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1227 Woodward RdDavie Countv. NC � . ' Tax Parr.el R ennrf Tuesdav. October 11. 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: G40000001101 Township: NCPIN Number: 5830032607 Municipality: Mocksville Account Number: 71456000 Census Tract: 37059-806 Listed Owner 1: STREET AVERY E Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 1227 WOODWARD ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE 2oning Class: DAVIE COUNN R-A State: NC Zoning Overlay: Zip Code: 2702&5864 Voluntary Ag. District: Legal Description: 1.73 AC WOODWARD RD Fire Response District: Assessed Acreage: 1.78 Elementary School Zone: Deed Date: 1/1988 Middle School 2one: Deed Book / Page: 001410585 Soil Types: Plat Book: Flood Zone: Plat Page: Watershed Overlay: Bullding Value: Land Value: Total Assessed Value: 9"�`�' Davie County, °��„�� NC 137230.00 Outbuilding 8� Extra Freatures Value: 23800.00 Total Market Value: 161030.00 WILLIAM R. DAVIE WILLIAM R DAVIE NORTH DAVIE Gn62,EnB DAVIE COUNTY 161030.00 � �� No y, .. �.. ,.._I , i Da�ie County Health Department �P bf� Environmental Health Section �� : � P.O. Box 848 � � ,�,5„ ` � � � � � � 210 Hospital Street O � �'S. :k:� Courier # : 09-40-06 �� OCT � C 2012 ocksville, NC 27028 Plione: (336) - 753 - 6780BY: ��^�T r'*�'T' vJASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection F�: (33G) - 753-1680 Name: ' '� �ti' e - ir�� Phone Number �� ��� 7� (Home) Mailing Address: ��Z� %�(�d [� (��%'L/'1^� � (Work) ���r;/tsu �I /e �I/C 2Zv� Email Address: Detailed Directions To S Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: ���i ,,� �� Type Of Facility:��V/� Date System Installed (Month/Date/Year): � ' Number Of Bedrooms: � Number Of People: � Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? Yes � If Yes, Explain: Please Fill In The Following Information About The NEW Fac ty�� a,z(, Type Of Facility: ��l/Pi iG�GI/�U/��-�' �U��.pa(� lLxs��i Nd er Of Bedrooms: Number of People Pool Size: Size: Other: xRequested B�:— �� �� , � _ --�t��.�r5�- XDate Requested: %� ��� ��z (Signature) , Approved Disapproved Comments: Environmental Health Specialist For Environmental Health Office Use Only Date: 1(% �� �� *The signing of this form by the Environmental Health Staff is�(n 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 #, Paid By Amount:$ Received By: Account #: Invoice #: Date: �} ODE w OS / ��1�5'���� __ �P ��:_ ^ �. . ,��. --,�:'�i:�. ,, , . . DAVIE COlR1TY HERLTH DEPRRTMENT � , � � IMPROVEMENT PERMIT and OPERRTION PERMIT IP�RDVEMENT PERPIIT � ' �N�OTE�� This i�prove�ent per�it DOES NOT authorize the canstruction or installation of a septic tanq syste� or any wasteHater syste�. RN RUTHORIZATIDN FOR IJRSTEfJATEA 5Y5TEM CDNSTRUCTI�1 �ust be obtained fro� this Depart�ent prior to the construction/installation of a syste� ar the issuance of a building per�it. (In co�plian�e with Article i! of 6.5. Chapter 130A, WasteNatar Syste�s, Section .1900 SeNage Treat�ent and Disposal Syste�sl IJRME �'�!/�� ,.� f �CPs ! PflOPERTY RDDRESS `�i�Ji)iJ<'�.'),( �C� rC1— I�'L�._ ." �/�� a�i c} DATE ��i'n.'" LOCRTION �.�I%/JO�Tl.�'/s9'r� SUBDIVISION NRME LOT MA�ER _ SEC./BLDCK NlA�1BER i � RESIDENTRL SPECIFICRTION: BUILDING TYPE ,/�'�d.