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158 Sand Clay Ln (� i� � t� i. _ �Y.� 4't;' E Y`YC��i'f l 4 �.YC ,..1 '�^i� �bL�'(i,>�{i��'�F'r f !T}r:^f., I� .4•'��',��h."r �'�' l rY S�.r^�N,nw �I;T�'#P"�4;'i! .��r A�'f Fr ' 1 „a4�\ yc Y i�.�r•'n��. .: 'y%'O" . � -AUT�RIZAT�ON NO: Q$2� DAVIE_COUNTY HEALTH DEPARTMENT � �'�{ Environmental Health Section PROPERTY INFORMATION ' � , f��e�uttee's`� / � /� _ P.O.'Box 848 � � 'Name: l,�hh � �tg2-1� `` , Mocksville,"NC 27028-� " Subdivision Name: ' .Phone'#:704-634-8760 ' Directions to property: l��`l`-�'./� - : � Section: ' Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#'��� GS�, _ .�.�,��._.. SYSTEM CONSTRUCTION ��b � Road Name: �f')���"V ' Zip:_�'�r v�� • � **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County:Environmental Health Section prior" to issuance of any Building Pemuts:This Form/Autfiorization Number should be presenfed to the Davie County Building Inspections ` Office when applying for Building Pernuts:`. (In compliance with Article 11 of C3.S.Chapter 130A,Wastewater Systems;Section,1900 Sewage Treatment and Disposal Systems) � '; . ***N01'ICE***TIIIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ;;��� -^'d.� �-��- '`� IS VALID FOR A PERTOD OF FIVE YEARS.:. - ENVIRONMENTAL HE LTH SPECIALIST - ' DATE ISSUED " - . _ _ _ �.�,.w"Y=fy1 '�3: ,? Yr `w " _. �� .,—, .`t:i'�*_j �,_ .�yr. •;� ��-y. .=a;�_�:�.aa ..y�a�-^�i .> .. —rss..�•t rfi�l`"���F� •tn•;�' ' • .,x �c;^��;yi, . _��:�,..�y. F � \ !� �.�. ,.�: . .. . . , . -. . . . _ . ' DAVIE COUNTY HEALTH DEPARTMENT � _.�„�,' -rir� , , '��' � •r � ' � � IMPROVEMENT AND OPERATION PERNIITS PROPERTY INFORMATION ' �u �. .�,���, � �" - '� ,�`��,' __f t � .�_ ... . , � , ,:l�lame°_;a-,. �;;���dl. Subdivision Name: J. --y. •'�.: �, •-�.:�. .�_ . . . ;. - . � . .. . _ . � . . � . . .� _ . ' . _�� . . , .,. . � .. . . . . . . D'uections to property: C! �°;�:�^'� Section: Lot: ; IlVIPROVEMENT : �.,�,.b ,r � . PERMTI' Tax Office PIN:#�r::�''fi' C�r..7; _ �R����- •:. � . � w . . . � .� �� � � � ��, Ci ,�� : 1 � �J� �Q-�U (J� Road Name'`-_����'�r • Zip: r �� fk y ��Y�.'� . � � . . .. .. ' . ' . !j; **NOTE**This Improvement Pemut DOFS NOT authorize the construction ar installation of a septic tanlc system or any wastewater system.An : ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION mast be obtained from this Department prior to the constcuction/installation of a system or the issuance of a building pemuL (In compliance with Article 11 of G:S.Chapter 130A,Wastewater Systems,Secfion.1900 Sewage Treatment and Disposal Systems) M1;,.1 ,,` _..,, ,,,,,,. *,•*NOTICE*#*THIS PERMIT IS SUBJECT TO REVOCATION IF S1TE _�'�'1 r%t''.��:;,� .''``';��:��:� �," '.f� 'i�� PLANS OR Tf�IlVTENDED USE CHANGE.YOUR WASTEWATER , ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR ML1ST SEE THIS PERMTI'BEFORE , INSTALLING THE SYSTEM. �RESIDENTIAL SPECIFICAT'ION:BUII.,DING TYPE�f�' #BEDROOMS s'� #BATHS .