606 Mr Henry Rd �avie County, NC - ' Tax Parcel Report �j �( Monday, October 3, 201 E
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WARNING: THIS IS NOT A SURVEY
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' ParcelInformation
Parcel Number: L30000000502 Township: Calahaln
NCPIN Number: 5716680486 Municipality:
Account Number: 82528842 Census Tract: 37059-801
Listed Owner 1: SECHREST CHAD MATTHEW Voting Precinct: SOUTH CALAHALN
Mailing Address 1: 606 MR HENRY ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 8.537 AC MR HENRY ROAD Fire Response District: SCOTCH-IRISIH
Assessed Acreage: 8.31 Elementary School Zone: COOLEEMEE
Deed Date: 10/2007 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 007330797 Soil Types: EnB,MsC
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 314360.00 Outbuilding&Extra 31360.00
Freatures Value:
Land Value: 66420.00 Total Market Value: 412140.00
Total Assessed Value: 412140.00
t��� All data Is provided as Is without warranty or guarantee of any kind either expressed or implied including but not limited Ito the
9�"'6� Davie County� Implied warranties of inerchantability or fltness for a particular use.All users of Davie Countys GIS website shall hold harmiess the
�T County of Davie,North Carolina,its agents,eonsultants,contractors or empioyees irom any and ail claims or causes of�ctlon due to
�OUN�S� 1�C or arisfng out of the use or Inability to use the GIS data provided by thls website.
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� Davie County Health Department
��'s�� � Envi.ronmental Health Section
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. Mocksville,NC 27028 �
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Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: �� ���r,�e� Phone Number ���p �gZ 21�T (Home)
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Mailing Address: . � (Work)
6� 'Q � Email Address:
Detailed Directions To Site:
Property Address: O PL , �71/�,��'l /'� I
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Please Fill In The Followin Information About The EXISTING Facility:
Name System Installed Under: ���l�i��.S� Type Of Facility: D�C-Sl`�i
Date System Installed(Month/Date/Year): Z 0 02� � Number Of Bedrooms: � Number Of People:�
r�•rI,P F�rilir�('nrrPnt e or How Lon ?
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Any Known Problems? Yes No If Yes,Explain:
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Please Fill In The lowin Tnformation About The NEW Facility:
Type Of Facility: �// �� �d 3� Number Of Bedrooms: �/ Number of People
Pool Size: ' G ge Size: Other: �
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�( Requested$y: ' Date Requested: p �
( ' a e) I
For Environmental Health Office Use Only
Approved � Disapproved
Comments:
Environmental Health Specialist Date: � I
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*The signing bf this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order # Amount:$ Date:
Paid By: Received By:
Account#: Invoice#:
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�`{�- �.s .`� warranties of inerchantabiifty or fitness tor a particular use.AII users of Davie County's GIS website shall hold harmless tha County of �fll/T3��I
Davie,NoRh Carolina,its agents,consultants,contractors or employees irom any and all ciaims or causes ot action due to or arising out Printed:May 1 D� 2��J
C� ot the use or inability to use the GIS data provided by this website.
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� DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC. 27028
(336)751-8760 Fax#(336)751-8786
OPERATION PERMIT
t�cc�uE�t #: 990005330 '�ax F�IC�€l�H#: 5716-68-0486
BiEled Ta: Chad Sechrest SU�Jt�IVIStUfI If3fQ:
R�fer�^r�c� �tan�e: Lac�tianir�c�c�r�:ss: Mr. Henry Road-27028
E�roposgd Fas;i€ity: Residence ��o�eriy SizQ: 8.53 Acre
�TC E�uEnber: 4986 ' .
**NOTE**The issuance of this Operation Pernut 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 funetion satisfactorily for any given period of
time.
System Type: �/ ' S.T.Manufacturer.�� Tank Date� Tank Size /�60 �
Pump Tank Size � �
System Installed By: (�/Z ���.5 E.H.Specialist: /�f � �ate:���
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DCHD 11/06(Revised)
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• , ' . DAVIE COUNTY ENVIRONMENTAL HEALTH � '
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760 Fax#(336)751-8786
OPERATION PERMIT
.�'�ec���t #: 990005330 "�ax PI�€:�H#: 5716-68-0486
Bil�et� Tc�: Chad Sechrest Si3�Jt�lYlStUf1 IfI�Q: ��D� .Nl R-!1'����C�+
F�ef�r�t�ce P�an�e: Loc�tiar�i�c�r�r�ss: Mr. Henry Road-27028
t'ropc�sQcl Fas�ility: Residence F'ro��r�y Siz�: 8.53 Acre
ATC f�uEnb�r: 4986
**NOTE**The issuance of this Operation Pemut shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S. Chapter 130A,Section.1900"Sewage Treahnent 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: �/ S.T.Manufachuert�n�.�,- Tank Date� Tank Size ��b0 <.�
Pump Tank Size ! �
System Installed By:���f�(iT.s E.H.Specialist:� �u � ate:
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DCHD 11/06(Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH ��
P.O.Box 848/210 Hospital Street Q?