�{ # BEDROOMS � 1 BpTHS �S t OCCUPRNTS � 6ARBAGE �ISP05f3L: Yes/No COMt�RCI{K. SPECIFICRTION: fRCILITY TYRE 1 PEDPLE � PEDFtE/SHIFT 11 5ERT5 INDUSTAIRL WASTE: Yes/No LOT SIZE �G TYPE WATER S�PI.Y �'C� DE5I6N NRSTEWATER FLON ffPD) ��/1 NEN SITE ii' REPAIR SITE _ SYSTQI 5PEC1fICATIDNS: TAr9( 5I2E � 6AL. F{,R6� TiMBI 6RL. TRENCH WIDTH -3�� ROCN DEPTH /7 J/ LIt�EAR fT. � OT}IER REf�UIRED 5ITE MODIFICATIDMS/CONDITIONS: #+;THIS PERMIT I5 SUBJECT TO REVOCRTION IF SITE PLHN5 OR TNE INTENDEU USE qif�1GE. YOUR IJHSTERI�ATER SYSTEM CONTRRCTOR MUST SEE THIS PEAMIT BffORE INSTALLIN6 THE SVSTEM. - .��a��� IMPRDUEMENT PERMIT BY /'v6'� /f f+FC�1TACT A REPRESENTATIVE OF THE DAVIE (Xri�ITY HEALTH UERFIRTMQtT FOR FINRL INSPECTION OF THIS SVSTEM BETtiIEEN B:30-9:30 A.M. OR 1:�-1:30 P.M. ON THE UHY OF INSTALLRTION. TEtEPHONE i IS 17041 634-8760. OPERATION PERMIT SYSTEM IN5TRLLED BY /� �iG�c.7 j%�J��$Di✓ 0.\\ ur`�`aN'�'• Z`FD� 3-X�� � �t� • I�lc..� w°�'� Rc,•. �:Y-r �.-: F'h�-�� :s �u �ocd�- v�, v+�.c.P �n� `�' }o c„-oss Kio o�t� La.� l�e� -f . �-w^.,t�J � � i�e. �e r-e.l % sr►�' �' L 4�t q� i�� rea-� �.�c) , w I,e-�.�. So, Iv u ,,, � �.s ��..9_ �r-. � .. � � �o � AUTHORIZATION N0. ?}oZQ'l� OGERATION DERMIT BY mTE S ' 6 -9P` - _ __ v +�THE ISSURNCE OF 7HI5 OPERATION PERMIT SHALL INDICRTE T}IAT THE SYSTEM DESCAIBED ABOVE HRS BEEN INSTRLLED IN COMPLIRNCE WITH AATICIE 11 OF G.S. CFI�PTEA 130A, SECTION .1900 "SEWA6E TitEATMENT pND �ISPOSRL SYSTEMS°, BUT SI#iLL IN NO WAY BE TWIEN �.S R l#JARANTEE THRT THE SVSTEM WILL FlINCTION SATI5FACTORILY FOR RNY 6IVEN PERIOD OF TIME. . ,. _ .._, .. ;. ,._.. - ._.._ y✓co ,. � IMPRDVEhIENT F�ERMIT DRVIE CDUNTY HEflLTH DEPARTMENT IMPROVEMENT PERMIT and �EAATION PERMIT +��NDTE�� This i�prave�ent per�it DOES NOT authorize the �onstruction or installation of a septir tank syste� or any NasteNater syste�. RN RUTHORIZATION FOR WRSTEWATER 5Y5TEM CDNSTRUCTIUN �ust be obtained fro� this Depart�ent prior to the construrtion/installation of a syste� or the issuance of a building per�it. (In co�pliance with Article 11 of 6.5. Chapter 13QA, Nastewater Syste�s, 5ection .1900 5ewage Treat�ent and Disposal 5yste�s) NAME �� l/�/'v1 ��t'�i / PRDFERTY ADDRE55 `7��()0�=1�( �Gk_ 1rC�L. !\� •~ � r�� � " DATE '�`i ' , LOCATION �/D/� /�'/A�/� SUBDIVI5IDN I�ME LOT M�IBER 5EC. /BLDp{ M�iBER i � m RESIDEI�ITAL SPECIFIC�TION: BUILDING TYPE /�<:� � BEDR�MS �� BATFIS �3 # OCCIIF'ANTS � 6ARBf�E DISP05Al.: Yes/No CDMMEREIRL 5PECIFICATION: fACILITY TYPE � PEDRLE � PEDF�LE/SHIFT # SEATS INDUSTRIRL NASTE: YeslNo L�T SIZE r ; C TYPE WpTER SUPPLY �'U DE5I6N I�STEWATER FLOW (GPD1 . S�'t'./% NEW SITE � REPAIR SITE 5Y5TEM SPECIFICA7I�IS: TANI( SIIE iY'i� 6AL. WJMP TAhd( 6AL. TRENCH WIDTH ?../� R�K DEPTH ,f_` LII�AR FT. .�:' � OTHER REQUIRED 5ITE MODIFICATIINJS/LXINDITIDNS: ���TNIS PERMIT IS SIIBJECT TO REVOCATI�I IF SITE F'LAN5 OR THE INTENDED 11SE CHANGE. VDUR WpSTEAWATER SYSTEM CONTRACTOR hN1ST 5EE THIS PERMIT BEFORE INSTALLIM6 THE SYSTEM. �����'�' IMPROUEMENT PERMIT 9V /�t�i� /� "��CONTACT A REPRESENTATIVE � THE QAVIE C�1TY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM RETWEEN 8:30-9:38 A.M. OR 1:�-1:30 P.M. ON TF� DAY OF INSTALLATION. TELEPHONE # I5 t7�4I 634-87E@. OPERATION PEAMIT s� SYSTEM INSTALLED BY ��G��� %Yi��Or✓ a�� �'r``'°�`��- Z � o' � �� � v��'� �t; . -p, r-r �; � Fti�` . .s V t.� a�cocQ - v�, v►,,�sP �C,�� . � . cx�ss KZo �.;� �r' �c� 'l.a� ls e � � : 3- w �� i�c. �e . - �e S � r�+ �" 'r1� YYW� L��w �.P-�.�. So, �- � � ' �S ��` i _ AUTHORIZATION N0. ?ja�� OPERATI�1 PE�IT BY DCHD 10/95 DATE S — b "e� p' _- : ` r_- � { 1. . _ �. , � �, . .,;,, wr . .�-�.:..� .. � r • .r k _ r� ���� - . ��v� ' _ '� `�, � 0 Davie County Health Depart�ent ' ENUIRONR9ENTRL HEALTH 5ECTIDN P.n. eox ��s Mocksville, N.C. 2702b AUTHDRIZATIOi! FOR WASTEWRTER SYSTEM CONSTRUCTIQ! fIssued in co�plianre with Article 11 of G.S. Ghapter 1s0A, Wastewater Systeis) �6 .