6800 Hwy 801Sit ^ei-` `.,•',t_ -,1 -`'tgi,.c..� •, •'i5�r .k .ur:�. v =�°{. .,,.;.; fi re2 .�..'�t, .. � �j'"n � �.,n , -b���a ; � .s �z •.! . ..,_x r. s
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**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 I1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME 25 .�/7: �/' PROPERTY ADDRESS 10 r�S • ' of "(bo5 Q DATE
c
IS
LOCATION ref/z
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS ,I # BATHS # OCCUPANTS , GARBAGE DISPOSAL: YeSOO
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE fAC TYPE WATER SUPPLY JA // DESIGN WASTEWATER FLOW (GPD) 91�9'!7 FEW SITE EPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE !! Y= GAL. PUMP TANK GAL. TRENCH WIDTHROCK DEPTH /a LINEAR FT. QjL�
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FILL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY
AUTHORIZATION NO. OPERATION PERMIT BY DATE eZ010X
**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 FLNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
Davie County. Health Department
ENVIRONMENTAL HEALTH SECTION 06
P.D. Box 665
Mocksville, N.C. 27 028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION2
(Issued in compliance with Article 11 of
B.S. Chapter 130A, Wastewater Systems)
-
***This Authorization For Wastewater System Construction oust be issued by the,Davae County Environmental Health Section prior to
issuance of any Building Permits. This.Form/Authorization Nus : ber should be presented to the Davi e'County Building Inspections.
Office when applying for Building Permits.***
AUTHORIZATION NLMR,
0 5 5,
NAME DATE 3
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRLICT WASTEWATER SYSTEM
***NOTICE*", -THIS AUTHORIZATION WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONMENTAL HEATH SPECIALIST , DATE
DCHD 10/95'
1. Application/Permit
Mailing Address
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
-n"Idl Ile, MC) 2410/2,k Business
2. Name on Permit if Different than Above
3. Application for:
❑ General Evaluation
4. System to Serve: ❑ House
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
G(Septic Tank Installation Permit
ErMobile Home ❑ Place of Public Assembly
❑ Other
No. of People �
No. of Bedrooms
No. of Bathrooms ll''
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
7. Type of water supply: �Public 21, 1 ❑ Private
8. Property Dimensions !griccjz� Sewage Disposal Contractor
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ BasementlNo Plumbing
2 -Washing Machine
[9 -Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes, what type?
❑ Community
'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
6�/s.� ,�� ems- �a�/✓,,
This is to certify that the information provided is correct to the best of my
incurred from this application.
' -n21r� r&44430,zal 4
DATE 14
Tax Off i cc PIN: # S7Y6 - 2V - 96.9x
,(,soa a 60 098 O/
PROPERTY ADDRESS, as follows:
Road Name: G%
City: f �—
SUBMIT A PLAT WITH THIS APPLICATION.
Revisions effective October 1, 1995.
e, and I understand I am responsible for all charges
SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 2'17 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 said site's suitability for a ground absorption sewage treatment
and dipposal system. . f-\ _ ,--. Q ' I
DATE - SIGNATURE
DCHD (1193)
I
(QV • e Y g)
2998
V 6T ' 9
(Ta' Ct75)
LO
i
ti
1
w
w
M.� DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME J/%l
'ADDRESS
PROPOSED FACIILTY . 2V41t
Water Supply: On -Site Well
Evaluation By: Auger Boring ZZ
DATE EVALUATED
PROPERTY SIZE Sii9
LOCATION OF SITE
Community
Pit
Public
Cut
FACTORS
1 2
3 4
Landscape position
,.._ 7—
Slope %
2 -
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
r
Structure
Mineralogy
-11
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S J
LONG-TERM ACCEPTANCE RATE
..
SITE CLASSIFICATION: EVALUATED BY:
LANG -TERM ACCEPTANCE RATE: I L/ OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape Position
R -Ridge S -Shoulder L -Linear slope FS-Footslope 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 ;lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vc.-y 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
3C -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 (01-901
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Parcel #: L50000007801
Davie County, NC - Basic Estate Search
. Basic Search Real Estate Search Tax Bill Search Sales Search 0
View Property Record for this PaMel View Mao for this Parcel View Tax Bill Information
Parcel #: L50000007801
Account #:68866500
Owner Information
261,1801
Tax Codes
01
M PBELL ANGELA SNIDER &CAMPBELL ERIC L LADVLTAX
FMO800
32,3701
-COUNTY T
293,5501
NC HIGHWAY 801 SOUTH
293,55g
READVLTAX - FIRE TAX
CKSVILLE NC 27028
Property Information
Township
Ll
nd (Units/Type): 5.190 AC
JERUSALEM
ddress: 6800 S NC HWY 801
Deed Information
Local tonin
ate: 02/2000 Book: 00326 Page: 0783
Plat Book: Page:
Legal Description
PIN
5.19 AC OFF HWY 801
1 68948000 5746 -74 -8652 -
Property Values
Building:
261,1801
BXF'
01
Land'
32,3701
Market:
293,5501
ssessed'
293,55g
Deferred'
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00326 0783 02 2000 WD Unqualified Vacant 0
View Property 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=1475597 8/31/2016