Mocksville,NC 27028 �'I
(336)751-8760 Fax#(336)751-8786 �
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
f'�ccnu�t #: 990005330 �"�x �€�€f�H#: 5716-68-0486
Bifleci 7U: Chad Sechrest Sll�Ji�9111SEUf1 �f3�Q:
Ref�r�E�ce Nan�e: Lac�iiani.�dr�r���s: Mr. Henry Road-27028
Propc�sec� F��i€ity: Residence �ro�er��/ Siz�: 8.53 Acre
�TC NuEnb+�r: 4986 �
Site Type: C3New ❑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 Treahnent 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 SpeciFcations: #Bedrooms � #Bathrooms .� #People�BasementB'$asement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
G Type of Water Supply: Et�ounty/City ❑Well ❑Community Well
Lot Size (�� '
System Specifications: Design Wastewater Flow(GPD)���Tank Size i �U GAL.Pump Tank GAL.
2 �. (r /
Trench Width J � Max.Trench Depth�� Rock Depth inear Ft.�
Site Modifications/Conditions/Other: Ay Stated in 1,�iA NCAC 18A.1969(5'�..,� �� R ��` S g
;!��pficti-�p��trr�y-atsv--�ertr.,�� ��,!°C �o N �
Contact the Davie County Environmental Health Section for final inspection of this system between
— m on the da of installation. Tele hone# 336 751-8760.
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Environmental Health Specialist Date: �� ��v � �
DCHD 11/06(Revised)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
' (336)751-8760/Fax(336)751-8786
Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) C�Both
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORh1ATION'IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. ,
APPLICANT INFORMATION ,
Name to be Billed � Vl�(� ���1(��J� Contact Person �'X�c�- ��5�
Bilfing Address � '��'� �`�t" Home Phone �I9 a�, ��`
City/State/ZIP ' C�� 1� ' ' Business Phone � �
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip I
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale)
(Permit is v id for(�0 months with sit plan,no expiration with complete plat.) `�
Owner's Name � � � �_l L r�-l� Phone Number �$`i� (,Q��'
Owner's Address �- � City/State/Zip �C,� �� L, ''I :�
Properly Address �Sj�'v�.e City
Lot Size ���,�, /}� . Tax PIN# �7���.- (Q - b�f�� �a� `'l � ��
Subdivision Name(if applicable) Secti nJLot# ��
Directions To Site: d�� �eN� lQ�Vr��-° P���
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If the answer to any of the fol owing questions is"yes",supporting documentation must be attached. �
Are there any existing wastewater systems on the site? ❑Yes C�to
Does the site contain jurisdictional wetlands? ❑Yes C3�o
Are there any easements or right-of-ways on the site? �Yes C�10
Is the site subject to approval by another public agency? ❑Yes C�10
Will wastewater other than domestic sewage be generated? ❑Yes C�3�10
IF RESIDENCE FILL OUT THE BOX BELOW
#People #Bedrooms #Bathyooms c Garden Tub/Whirlpool ❑Yes o
Basement: Yes ❑No Basement Plumbing: ❑Yes [��10 .
IF NON-RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building #People�
#Sinks #Commodes #Showers #Urinals
Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: #Seats
Type system requested:. �Conventional ❑Accepted ❑Innovative ❑Alternative OOther
Water Supply Type: � County/City Water �New Well ❑Existing Well ❑ Community Well
Do you anticipate additions ar expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes,what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any pernut(s)or ATC(s)issued hereafter are subj ect to suspension or revocation if the site is altered,the intended use changes,or if
the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representat�ve
of the Davie County Health Department to conduct necessary inspections to deternune compliance with applicable laws and rules.
I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging
or staking the house/facility location,proposed well location and the location of any other amenities.
