topography and landscape position (d) - Complex slope patterns and slopes dissected by gullies and ravines shall be considered UNSUITABLE with respect to topography. (e) - Depressions shall be considered UNSUITAPLE with respect to landscape position except wh n the site complies essentially with the requirements of this Section and is specifically approved by the local health department. Due to the limitation(s) on your site, this office is not aware of any modifications or alternative measures that can be implemented at the present time to upgrade the classification from "unsuitable" to "provisionally suitable." Your application for an Improvement Permit must, therefore, be denied. You have the right to an informal review of this decision by the Environmental Health Director of this office and also by the regional staff of the Department of Environment, Health, and Natural Resources. You should contact this office to arrange for this further review. You may also wish to obtain the services of a private consultant to collect site-specific data and submit such data and a system design to this office for technical review. A site may be reclassified to provisionally suitable provided written documentation, including engineering, hydrogeologic, geologic or soil studies indicates to this office that a proposed on-site sewage system or a proposed alternative system can reasonably be expected to function satisfactorily. The substantiating data from these studies must indicate that: Fage 2 `John R. Link, Jr. November 5, 1597 A.,The effluent (wastewater) will receive adequate treatment; B. The effluent (wastewater) will not contaminate any ground water or surface water; and C. The effluent (wastewater) will not be exposed on the ground surface or be discharged to surface waters where it could come into contact with people, animals or vectors. Finally, you have the right to a formal appeal of this decision if you iile a petition for a contested case hearing with the Office of Administrative :,earings, P. 0. Drawer 27447, Raleigh, N.C. 27611-7447. A copy of a petition form can be provided to you upon request. The petition must be received by the :iffice of Administrative Hearings within thirty (30) days of the date of this •otice. The hearing may be held in Davie County. If you file a petition for a hearing, you must send a copy of the petition to hr. Richard Whisnant, DEHNR, Office of General Council, P. O. ' Box 27687, Raleigh, N.C. 27611-7687. Please call or write this office if you have any questions or need any additional assistance. Telephone number: 704/634-8760 Address: Davie. County Health Department Environmental Health Section P. 0. Box 848 bocksville, N.C. 27028 Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section b:H/wd Enclosure(s): Soil -Site Report Billing Statement Davie County, NC 51 Tax Parcel Report C.7-4 Thursday, August 25, 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: L60000002104 Township: Jerusalem NCPIN Number: 5756447426 Municipality: Account Number: 45696000 Census Tract: 37059-807 Listed Owner 1: LINK JOHN RICHARD SR Voting Precinct: JERUSALEM Mailing Address 1: 6280 NC HIGHWAY 801 SOUTH Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-5409 Voluntary Ag. District: No Legal Description: 2.601 AC HWY 801(1.19 AC) Fire Response District: JERUSALEM Assessed Acreage: 1.19 Elementary School Zone: CORNATZER Deed Date: 4/1997 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 001940043 Soil Types: RnC,RnD Plat Book: 8 Flood Zone: x Plat Page: 313 Watershed Overlay: WS -IV -P Building Value: 0.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 16350.00 Total Market Value: 16350.00 Total Assessed Value: 16350.00 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 °u e'� causes of action due to or arising out of the use or inability to use the GIS data provided by this website.