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361 Fork Bixby Rdnnt,IP rnl lnh, mr- .. t Tnv Darr -al Ronnrf I ( .I . 4 � IAiea—A— (2--f—k-00 on19 a Parcel'Ioformation`: All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or Parcel Number: J70000009201 Township: Fulton NCPIN Number: 5778210587 Municipality: Account Number: 5193000 Census Tract: 37059-804 Listed Owner 1: BEACH DANA D Voting Precinct: FULTON Mailing Address 1: 1024 BEACH LANE Planning Jurisdiction: Davie County City: YADKINVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27055-8737 Voluntary Ag. District: No Legal Description: 1.05 AC FORK BIXBY RD Fire Response District: FORK Assessed Acreage: 1.05 Elementary School Zone: CORNATZER Deed Date: 6/1992 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 001640031 Soil Types: PcB2 Plat Book: Flood Zone: X Plat Page: Watershed Overlay: WS-IV-P Building Value: 0.00 Outbuilding & Extra 9000.00 Freatures Value: Land Value: 21730.00 Total Market Value: 30730.00 Total Assessed Value: 30730.00 a Davie County, NC All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or °U H� causes of action due to or arising out of the use or inability to use the GIS data provided by this website. , t " DAVIE COUNTY HEALTH D PARTMENT AUTHORIZATION I`1t7: U" J� Environmental Health Section PROPERTY INFORMATION ` , t P.O. Box 848 Permittee's �, Name: i 'I, C\ '�^ �� Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: 4t ` t`' #� Section: Lot: AUTHORIZATION FOR } WASTEWATER . Tax Office PIN:# 1 SYSTEM CONSTRUCTION Road Name 'rC %K 7tyc1', p: **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 FormlAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In complianc"ith Article 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) J ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 411 IS VALIDFOR A PERIOD OF FIVE YEARS. ENV1R ISI N ffCL HEALTH SPECfALIST iSSUED n A DAVIE COUNTY HEALTH D PARTMIENT ------- IMPROVEMENT _ � � ..--. -- -IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Fermis ee's %r. 'l~Name:- - - .; ^,�` i-1 Subdivision Name: Di>< lions tD property: � /-� I "° a :l; Section: IMPROVEMENT Lot: 'i t ;-, i 4,>,4 t PERMIT Tax Office PIN:# - - ., Road NEfinO: t 1 `, �._ ' p. ; ! .Zip: r **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 Articled l 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 ENVIRONME ' r SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE NTAL HEALTH SPECIALIST ATE ISSUED p INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE M 1-1 # BEDROOMS _.�-- # BATHS I # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT / # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY�t--t_`r DESIGN WASTEWATER FLOW (GPD) "`�ry NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZJ U(0 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER 2.- -P1 ',51 ILI E» JTI o 1 , REQUIRED SITE MODIFICATIONS/CONDITIONS: r l�VL G^� 'J-IUV (<<= .� 04--u— IMPROVEMENT PERMIT LAYOUT.:APPFGVED EFFLUa2T FILTERS *RISEIt(S) IF 6" L'ELDU FIMS4ZID GRADE* r_ .4y�T -1 ".+..� i�OT "CONTACT A REPRESENTATIVE OF THE DAV f N EALT TMENT FOR FI L SPE ISN OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. QR 1:00 - 1:30 P. ON THEY OF I TALLATION. TELE O # IS 03j7fi.B9S0; 1 (33L-0 151-8760 OPERATION PERMIT LP 1 40 AUTHORIZATION NO. OPERATION PERMIT BY: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL Ir WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI9 DCHD 05/96 (Revised) r. t t SYSTEM INST ED : 1)ilV 3^ IA ja3 �h- DATE: Z. /OO TE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE AGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A DRILY FOR ANY GIVEN PERIOD OF TIME. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittees = Name: Subdivision Name: Directions to property: Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name: 3 3 d<' " 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 HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. .; RESIDENTIAL SPECIFICATION: BUILDING TYPE rel H # BEDROOMS #BATHS #OCCUPANTS %' GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY—^t ��ty� DESIGN WASTEWATER FLOW (GPD)'��� NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIA Ui Q GAL. PUMP TANK GAL. TRENCH WIDTH (-' ROCK DEPTH 1 r LINEAR FT. •� x OTHER s l : '� ^;T �- t G• +_IT 1 , . , -..