� #OCCUPANfS "r+� GARBAGE DISPOSAL:Yes or No � COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLFISHIFT #SEATS INDUSTRIAL WASTE:Yes or No I LOT SIZE TYPE WATER SUPPLY ( �/ DESIGN WASTEWATER FLOW(GPD) �J�a� NEW SITE "� REPAII2 SITE SYSTEM SPECIFICATIONS: TANK SIZE dD!)GAL. PUMP TANK GAL. TRENCH WIDTH ���� ROCK DEPTH� LINEAR FT.� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ' . � � �°�tS%,�3":�� S _ i � � � � � �� '*CONTAGT A REPRESENTATIVE OF Tf�DA�COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BET'WEEN 830-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. OPERATION PERMTf SYSTEM INSTALLED BY: � ����� � � �o,��'`g '' H � b AUTHORIZATION NO.��OPERATION PERMIT BY: ��Cl� DATE: �'��fl'��"� **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT Tf�SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECITON.1900"SEWAGE 1REATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT TI-IE SYSTEM WII,L FUNCTION SATISFACTORII,Y FOR ANY GIVEN PERIOD OF TIIvIE. DCHD OS/96(Revised) . ' � S • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE IT �- A'r[' , Q� ' Davie County Health Department � � � � � '� � , �" ', (} .��'� , � Environmental Health Sechon ��. ' � P.O. Box 848 �,� , � APR � 8 1997 Mocksville,NC 27028 , � � j (704) 634-8760 � M ! �wv'ao°avi aa���;'�°� , . '�*'�'�IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL ; THE REQUIRED INFORMATION IS PROVIDED. � ` � ,,! 1. Name to be Billed � �� Contact Person �v h 1� 1-�� ��l U��,+�.-. . Mailing Address �0 � � � � � Home Phone � 9 0� ' 7�� � City/State/Zip � a �'_ �� � �I��� . /U � e' `��Q��Business Phone " 2. Name on PermidATC if Different than Above ; � � Mailing Address City/State/Zip 1 3. Application For: [ ite Evaluation [ ]Improvement Permit&ATC [ ]Both � 4. System to Serve: [ ]House [ obile Home ( ]Business [ ]Industry [ ] Other , 5. If Residence: #People_� #Bedrooms�_ #Bathrooms �-- [ ishwasher[ ]Gazbage Disposal [✓J"�Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing ' 6. If Business/Other:Specify type #People #Sinks #Commodes � #Showers #Urinals #Water Coolers ; If Foodservice:#Seats Estimated Water Usage(gallons per day) , ; 7. Type of water supply: [ County/City [ ]Well [ ]Community � 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [� ! If yes,what type? - ' EITHEIZ A PL�IT OR SIZE P1AN PROPERTY INFORMATION REQUIItED:***IMPORTANT***A�OF THE PROPERTY MUST BE ; y SUBMITTED WITH T APPLICATION. t ' I � t Property Dimensions: I�/ ��" � � � � �WRITE DIRECTIONS(from ocksville)TO PROPERTY: Tax O�ce PIN: # 5 7� d 2 - 3�s S ! � '� �/°�'i� Er (�U C'S Z�� !�7' � °�-Yl ��/' Property Address: Road Name�p T� � �('a.U t'�� �1!f — i �+ � " U� ; City/Zip ��C kS 1�/I� �70�i 0 ; t 21 �. t�.. �� ; � i If in Subdivision provide information,as follows: � r'� Y'i � � � , � Name: � � � Section• Lot#• � , , � • This is to certify that the information provided is conect to the best of my knowledge.I understand that any pertnit(s)issued hereafter aze subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or i changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized ; Representative of the Davie County Health Department to e on above described property located in Davie County and owned � � by to d 11 tes i g procedures as ary t determine the site suitability. , � � DATE �— �� g� SIG ATURE Revised DCHD(06-96) , THIS AKEA �11AJ $E USEb �'OR bRtt► NG JOUIt SZTE PLtN: ' c A r o ��� e�f� /�a h1 e. /I3$ l� � Sl GtJ.