376 Village Rd�
Davie Countv. NC
Tax Parcel Rennrt
Tuesdav. October 1 l. 2016
Parcel Number:
NCPIN Number:
Account Number.
Listed Owner 1:
Mailing Address 1:
City: MOCKSVILLE
State:
WARNING: Ttll51S NU"1' A SUIZV�Y
Parcel Information
K10000001402A Township:
4797951043 Municipality:
80008000 Census Tract:
WILSON CEOLA Voting Precinct:
376 VILLAGE ROAD Planning Jurisdiction:
Zoning Class:
NC Zoning Overlay:
Zip Code: 2702&8474 Voluntary Ag. District:
Legal Description: 1.000 AC VILLAGE RD Fire Response District:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Totai Assessed Value:
�9�—�--��'�' Davie County,
�a� �� NC
0.75 Elementary School Zone:
2/1994 Middle School Zone:
001720818 Soii Types:
Flood Zone:
Watershed Overlay:
0.00 Outbuilding 8� Eutra
Freatures Value:
14810.00 Total Market Value:
23810.00
Calahaln
37059-801
SOUTH CALAHALN
Davie County
DAVIE COUNTY R-A
COUNTY LINE
COOLEEMEE
SOUTH DAVIE
PcC2,CeB2
DAVIE COUNTY
23810.�0
No
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�_ ' a 'FY. e.+ 1 . „
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AUTHORIZATIQN NO: O 6 3%' DA`VIE COUNTY HEALTH DEPARTMENT
' � Environmental Health Section PROPERTY INFORMATION
. Permittee's,,.� P.O. Box 848
Name: �! (�O�Q �I�/�✓� ./"���� / f Mocksville, NC 27028 Subdivision Name:
� Phone #: 704-634-8760
Directions to property: !/' �:r� .� ,r- ;� Section: Lot:
� i AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# r� �� l� 3
SYSTEM CONSTRUCTION ��—L-L� - � - ��
RoadName:_L�/�'a�.j� �'c�. Zip: � L���
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts. '
(Tn compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
� � / : � „ ; ��,,,� � ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
`�'`i; u<.- �ii. '�-�;�"�, �, � _,��' ij,�: y LS VALID FOR A PERIOD OF FTVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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+� � ' I�A'�IE COUNTY HEALTH DEPARTMENT
-�- �1� �'+ IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
r �QCII11CtP.8' $ • �� / <
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Name: �� ��-�� f r-�l�!'� �.!.f':�i!�i9�;r Subdivision Name•
Directions to property: � #'
IMPROVEMENT
PERMIT
Section: Lot:
Tax Office PIN:# E f'`- r" 6-�` _ t' �,� 'a
Road Name:_�f �1 • ; ._ _R;�_�. _ Ziv: _' ''� �` _ '� �''
**NOTE** This Improvement Pernut 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 pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
` l:� ,, �- ***NOTICE*** TIIIS PERNIIT IS SUBJECT TO REVOCAITON IF STl'E
!: ; ,.,. � , ,,�', �;' :: PLANS OR TI� INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
_ INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUII..DING TYPE j%J �# BEDROOMS �% # BATHS �# OCCUPANTS _� GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILTI'1' TYPE # PEOPLE # PEOPLFISHIFI' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE 1�� f�� ,�TYPE WATER SUPPLY �'��' �� DESIGN WASTEWATER FLOW (GPD) �Ji �� NEW SITE � REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE ��a� GAL. PUMP TANK GAL. TRENCH WIDTH ���"� � ROCK DEPTH � a , LINEAR FI'. � F` `.f �
REQUIRED SITE MODIFICATIONS/CONDITIONS: _
IMPROVEMENT PERMIT LAYOUT
�-�f��r
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- (�
�C .� r i7 •+/ `� !•J f i
N
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 930 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
I OPERATION PERMIT
SYSTEM INSTALLED BY: �'V A�� L pp i j�S
�,�K � i�- �1—I
(r.1 oT a►J S �rC�
N1. ►-10�1�
F
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5 'f- � -7 �
L
AUTHORIZATION NO. ���� OPERATION PERMIT BY: DATE: �Z �I /
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM D CRIBED 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 WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. .
DCHD OS/96 (Revised)
' �,1 �-d'
,�►� r �� . .
`, ��', � Y r � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & �jJ —C �-"�"
�11 � �'D � _�/ Davie County Health Department � � � � �=/ �
� 1� � �,,/ T7"� � Environmental Health Section D
` (i-�`� � �1 ' � . P. O. Box 848 ,�`-
` � �:--.�t: 1
` �1l) ��, � Mocksville, NC 27028 '� 1997
� � `� (704) 634-8760
U'
� '��'�* PORTANT**** THIS APPLICATION CANNOT BE PROCESSED U
ALL THE REQUIRED INFORMATION IS PROVIDED.
1 �n��
1. Name to be Billed 0�� ��"" "� l� Contact Person
b �Mailing Address Home Phone �
City/State/Zip �%����,�(��� � C � � � �� Business Phone
2. Name on PermidATC if Different than Above �%�1�� ('Y�
Mailing Address _
3. Application For:
4. System to Serve:
5. If Residence:
❑ Dishwasher
6. If Business/Other:
# Commodes _
If Foodservice:
❑ Site Evaluation
❑ House � Mobile Home
# People �
❑ Gazbage Disposal
Specify type _
_ # Showers
# Seats
City/State/Zip
�' Improvement Permit & ATC
❑ Business ❑ Industry 0 Other
�" Both
# Bedrooms � # Bathrooms _�
�Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
7. Type of water supply: ❑ County/City
# People # Sinks
# Urinals
Estimated Water Usage (gallons per day)
�' Well
# Water Coolers
8. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Community
❑ Yes �'No
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
� y A�
Property Dimensions:
i
Tax Office PIN: # r - �S � - �� �� �
I
� 1
', Property Address: Road Name _� r L�� f �
� 1
City/Zip /�DG���� �/ �
1
1
If in Subdivision provide information, as follows: 1
1
Name: �
I
Section: Lot #: �
1
1
WRITE DIRECTIONS (from
Mocksville) TO PROPERTY:
���L/L �P'� f/! -
�.
S� �
,�'�' ,
This is to certify that the infortnation provided is correct to the best of my knowledge. I understand that any permit(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 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 enter upon above described property located in Davie County
... n n E n
and owned by
as necessary to deternune the site suitability.
�;DATE � �� �' 9 � SIGNATURE
Revised DCHD (06-96)
conduct all testing procedures
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� DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
SoiUSite Evaluation
APPLICANT'S NAME ��<S 6�'L
PROPOSED FACILITY /.i`/b`�
SUBDIVISION _ �
Water Supply: On-Site Well Community
Evaluation By: Auger Boring Pit
FACTORS
Slope %a
HORIZON I DEPTH
Texture group
Consistence
Structure
HORIZON II DEPTH
Texture group
Consistence
Structure
HORIZON III DEPTH
Texture group
Consistence
HORIZON IV
Texture group
Consistence
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
1
SITE CLASSIFICATION: �
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (OI-90)
2
DATE EVALUATED `��%
PROPERTY SIZE /Z t�
ROAD NAME %�%����
Public
Cut
3 4 5 6 7
EVALUATION BY:
OTHER(S) PRESENT:
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 clay loam SIL - Silty loam CL - Clay loam SCL - Sandy 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 - Subangular blocky PL - Platy PR - Prismatic
Mineralogv
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of iill - In inches
Restrictive horizon - T'hickness 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
Classifcation - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gallday/ft2
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