6538 Hwy 801SEnvironmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028 /
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001822
~ Billed To: Wanda Reeves
Reference Name:
Proposed Facility: Residence
Tax PIN/EH #: 5756-16-4100
Subdivision Info:
Location/Address: Highway 801 S-27028
Property Size: see map
**NOTE* i i 2904
Isgmpremment/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 TypeAl- #People ! #Bedrooms .2 #Baths
Dishwasher: /Z Garbage Disposal: ❑ Washing Machine: ICS Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: NewM'Repair ❑
System Specifications: Tank Size/000 GAL. Pump Tank GAL. Trench Width —1 /01 Rock Depth _/,� Linear Ft.
%1=
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED E
FINISHED GRADE. ****NOTICE: Contact a representative of the Dav
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day
r FILTER RISER(S) IF 6 " BELOW
Health Department for final inspection of this
tion. Telephone # is (336)751-8760.****
/--/W
Environmental Health Specialist's Signature: Date: (p '27el
DCHD 05/99 (Revised)
Account #: 990001822
Billed To: Wanda Reeves
Reference Name:
Proposed Facility: Residence
ATC Number: 2904
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section,
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5756-16-4100
Subdivision Info:
Location/Address: Highway 801 S-27028
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 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: lee Date: g!5� .27
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.
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date: 7 `/0—Pj
1.
2.
I P"1 2 r
�E� H u TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
JUN 2 2 2001 Environmenta/Hea/th Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
ENVIROl OMENTAL HEALTH (336) 751-8760
n A111[ nnn..r.
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
Name to be Billed/( a"r �
Mailing Address &53
City/State/ZIP Le)c
Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: Site Evaluation
4. System to Service: /\❑ House EfMobile Home
5. If Residence: # People
Contact Person
Home Phone n
Business Phone �/ �(U t%'
City/State/Zip
yImprovement Permit/ATC
❑ Both
❑ Business ❑ Industry ❑ Other
# Bedrooms # Bathrooms 6_
O Dishwasher ❑ Garbage Disposal VWashing Machine ❑ Basement/Plumbing H Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats *ounty/Clty
Estimated Water Usage (gallons per day)
7. Type o£ water supply: ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes )k�No
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: # �5�—�� `�� `, v
Property Address: Road Name _v
J
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
�e d r� .S � �� (' PQ Sy Cd'✓
%t l
Lv( t/ ate' J S
�--
Date Property Flagged: �-
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 an 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
to conduct all testing procedures as necessary to determine the site suitability.
DATE
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).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Revised DCHD (07/99)
Account No. a
Invoice No.
a3���
ople ulloolm
m
N-1
s
0499
DAVIE COUNTY HEALTH DEPARTMENT
y Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990001822 Tax PIN/EH #: 5756-16-4100
Billed To: Wanda Reeves Subdivision Info:
Reference Name: Location/Address: Highway 8016-27028
Proposed Facility: Residence Property Size: see map Date Evaluated: 05� 27-w
Water Supply:
Evaluation By:
On -Site Well
Community_
Auger Boring l -1 — Pit
Public VJ
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
r' ?
''•'?
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
66 a
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
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
DCHD 05/99 (Revised)
Parcel #: L60000000903
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search 0
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View Property Record for this Parcel View Man for this Parcel , View Tax Bill Information
Parcel #: L60000000903 Account #: 8302957
Owner Information
Tax Codes
19,43
ETCHIE DESTINY R & REINHARDT KAYLA ETTAMAE
6,50
ADVLTAX -COUNTY T
30,82
42 HOBSON DRIVE
56,75
FIREADVLTAX - FIRE TAX
56 75
OCKSVILLE NC 27028
01
Information
Township
EressProperty
(Units/Type): 3.120 AC
JERUSALEM
:6538 S NC HWY 801
Deed Information
Local Zonin
ate: 12/2013 Book: 00945 Page: 1039
Plat Book: Page:
Legal Description
PIN
13 AC HWY 801
5756164100
Property Values
uildin
19,43
BXF:
6,50
nd:
30,82
arket•
56,75
ssessed:
56 75
eferred•
01
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00945 1039 12 2013 WD Unqualified Improved 0
2 00155 0056 07 1990 WD Qualified Vacant 14,000
View Prooerty Record for this Parcel View Man for this Parcel View Tax Bill Information
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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=1458976 8/31/2016