��� t-'��� Site Revisit Charge
Property owner's or owner's legal representative signature
Date(s):
� Client Notification Date:
Da e EHS:
Sign given ❑Yes ONo Account# ���i
Revised 11/06 Invoice#
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,-':�PPLICA OR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
� n �( �, Davie County Environmental Health
' � � �� P.O.Box 848/210 ��ospital Street
Mocksvi11e,1VC 27028
� , � � �; ZdQ�J� . (336)751-8760/Fax(33�751-8786
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�p ication For: q ' uation/ provement Permit �'Authorization To Construct(ATC) [�Both
Typ o�A. ' ��"�� w S s ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
E��` �tE COU�1
*** AIVT***THIS APPLICATION CANNOTBE PROCESSED LTNLESS ALL OF THE REQUIRED
NFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION �
Name to be Billed �o (�!Y �.. �:I�,//} l.. ({ �;l�; Contact Person ,��r��=
$illing Address 17.a 1�'k �. � �' 6� 6'��r Home Phone ' i � �, G G
City/State/ZIP �S��E c,� �../'�',S {���L � , �';�,�?. ��, r� ���"Business Phone
_.�
Name on Permit/ATC if Different than Above C h 0.a. m 0.�`t71 EE.J ����'"4°.S � 3�P ���� .�
Mailing Address ,��4� 1�( , 71'),�,'n ,$f City/State/Zip �p�J,��'�,����'u�!r ,fa;,', t� . �'���•�
PROPERTY INFORMATION *Date House/Facility Corners Flagged a. �
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan �Plat(to scale)
(Pernut is valid for 60 months with site plan,no expiration with complete plat.)
Owner's Name :;:1' e� �� 1't �r • �;,,,1 r�d L ��,'f? Phone Number ,"�"'S'/� .�_«'�'�
Owner's Address !73 /r!�L!.V A Id E. City/State/Zip M h G ►�S t/r L L. �r h(�-�.70�`'
Property Address fi" �''� �NI /j', J��„�YY({� �j p . City ,�^� � (;; !e�� V t �- � �=
Lot Size �: 3'3 .C`i � R LS Tax PIN#�7 �'Z��S 1��I
Subdivision Name(if applicable) Section/Lot#
Directions To Site: t� �. S a.w��. s-• c�r.+.�. .���.r _ c.-A�.., 5 Gu OpI.- �'t �F.�-,
a,�✓ /�v R , �-1 E N R Y 3� i� � r
If the answer to any of the following questions is"yes",supporting documentation must be attached.
Are there any existing wastewater systems on the site? ❑Yes !�lNo
Does the site contain jurisdictional wetlands? OYes L�'No
Are there any easements or right-of-ways on the site? �Yes C�No
Is the site subject to approval by another public agency? ❑Yes �No
Will wastewater other than domestic sewage be generated? ❑Yes �No
TF RESIDENCE FILL OUT THE BO L W 0V� ����� � �d���
#People �, #Bedrooms #Bathrooms v7 Garden Tub/Whirlpool ❑Yes o
- Basement: [a'i'es ❑No Basement Plumbing: ❑Yes B'l�fo '
IF NON-RESIDENCE FILL OUT THE BOX BELOW
Type of FacilityBusiness Total Square Footage of Building #People
#Sinks #Commodes #Showers #Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: #Seats
Type systemrequested:. C�kt'�onventional �Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: ❑ County/City Water �New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Ca''�10
If yes,what type?
This is to certify that the information provided on this application is true and conect to the best of my knowledge. I understand that
any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if
the informatiou submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representativc
of the llavie County Health Department to conduct necessary inspections to deternune compliance witli applicable la�vs aud niles.
I understand that I am responsible f'or the proper identification and labeling of property lines and coniers and locating and flagging
or staking tl�e l�ouse/facility location,proposed weli location and the location of auy other amenities.
� � � L�C(�- _ _. Site Revisit Charge
Prop -v o�vner's or owner's legal representative signature
Date(s):_,_
r5''-�/• � r Client Notification Date:__,
Date I:HS: � _
Sign given ClYes ❑No Account# ,/c Z-'
Revised 11/06 Invoice# �C�
• � •.. • DAVIE COUNTY ENVIRONMENTAL HEALTH P�`' �
' P.O.Box 848/210 Hospital Street �I f���
Mocksville,NC 27028
(336)751-8760 Fax#(336)751-8786
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990000742 Tax PIN/EH#: 5717-64-5969
Billed To: Johnny Walker Subdivision Info:
Reference Name: Chad Matthew Sechrest Location/Address: Mr. Henry Road-27028
Proposed Facility: Residence Property Size: •8.53 Acres
ATC Number: 4738 Site Type:�w ❑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�#Bathrooms 2 #People �— Basement�asement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lot Size ���`�'�� Type of Water Supply: ❑County/City��Vell ❑Community Well
System Specifications: Design Wastewater Flow(GPD} � Tank Size ��AL.Pump Tank GAL.
