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606 Mr Henry Rd �avie County, NC - ' Tax Parcel Report �j �( Monday, October 3, 201 E ,�k f r,.. '.� 'y�"�� I �. � � � � t 'i 4 .i' � � �1 �-'"�- 1� �f.,r �,� ��� ��r I � �`•�t �� 4 � � ���� r_... �� ��k�.:,,,•�-` �� � r �k � , ����'� `��� � y EaE �;�2 -�. 41�.L_ �� � � ���"'`�,. Q ��"--�-_''!_`_ k��k� 1,� �1 ` __- /, -��'��� �� �� /�, E�$� ,k, �k 1i / , k��kt•� _ —� � 4y't� _ �y�-�,."'t�I '� - , : k. � ..........r_.. .............................................. ....................................................._.........................................................................._.............y.. s.._1._.. WARNING: THIS IS NOT A SURVEY �_--..e �-- - _ _�� ��� � _ , , _ a, ... _ ,. � . _ _ _ - __ � -�-- �.�, „ _,�o,. ,. �. , .��.�._ . , _� e �._�e_ _ ,_�. , _ . ._. � ' 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. _ , _ .. . . .. . . .. � Davie County Health Department ��'s�� � Envi.ronmental Health Section . �, ��1, P.O.Box 848 C� �� � ;�, 210 Hospital Street . '' � �. . �; Courier#: 09-40-06 � .�c��.� �J � '' ' , . Mocksville,NC 27028 � ,,� �,, I 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) � I Mailing Address: . � (Work) 6� 'Q � Email Address: Detailed Directions To Site: Property Address: O PL , �71/�,��'l /'� I � —�— 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 ? � Any Known Problems? Yes No If Yes,Explain: � 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: � �} i • �( Requested$y: ' Date Requested: p � ( ' a e) I For Environmental Health Office Use Only Approved � Disapproved Comments: Environmental Health Specialist Date: � I � *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#: � `'. :3 �""�r���- _ " . J �f��,., /� �SQ� ` � � � `�C �1 .�' . F� •-rr v � 04$6 � �:�'y y 2 ��'�C / .. . .. . ._ _.. .. 3;h7t . . �C7 ` _w.�g . .. .. . r.--Y s . �x73 . .__.� •----" '� w �i • ;a }�4°v Gf�7 � �4� 8161 �,, t i jiS .. �; �� , i � _ � qP�t�I �113a is prov e as s w hou warran y or guaran ee o any in�-�ther expresse or imp iea-lncrding 6ut notl�ited to thelmpifetl � �`{�- �.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. I .�' . � � �,��� � 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:��� �. . / , J� �o . Lf��� /2O, /�, l�� ��,� r�� . . �eu. - � � 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 .�'�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: ����� �- l�� '!Zu S . .� � �� �o` L/�`.c� /z 0' �S�' �.,'�� /.s�' ��r . �eu. /'Go� . 7 � DCHD 11/06(Revised) � . . � , � . . 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. . - ;� �-� �� �`�� � � ,�,�+^ � � c � �.__`._.�� ��w.�- -:..._.. _. —� a � 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��� � Z � 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# / . ' , . • • r • ��5��1 . � � � � ,-':�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 1 � ��i�� � J �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. f� � � G�17� r ,�.-�� .-�- � AQ L-- �a ` N`� !�� 1� �� ��� 1 � � ' � n ti .� �' qo , � � 3�s � � �`��' �' � � . � ��� � 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# ____ __ ___ _ —, � � �C9 ; 0 �, � � d � 2 ' � r. '� ', � � 9�l Q- , `3�l � l Q� �O � ` ' ��3 N _ � 1 � � � � � �yg01 � � ��� W � I ' � � -g11 I� 0 � � �/ �,501 � � � � ' ; � � ����� � � �� � r, \ ,� � � aR � � � U � 'I i � `�� � � � o � � � � � � . �h � � � _ �� ! � ,� ; � �o ;, � r � i , � I r' i, Q I � � � � ' ( . „; : .. �c�"g" ...<. , � m ��a � C � ii', �� W �� d � � . -.�...�.. .. .. 97£ � ✓ „.,....b. L£Z �� �� , ,��..-� ' � ,i .. I . � � � � � � � � � iq��'��� ' � I � � ' ���'o E ���i�e ���� ` � i � I ����, ������� , � � � �i � ,t � � � "���"���� ��i��e . � ��. � ���� ��a ��: . '�u1��������ii i a i.,, 'I .� �� .. ���� a� �Y� �I , , � � � i � ... . � . uj I � � G.�i��sw,�..n€ .. .. . �. . � � . 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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 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WALLER °i6� R�F° D.B. 1 1 1 Pg. 858 ��A�° �i ����N s � r� (n � � 1 No Sc�\E U� �/ = T (V � / �� � � � `� Z� �`� .. � � � �y � � b�'�o•R8 ,�p,�' r'7" w w �n N 62y'�0 � � o� � � ��� N v� � �M N � � �y3 � � N �+ .� ��' 0 � ��O�� � �C!� J `P� 5t O a 'y W � v. n �� AREA = 8.037 ACRES � � � a � INCIUDES S.R. t 143 R/W . � - � N —� WILLIAM M. W A L K E R, E T A L ~ � W �``' D.B. 44 Pg. 515 � ^ vi � __--� � fn m .�' � ,� -�~+ w �R��N ��t R SP1kE 6,� p in M .. -_ _ NE � o _ �----_" -/'�p0 _.,- . 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ENTER pF �oq� ����c,�S��i.��.�i�,..+ C 704) 492-S616 . . y� o ��Q�s : ---�` _�; S��L i : S 83•38�36• E ���,� - � r Z • • 122,�p `OJ��t - � ' SOUAF��' � � 52� ' / S��IIG rR��p; � : ';! �"2 �O= * � :;'�,:vp + 1080,62 �> ••"� •��9�,� SUR�cc,��.•0���• 7'pTq� `, • / �� '•......••' Q` .` > � �� ,� �^ �_ 1053.7g •� d: �83-..- 23_Sg� �� �n ; ,+,���������'��j�����,, wh;�e �E f� C� -- �•84 UNMqRkED POfNT CENTEr� pF ROAD �`f8f�{yp — .�. ._„ DANNY L. McGUIRE � RICKY � ' D.B. 'I9') Pg. 379 {` D•B• �. HOWEL� PLAT p�' SURYEY FDR� I.��� �� �69 P9' 642 WILLIA�I M. y�ALKER, ET AL �vlsloNs ��, 1" = 100' �p�� yr. �� yy, MEC � SPM , , AUGUST ?7, t998 GlT BEING t 6.574 ACRES OF THE WILUAM M. WALKER, ET AL PROPERTY 1 00 S� 0 l�� 2�l� 300 (D.B. 44 Pg. 515) LYING IN THE CAIAHALN TOWNSHIP , � , DAVIE C011NTY, NORTH CAROLiNA SCALE IN �EET TAX MAP RE�': L-3, c portion of PARCEL 5 �'"'I"� M� " t 9298-3 , �' . , f � � . . � : �. . : ,, , . . . , ,, .: : , _ .� ' � ' 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 Nb�'� � �A�� �A �----- �3� o �� �?.1�. ��'�`A 1 t� �l-��''� a.t� G� : ��� �,.�- . P� Environmental Health Specialis Date � __ i.p.i 1-06