�s�"�� ���,� � _--------=— +��*This Rutharization For Waste►+ater 5yste� Construction �ust be issued by the Davie County Environ�ental Health 5ection prior to issuance of any Building Per�its. This For�/Ruthorizatian Nu�ber should t,e presented to the Davie County Building Inspections Offire when applying for Building Per�its.+�� ,� � AUTFDRIZATION t�ER NAME �,�7t,'r.''�` v� �,/lP�' � DATE �/-, /�—G'� r',� ° �i � � .', NRME ON IlPR04EMENT PERMIT (If different than above) : SITE LOCATI�N �i�'l,u�/G�' �/_� � COMI�ENiS/CONDITIWS ON AUT}IDRIZRTION TO I:ONSTRUCT I�ASTEWATER SYSTEM ��TICE� TH15 AUTHDRIZATIDN FDR Wfl5 RTER SYSTEM CDN5TRliCTION IS VALIO FDR A GERIOD OF FIVE {5) YEARS. / l/ /�� '�-`� -��,/ � � ENVIRON�ENTAL FfALTH 5P�CIALIST ' DATE DCHD 10/95 • , , , � APPLICATION FOR SITE EVALUATION/IMPROVEMENTS • i Davie County Health Department . Environmentai Health Section P. O. Box 665 Mocksville, NC 27028 �t;� l5 M I t'� � � � � � ��_ M " � ^ F +dr��� 1. Application/Permit Requested By t��ir't��/ C• ��V' r" `e � Mailing Address ��� �� h a l� (� � Home Phone �'f� rl — 7� lr`6'� ��' 3 ��,��� zr�'%1� �, �', � 70� � Business Phone 9��—I��"���3 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation 4. System to Serve: �ouse ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms No. of Bathrooms G Dwelling Dimensions � 2 �� � �eptic Tank Installation Permit ❑ Mobile Home O Place of Public Assembly ❑ Other 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Lavatories No. of Showers No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: ❑ Public C�Private 8. Property Dimensions � 1� 73K 2c, . Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Unknown Section Lot # C�BasemenUPlumbing ❑ BasemenUNo Plumbing C�' Washing Machine [�Dishwasher ❑ Garbage Disposal ❑ Yes G�' No O Communiry *NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: (00 I I�i � . l�• CA�ntF� �I oc�. �- Wocx�wa�cQ �i d • SSf �4� �- � s} b�;�k ho�� o u�. � lx�wa�n) 'i'�,c Z gr�c.iC kiouSes�. PROPERTJ IN�OIZMATZON REQUZIZEb: Tax Of f i ce PIN: # �''g_�/} - D,3 - Z�� C? � PIZOPERZJ Abb1tESS, as follows: Road Name: '�'��.Q����� city: j�yj,��_k�r,' ll _ IVe SU$MZT tl PLAT WZTH THZS APPLICAT20N. Revisions effective October 1� 1995. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. ` � ;O /. /�i9G� � =� ATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: �. I OWN the property. ❑ 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie Coy�?ty He Ith Department to enter upon above described property located in Davie County and owned by � _�' J� e� to conduct all testing procedures as necessary to determin said site's suitability for a ground absorption sewage treatment and disposal system. � � ,L � � � �� � � �� DATE/� —� SIGNATURE pCHD (1/93) � ' � r ' ' � ' ' ' DAVIE COUNTY HEALTH DEPARTMENT . - Environmental Health Section Soil/Site Evaluation NAME S��L� � DATE EVALUATED ���b �� ADDRESS PROPERTY SIZE �e �/IG PROPOSED FACIILTY LOCATION OF SITE �/EJlt�l�i�if� ,�� Water Supply: On-Site Well _ Community Public t� Evaluation By: AugerBoring // Pit Cut Far.TORs 1 2 3 4 S 6 7 � Landsca e osition �- .L. Slo e R HORIZON I DEPTH '- Texture rou Consistence Structure Mineralo HORIZON II DEPTH 3 L�� � r Texture rou � Consistence � Structure C /C Mineralo �, ' / HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON CLaSSIFICATION TANCE RATE SITE CLASSIFICATION: EVALUATED BY: LDNG-TERM ACCEPTANCE RATE: •� OTHER(S) PRESENT: REMARKS: 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 �:lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR- Vc.