1590 Junction Rd� :)8vie County, �@� - 6k4O� - September
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WARNING: THIS IS NOTA SURVEY
Porrp| Information
Parcel Number: M40000002301 Township: Jerusalem
NCP|NNumhec 5735287820 Municipality:
Account Number: 51554880 Census Tract: 37059'807
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Listed Owner 1: KxOJ|CAmwvOR Voting Precinct: C0OLeemss
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Mailing Address 1: 1729ANGELLRD Planning Jurisdiction: Davie County
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� City: MOCKSV|LLE Zoning Class: DAV|ECOUNTY R+A
State: NC Zoning Overlay: DAV|ECOUNTY CZOD
Zip Code: 27028-4003 Voluntary Ag. District: No
Legal Description: LOTS G-7RVYKURFEES Fire Response District: C00LEEW1EE
Assessed Acreage: 178 Elementary School Zone: COOLEEK4EE
Deed Date: 2/2015 Middle School Zone: SDUTHDAV|E
Deed Book /Page: 009800105 Soil Types: PoC2.CoB2
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Plat Book: 0002 Flood Zone:
Plat Page: 008 Watershed Overlay: DAV|ECOUNTY
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Building Value: 5158O00 Outbuilding &Ent'a 122000
� � FreoturesVa|ue: �
Land Value: 21540.00 Total Market Value: 74350.00
Total Assessed Value: 74350.00
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie
implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County, County " Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims orcauses * action due m
|| |Nv. |= arising out mthe use orinability muse the GIS data provided uvthis website. |
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
t
IMPROVEMENT PERMIT
**MOTE** 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 11 of B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME1 / �P� ' / S.� /�'r,. PROPERTY ADDRESS .0/ t' 07-,L DATE
LOCATIONl/i/�f
SUBDIVISION NAME LOT NUMBER SEC./BLOC( NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: YeVN
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE �'S%�!> TYPE WATER SUPPLY f G DESIGN WASTEWATER FLOW (GPD)- -nO NEW SITE t`'� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIIE f) GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH %% '� LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MAST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY�
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL 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) 634-8768.
OPERATION PERMIT ALLED BY
ep
AUTHORIZATION NO. tl �V"' OPERATION PERMIT BY DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED A VE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1908 '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 10/95
H ..
.s FR7JUN
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIDavie County Health Department
Environmental Health Section 1 2 1996
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By fZo 6A-13 As U44
Mailing Address es y Home Phone l/l - Z' ��s�J z
K— Business Phone
2_ Name on Permit if Different than Above
3. Application for:
4. System to Serve:
❑ Business
❑ General Evaluation
❑ House
❑ Industry
5. If house, mobile home: Subdivision
U,Septic Tank Installation Permit
p'vl!tobile Home ❑ Place of Public Assembly
❑\ Other ❑ Unknown
a
No. of People 2
No. of Bedrooms - )
No. of Bathrooms
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
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: Ca-15ublic ❑ Private
8. Property Dimensions a or) 3, 4ou Sewage Disposal Contractor
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
2, Washing Machine
E; -Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 1 fkwo
If yes, what type?
❑ Community
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property: f)1-44-3.3-01
Mal, -Aa) S+. C6pkkoral
CLckws
Qbm
vPQ� �Ei�
This is to certify that the information provided is correct to the best
incurred from this application.
ja J 96
DATE
Tax Office PIN: #
PTT) -
PROPERTY ADDRESS,
Road Name:
City: N oe-kc u i lle
SUBMIT A PLAT WITH THIS APPLICATION.
Revisions effective October 1, 1995.
SIGNATURE
I am responsible for all charges
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: O4. I OWN the property. ❑ 2. 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' to ' ity for a ground absorption sewage treatment
and dispos�yste
DATE SIG ATURE
DCHD (1193)
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` - DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
. Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE j c
LOCATION OF SITE
Water Supply: On -Site Well _ Community Public.'___�
Evaluation By: Auger Boring �_ Pit Cut
FACTORS
1
2
3 4
Landscape position
L
L
Sloe Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
G
Consistence
Structure
S
Mineralogy,'
/
/ ' /
/.•
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATIONs
LONG-TERM ACCEPTANCE RATEJ::�%,�
-
SITE CLASSIFICATION: EVALUATED BY: l`Y z
LONG-TERM ACCEPTANCE RATE: _ OTHER(S) PRESENT:
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 :lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vl,.-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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t ` Davie County Health Department
' ENVIRONMENTAL HEALTH SECTION
P.O. Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***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.***
/ AUTHORIZATION NUMBER
NAME DATE ��5" ��` N2 0 4 00"
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
4WICE*** THIS AUTHORIZATION F WA5 WflTER 5Y5 CONSTRUCTION IS VALID F R A PERIOD OF FIVE (5) YEARS.
ENVIM ENTAL WFL1qSFECNLIST DATE
DCHD'10/95
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