Trench Width �(o�, l�sx.Trench Depth�`"_3y Rock Depth� Linear Ft. ����
Site Modifications/Conditions/Other: L,e� '�r� Z ,3 �1�(� .� c� �
�����.�. • (�/1 �L
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760.
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Environmental Health Specialis �r %' Date: � O
DCHD 11/06(Revised)
� � ' � DAVIE COUNTY ENVIRONMENTAL HEALTH •
• � P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760 Fax#(336)751-8786
OPERATION PERMIT
Account #: 990000742 Tax PIN/EH#: 5717-64-5969
Billed To: Johnny Walker Subdivision Info:
Reference Name: Chad Matthew Sechrest Location/Address: Mr. Henry Road-27028
Proposed Facility: Residence Property Size: 8.53 Acres
ATC Number: 4738
**NOTE**The issuance of this Operation Pernut shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S.Chapter 130A, Section.1900"Sewage Treahnent 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: S.T.Manufacturer Tank Date Tank Size
Pump Tank Size
System Installed By: E.H. Specialist: Date:
DCHD 11/06(Revised)
. � �� , ���. � � � �j��S��-��
„ s�PPLICA OR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
� n � � Davie County Environmental Health
� (� �� P.O.Box 848/210 Hospital Street
D Mocksville,NC 27028
� �� 1 5 �Q��� � (336)751-8760/Fax(336)751-8786
i ic�ion For: q ' � uation/ provement Permit f$'Authorization To Construct(ATC) [�Both
Typ o , ,1 ' ���ouN w S s ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
ViE
*** ANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OE THE REQUIRED
NFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed �o l-�N L.. W/� � �'C �1� Contact Person ,,,,��n^��
Billing Address_ 17.� l�'k l, �. y �} G+�, Home Phone ')S' 1 • �, G �f�
City/State/ZIP_ �d �./'�,� ��(� � , �+,�. �;� r C� '�-�`Business Phone
Name on Permit/ATC if Different than Above C h ad �1a-t`-f�i e i..J �C'C�11''�'_S� .��P ���49 .3
Mailing Address_/��i 0 1�( , 7Y)R�,� �f City/State/Zip�pc svi,�/r t��, C, .�'7 G��$
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan �Plat(to scale)
(Pernut is valid for 60 months with site plan,no expiration with complete plat.)
Owner's Name �' D 1> N � . (�.J Fi L kE R Phone Number 7'S/' .2 G��
Owner's Address /73 Ir�'L L V A V E. City/State/Zip M 6 G ►<5 d i L L �� K�-J�70�'
Property Address �' �`� �vl /�, y�;�Y�2/ f7 D • City � o C /Y� v � L L E
Lot Size �: ,�"� G e R L-'S Tax PIN#�'7 J� ��S�'j G q
Subdivision Name(if applicable) Section/Lot#
Directions To Site: S s-wE"t��.. � .4a. �»c^ F.. � etr oct- t G.-,
O/v /►'l R , El 'E N R � R l� �
If the answer to any of the following questions is"yes",supporting documentation must be attached.
Are there any existing wastewater systems on the site? DYes f$No
Does the site contain jurisdictional wetlands? ❑Yes L�No
Are there any easements or right-of-ways on the site? �Yes C�No
Is the site subject to approval by another public agency? ❑Yes �No
Will wastewater other than domestic sewage be generated? OYes�No
IF RESIDENCE FILL OUT THE BO L W��� ����� � �d���
#People � #Bedrooms #Bathrooms v� Garden Tub/Whirlpool ❑Yes o
� Basement: f�es ❑No Basement Plumbing: ❑Yes 81�0
IF NON-RESIDENCE FILL OUT THE BOX BELOW
Type of FacilityBusiness Total Square Footage of Building #People
#Sinks #Commodes #Showers #Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: #Seats
Typesystemrequested:, L�K;onventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: ❑ County/City Water �1ew Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C�10
If yes,what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any pernut(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if
the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative
of the Davie County Health Department to conduct necessary inspections to deternune compliance with applicable laws and rules.
I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging
or staking the house/facility location,proposed well location and the location of any other amenities.
