6773 Hwy 801Siy
Reference Name: Stacy West
Proposedd FF ili : RFPAIR
�N E The issuance of this Operation Permit shall indicate the system described on the ATC 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.
System Type:b S.T. Manufacturers /tank Date Tank Size
P
'Pum Tank Size,"
System Installed By: jLaq A Le v-' " E.H. Specialist: Date:
Account #: 990005774
Billed To: Stacy West
Address: 6773 HWY 801 S
City: Mocksville
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax #(336)753-1680
REPAIR OPERATION PERMIT
Tax PIN/EH #: L50000007902
Subdivision Info:
Location/Address: -67-7-3 Hwy 801 S.-27028
Property Size: 1.148 AC
GPS Coordinate:
4EA- ,
n
L`r.
f
DCHD 11/06 (Revised)
l
TNNQ
010
DAVIE COUNTY ENVIRONMENTAL HEALTH
• P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax #(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005774 Tax PIN/EH #: L50000007902
Billed To: Stacy West Subdivision Info:
Reference Name: Stacy West Location/Address: 6773 Hwy 801 S.-27028
Proposed Facility: REPAIR Property, Size: 1.148 AC
ATC Number: 5841 Site Type: ' ❑New ❑Repair ❑Expansion
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental.
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms -5 # Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size 1. l Type of Water Supply: 96.unty/City ❑Well ❑Community Well
_Ej�l.1nc,
System Specifications: Design Wastewater Flow (GPD) 3 Tank Size�GAL'Pump Tank GAL.
Trench Width ?� Max. Trench Depth _Rock DepthJuAinear Ft3e'o of
Site Modifications/Conditions/Other: 2�Fk3 JC,\c5''t
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
r
306
Environmental Health Specialist,
DCHD 11/06 (Revised)
fish ��• � �
i
� o
'61 a fe
doe"
r_eAld�e
11
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
�"Ak
PHONE NUMBER
ADDRESS b ` 73 SUBDIVISION NAME J" ✓
_Ael r k�--6 0,' -) 00 LOT #
DIRECTIONS TO SITE ,�F 773
DATE SYSTEM INSTALLED j Ct I NAME SYSTEM INSTALLED UNDER ?
TYPE FACILITY - NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED l
TYPE WATER SUPPLY CD. 10P bi SPECIFY PROBLEM OCCURRING '5LA-C4 c ---e
DATE REQUESTED l G— �7_ 1 1 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge. and that I
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
'SSU --e
for all charges incurred from this application.
: DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990005774 Tax PIN/EH #: L50000007902
Billed To: Stacy West Subdivision Info:
Reference Name: Stacy West Location/Address: 6773 Hwy 801 S.-27028
Proposed Facility: REPAIR Property Size: 1.148 AC Date Evaluated: je a 7 —
t3
Water Supply. On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
—=7—
Slope,%
HORIZON I DEPTH p 1
Texture group L
Consistence y
Structure AA
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure S V
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:y EVALUATION BY.
LONG-TERM ACCEPTANCE RATE: 3 OTHER(S) PRESENT:
4 -
REMARKS:
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
ON4IST .N . .
Moist
VFR - Very friable FR -,Friable FI - Firm VFI - Very firm EFI - Extremely firm
3Yet .
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)
Parcel #: L50000007902
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search
Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #:L50000007902
Account #:77610000
Owner Information
uildin :
Tax Codes
BXF:
EST STACY F & WEST STEPHANIE I
ET
nd•
ADVLTAX - COUNTY
Market:
753 NC HIGHWAY 801 SOUTH
ssessed•
FIREADVLTAX - FIRE TAX
eferred•
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 1.150 AC
Fcddress:
JERUSALEM
6773 S NC HWY 801
Deed Information
Local Zoning
ate: 07/2004 Book: 00563 Page: 0314
Plat Book: Page:
Legal Description
PIN
1.148 AC HWY 801
5746849458
Property Values
uildin :
33,69
BXF:
30
nd•
20,67
Market:
54 66
ssessed•
54 66
eferred•
Sales Information
No. Book Paye Month Year Instrument Qual/UnQual Improved Price
00563 0314 07 2004 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
« Return to Basic Search
Page 1 of 1
oP�tc�
C.,° U l3'C
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=1462624 8/31/2016