-y friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Stightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic 5tructure ,iC--Sin�le grain M-Massive CR-Crumb GR-Granular ABK-AnQular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mi nerala�cy 1:1, 2:1, Mixed Notes Eiorizon 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 watef 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/ftz DCHD(01-901 ■�■■■������■■������■���������������e���■ ■��������������■ ■■ !��■ ■��■�������■��■������■N����������■n�����������■ ���■����������■■ ■■������■��� ■���■■������/�������������r������������■��■���■����■ ................................ ......■=�'C..■■■■■■■■.■■...■■..■ ......................................... . ..................... .................................................................. .................................................................. ........................................... ........ ............. ..........................................C........ ............. .................................................... ............. ............................�...�................. .............. ................................ ........■........_.............. ...........................�...................'... �............. ........................... ................... .... ............. ■������\������■■\���������s�■���������■/�■���� ��■�� H �■���■���■ ■����■■���������■�����■���■�������������� �■■ ■ ■ ■�■ ������■ ■■ ■�������������������������_■����������������_ ���_■���������n�ii �� ■��������■■■■����■����■��■ ■■��■����������������� ■��■����■�■■■��� ■���■�����■■���■■������■�■���������■■�■������������������������� ■�����■■��■����������■������■�■ ■��■���N■�■�■��■�������■������■ ■�■�������■��■��■�����■���������■��e�■�������■� ■ ■�����HO����■�� ■���■�■�������■���■���������������■����������■������������■■���■�■ ■■��■����■■����■�����������������■■■ ■H��� �����■ ����� �■�����■ ■■������■����■�■������■■����■����■ ■��■■■■��� ���■�■����■ �■��� � ■�������������������■����������5����■�■■��■�������■�����■�■��■��� ■��■■����������■������������■����������������������� S��■���� ��� ■������n��■��������\�����������������HO��■�u�■�■���������� ■���������■����■■■��������■����■ ����N�� ■ N���������■�\���■ ■���■■��������������aa■����■��■���■�■■�������i�i��■■=■�����■��� � ............................................... ... ...�......� ...............................................�C ��.� ...... � ..............■........................■.....■■ . ......... �����N�������\�����������������������u��������� ���������������� ................................�.......................C........ ■�N�■■���■����■�����■■�■■��■■�� �■��H������ ��N��l� ������� ■����u���������������������■�����r���������■.������� ������� ■■����������������������������■■� ■ ���■ ■ �����■����� ■��■■���������������■■ �������■��� ������ �■�■ ��■��■ ■��������■�■���������■�Nn����■ ■ ■ !_ ■�� ��■�_ ■��■���������■�������■■�\�������Gi���■ N � n����� ������. ��������������������������������� ��� ■ ����������� ■��������■N����������■���I���■��■■��■� ■ ■���■������ ■��■�����������■�������■HI/�■��������� �N��� ����■��� ■�■��■���■������■■�■■����II��������u �� ��■�■��■ ■�����e��■��■n���■�����a�ll�u� ��0■ ■ �■ �N�� �� �����������v�■�■���������11 � v� �� �■■�■��■ :::::::C::::::::::::::��::::::: : :��_:::::�� ................................ ........ ... ............�::.::.::�:::_:� .. 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