Site Revisit Charge
Prop owner's or owner's legal representative signature
Date(s):
.b"'- //- (7 7 Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account# �
Revised 11/06 Invoice#
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� ' DAVIE COUNTY HEALTH DEPARTMENT
' _ "~ Environmental Health Section
Soil/Site Evaluation
APPLICANT.INEOR1tiIAT�ON I'RQ�',F�RTY INFORMATION
ccoun . 2— Tax PIN/EH#: 5717-0�9
Billed To: Johnny Walker Subdivision Info:
Reference Name: Location/Address: Mr. Henry Road-270 8
Proposed Facility: Residence Property Size: 8.53 Acres Date Evaluated: cv �� ��
Water Supply: ' On-Site Well � Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position �,,,_ L !"i L
Slope% Z-� 'I „
HORIZON I DEPTH - E-i - .- � _ � - Uj
Texture grou 1< C�L SLL
Consistence S ��' .{ f-�^ SS:
Structure `� �' � ( � s.� �
Mineralo . -L� , , '�i;
HORIZON II DEPTH 4 �- — �
Texture rou � G
Consistence ;�Si/ ` ' �c,`"1�$
Struc[ure /,�,� L �
Mineralo (;,.�C, ItZC, �
HORIZON III DEPTH 1(p-� � 1 - — �20
Texture rou �.Sa C 1 � �+�
Consistence ' ' :VS �;
Structure ' � L M M
_. Mineralo MI k,G► ti =� 1.��?C.
HORIZON IV DEPTH .� -+- • O ,
Texture rou .' � �s.
Consistence � ' r
Structure �'�''�
Mineralo 1'��
SOIL WETNESS — '—
RESTRICTIVE HORIZON (�� �y � '�
SAPROLITE V "'
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
_ SITE CLASSIFICATION: EVALUATION BY: �� r �C-I-�'�,l�'�+�
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:
REMARKS:
LEGEND
i.�ndscape 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
T�xtiu� .
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
.ON I T .N .
�Q1S�
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
�
NS -Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
StructilTg
SC- Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogv
1:1,2:1,Mixed
1Y�
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 OS/OS(Revisedl
� .� � � ' - ' DAVIE COUNTY HEALTH DEPARTMENT '
' • ' Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
��. �� �
WA'.�` g �,
� f
Water Supply: ' On-Site Well }f Community Public
Evaluation By: Auger Boring Pit � Cut
FACTORS 1 2 3 4 5 6 7
Landsca e posi[ion t� ' •
Slope % �
HORIZON I DEPTH � - �-/Z
Texture grou GL� `
Consistence �
S tructure
Mineralo
HORIZON II DEPTH � — - � �
Texture rou � - �
Consistence 1�; , . �
Structure N`�
Mineralo
HORIZON III DEPTH � �p r - �
Texture rou G� �
Consistence /"�- — � -
Structure
Mineralo � � 1�^�
HORIZON IV DEPTH -
Texture rou S p c1. � L
Consistence �'-r �
S tructure • �
Mineralo /�I�t
SOIL WETNESS '— �— --
RESTRICTIVE HORIZON !2
SAPROLITE "
CLASSIFICATION �
LONG-TERM ACCEPTANCE RATE . �
SITE CLASSIFICATION: EVALUATION BY: .�.� �-`\J.�il `�9'V\�
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: U"�� �����`" J
REMARKS:
LEGEND
i,an sc e 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
T�xtur�
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
lYIQiS�
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFT-Extremely firm
�
NS -Non sticky SS - Sligh[ly sticky S -Sticky VS -Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
�tructure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic ,
Mineralo�v '
1:1,2:1,Mixed
LYo�
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 DCHI�(15/O5 (Revi�e�il
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' � ' Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751=8760/Fax(336)751-8786
IMPROVEMENT PERMIT
Account #: 990000742 Tax PIN/EH#: 5717-64-5969
Billed To: Johnny Walker Subdivision Info:
Address: 173 Kelly Avenue Location/Address: Mr. Henry Road-27028
City: Mocksville Property Size: 8.53 Acres
Reference Name: Chad Matthew Sechrest
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to
revocation if site plans,plat or the intended use change.
Pemut Type: ew ORepair ❑Expansion Pernut Valid for: �Years ONo Expiration
Residential Specifications: #Bedrooms3 #Bathrooms Z #People �- Basemexy�8'�3asement plumbing0
Non-Residential Specifcations: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): � Type of Water Supply: ❑County/City�'6Ve11 ❑Community Well
Site Modifications/Pernut Condirions:
S stem T e LTAR
Initial AC�� e-� d,1S'�
Re air /� '�'"� p, �S
Site Plan
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Environmental Health Specialis Date � __
i.p.i 1-06