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AUTHORIZATION NO: Q 9 3 6 DAVIE, COUNTY HEALTH DEPARTMENT
ti ,-�' Environmental Health Section PROPERTY INFORMATION
l P
tee - P.O. Box 848
Names'`° Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760
Directions" to property: ; ?�//'^x�'%J� . Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#576 _ oto
SYSTEM CONSTRUCTION '
Road Name: 70• . Zip: o
**NOTE** 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.
(In'compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH. SPECIALIST _ DATE ISSUED
�M�j ,r!n"Y -rix .r 'r'`+N" +yid" °'fa).2 e.;." +ke.r'k�`°!?"+:w`a,firrli�tFsra .. ¢�'v P.=.v" 'i xr�;r„�t ..,.. as"'i „�'*=. ,t +y,m'it•° ��"`,`7 ,.r�„`i-y ,"�r�`'. 4 .rt:
= 'z° DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Nam JaxF'` 'Subdivision Name
' Directions property: w r°a r-. ,* -Section: Lot:
x✓ IMP OVEME141T .. aar /
PERMIT Tax Office PIN:#y6A- 4 -
d Road Name: 6 Af Zip:
**NOTE** 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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
..• ”, PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEAL I H SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE /i% # BEDROOMS /`.� # BATHS #OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE - r. TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE_kREPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE, � D GAL. PUMP TANK - GAL. TRENCH WIDTH ROCK DEPTH / �. LINEAR'Frx �/
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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) 634-8760.
OPERATION PERMIT ip
STEM INSXALLED BY:
Cp
o,
AUTHORIZATION NO.OPERATION PERMIT BY: DATE:
Sj
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA ,
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section r
P.O. Box 848 EPP—E OAK
�' P
Mocksville, NC 27028 JUN _ 91991
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE P.
THE REQUIRED INFORMATION IS
1. Name to be Billed Vivian A. McKnight
Mailing Address 1351 NC Hwy 801 N.
City/State/Zip Advanre, NC 27006
2. Name on Permit/ATC if Different than Above
Mailing Address
Contact Person Vivian A. McKnight
Home Phone 910-498-8153
Business Phone 910-99g* 4620
City/State/Zip
3. Application For: [ jt Site Evaluation [ ] Improvement Permit & ATC
4. System to Serve: [ 4 House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other
[ ] Both
5. If Residence: # People --L— # Bedrooms 21 # Bathrooms be ] Dishwasher [ ] Garbage Disposal
� ] Washing Machine [ 3 Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type
# Showers # Urinals # Water Coolers
# People #Sinks # Commodes
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: [ l 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?
[X] No
EITHER A PLAT Oft SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AVEAVCOF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION
Property Dimensions: WRITE DIRECTIONS (from ocksville) TO PROPERTY:-
Tax Office PIN: # 5862 - 06 - 5715 Hwy #158 to Farmington Road - right nn
Property Address: Road Name so/ Hwy 801 - 2 ' miles - drive on right
City/Zip Advance, NC 27006 directly across from McKnight Road.
If in Subdivision provide information, as follows: (no name on drive) Go down drive
Name: ; through metal gates, turn left into
Section: Lot#: wooded area at rail fence.
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are
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 nter upon above described property located in Davie County and owned
by Vi
// 1 G,. o—pnduct all test es as cess ary termine the site suitability.
DATE (D '%' %7 SIGNATURE '
Revised DCHD (06-96)
THIS AREA MAY $E USED FOR DRAWING YOUR SITE PLAN:
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME DATE EVALUATED 7 -
PROPOSED
PROPOSED FACILITY Zt PROPERTY SIZE y��c
SUBDIVISION ROAD NAME
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position 'CL -
Slope
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence _
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: ®� /a �� EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: it
C OTHER(S) PRESENT:
REMARKS:
Landscaue 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
Structure
SC - 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 (01-90)
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Parcel #: C600000083
Davie County, NC - Basic Estate Search
Page 1 of 1
vPIZt1A
C tA.
°v.,
Davie County Web Site
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View Property Record for this Parcel View Man for this Parcel View Tax Bill Information
Parcel #: C600000083
Account #:49845000
Owner Information
BXF•
Tax Codes
Land:
CKNIGHT VIVIAN ANN
IMIDVANCE,
Market:
ADVLTAX -COUNTY T1
ssessed:
WILLOW OAK LANE
Deferred:
FIREADVLTAX - FIRE TAXNC
27006
Property Information
Township
Land (Units/Type): 49.500 AC
FARMINGTON
Address: 201 WILLOW OAK LN
Information
Local Zoning
ID��Deed
a�te:085 Book: 00127 Page: 0137
Page:
Le al Description
PIN
9.50 AC HWY 801 OFF
5862065715
Property Values
Buiidin
184,69 01
BXF•
18,56
Land:
27094
Market:
47419
ssessed:
24376
Deferred:
23043
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00127 0137 06 1985 WD Unqualified Vacant 0
>_ 00127 0143 06 1985 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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All information on this site 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 herein was created for the Davie County's internal use. Davie County,
its employees and agents make no warranty 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 merchantability 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=1467549
9/13/2016