�-s� . � p�-�..�? �.�, � ;, � �___._�. ..:� �„Z�� --' �da._,----.."'"- �, o���n�...� �y 1 �`�� i9�pY � c�,�.r e.� + � 3, 4-� �`� wd� � + � ; `= ��._ -� ,�h �S �.� �:_'— l,cl � y�e,�.� � �+�v� �Ira. � � � �✓� � r�v; tt ��-r k- h e`�o v� e.. w �.. . ��� . �,�. ..IL � � S �q�� Y" `� C�o s � v n l� � t � � `� � J.� � �� � K � � .�T`,+nr�� `S' l4 � i�I'�„"'%k'�JHl`�-c ? � T,i,Y�'� �.c.�,� f J� �.�. . . :i.;� �yi�k J �'�:(.�tytl�Ce �� '�: �"��w,: �y, `b�' N� t0 � O:�,7„ � Y, � Ia�r1 � ,.� '74 t �' 4Y� : "S�1�' >Fs�4 2 9 7.. 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' � uF Z:. � �t. . -,FF'tx� v t 1-�� �.�y;y� ( 9 � 2 ` �e 'E'i�'i�'s.�F�:�d�3 z a#""r,c 1 •n+ . � ' . t fi J ,- a . -- . � .. �'' r i �'A�s� �i;t *' e �" ��39A�. � . �- _ �3o�'a / . - ''��.? �`' . . , s�' ��.' �. , . .sx.- :�:"�,...k�.r.:ssB; ,F a. ,.... , __ .,r-:.. .r�,.» .. 31�.._ •.. Yi35m �. _ .a' ,:.T� M�.a,. ::'e6l�A+ A'A , • � DAVIE COUNTY HEALTH DEPARTMENT �. ,• - � � Environmental Health Section SECTION LOT SoiUSite Evaluation . APPLICANT'S NAME D �//�dM'� DATE EVALUATED �/J�9� PROPOSED FACILITY I�'l/Y' PROPERTY SIZE ��A"� - SUBDIVISION ROAD NAME �,�, � G(/� Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition ,C., Slo e% 2 HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEP'TH y�'�- '�1p r Texture rou Consistence � , SWcture J� S�// Mineralo ; / /,'/ HORIZON III DEP'TH Texture rou Consistence Structure Mineralo HORIZON IV DEP'TH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , �( , SITE CLASSIFICATION: �� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: REMARKS: LEGEND Landscane 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-Saady clay loam ' SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic • Mineraloev . 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-gaUday/ft2 DCHD(01-90) ■�■������■■�■�■■��■��■■�■■■������������■���■■�■■��■■■�����■■■■�i�■ ■■■���■��■■���■��■■��■��■■■�■��■■��■■■■■■�■■■�■���■■��■���■�■■■■�■ 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H300000072 Account#:46618000 Owner Information Tax Codes YERLY CAROLYN LATHAM ADVLTAX-COUNTY T 158 SAND CLAY LANE READVLTAX-FIRE TAX OCKSVILLE NC 27028 Pro e Information Townshi nd(Unfts/Type): 11.230 AC CALAHALN ddress: 158 SAND CLAY LN Deed Information Locai Zonin ate: 01/1900 Book: Page: lat Book: Pa e: Le al Descri tion PIN 11.22 AC HWY 64 OFF 5729023355 Pro e Values Buildin : 40 29 BXF• Land• 61 31 Market• 101 60 ssessed: 101 60 eferred: Sales Information No Sales Data found. View Pro�ertv Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search All informatlon on this s(te 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 hereln was created for the Davie County's (nternal use. Davie County, its employees and agents make no warcanty 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 inerchantability 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=1461264 7/12/2016