` v �� REQUIRED SITE MODIFICATIONS/CONDITIONS:, rs, lhl. t- IMPROVEMENT PERMIT LAYOUT*A;%1pR0VED EFFLUENT FILTERK .41RISER(S) IF 6" PEL010 FINISHED GPPPDE* ......I..: - -- -- lit YnL� "CONTACT A REPRESENTATIVE OF THE DAV T HEALT � TMENT FOR F L SPE ~IiON OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. R 1:00 - 1:30 P. ON TH Y OF I TALLATION. TELE O # IS 9)`7 $§1 I$tGiO.' rk OPERATION PERMIT (,+� SYSTEM INST ED� 1 f 3 V I AUTHORIZATION NO. �w" OPERATION PERMIT BY: / DATE: Z jq)co "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE StEM 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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION /��fG //J t WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT-/ NAME �4��_ ��� C PHONE NUMBER Y'3310! 7&J ADDRESS /6.2 y �eae---4 �SUBDIVISION NAME SUBDIVISION LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED-' NAME SYSTEM INSTALLED UNDE SPECIFY PROBLEMS OCCURRING DATE REQUESTED1/ /1GU INFORMATION TAKEN BY z*00 k.o,J. I , 6 / Z,—, L) 7 -3'6e -"-S' Gr-.r-jE Lu --s Wek.L- lefty loo! ^%, rn�L+� 5 _ 33o 1 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME HONE NUMBER ADDRESS 3(O 1--0 �-I� I�� IX �D SUBDIVISION NAME LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED. ('p►'ila 71 AME SYSTEM INSTALLED UNDER 01 11zTYPE FACILITY V� • 4()'&—e -NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY PECIFY PROBLEM OCCURRING 5)i?A4Gf JCS CA4- DATE REQUESTED & NFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 for all charges incurred from this application. P1 ef1 / a1 ¢ 1 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 Application/Permit Requested By 'h X-� f ►GL �2/QGY) Mailing Address �� 457-� mOClCsylIle 0 C� 67%D �j Home Phone q19 y63- 5630 Business Phone 2. Name on Permit if Different than Above _ 3. Application/Permit for: 4. System to Serve: ❑ House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People - 4 3 No. of Bedrooms _2 No. of Bathrooms ❑ General Evaluation p'Mobile Home ❑ Other Dwelling Dimensions wcpro 1a03' 60 6. If business, industry, place of public assembly, other: Specify type No. of People Served -2 4 3 No. of Commodes No. of Lavatories J No. of Sinks No. of Urinals No. of Water Coolers No. of Showers / Watterr Usage Figures _ 7. Type of water supply: ElPublic Lvl Private 8. Property Dimensions acre-' /l,7oleor AK Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing E'�Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes Z?No ❑ Community "NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: 6y a" 4 Fort' pro 4er ly orl /e7c/- . �/I%ai�6a��� ¢ o -k, e e -I M P'' 74 4 v eNra rr- -S4/0 c�,o�ier �ob.�e �iur1B des/fje G1�/S�r�Cf 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. 6- 18- q.? - ok-,� zeCA DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: P -l. I OWN the property. ❑ 2. 1 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 Af the Davie Co4nty Health Department to enter upon above described property located in Davie County and owned by mai-' dr/7 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (12-90) [ ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �Cz��� DATE EVALUATED ADDRESS PROPERTY SIZED PROPOSED FACIILTY . 23 LOCATION OF SITE Water Supply; Evaluation By On -Site Well Auger Boring Community Pit Public— Cut ublic_Cut FACTORS 1 2 3 4 Landscape position L L L Z_ Slope % x-12-- �/ 4/ L/ HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy A,/ - HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE -- CLASSIFICATION 77T 1 797 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 0 EVALUATED BY: _ /�� C f LONG-TERM REMARKS: DCHD(01-901 TAN E RATE: 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 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 -Finn VFI-Very firm EFI-Extremely firm Vet 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 Mineralopy 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 ■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■.■■n■■■■■■■■■■■■■■■■■■■■�■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■.■■■■.■■■■■■■■■■■■■■RAW■■■■■t1■■■■■■■■■■■■.■■■■■■■■■■■■■ ■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ON mom ■■..■■■.!■■■■■■■■■■■■■■■.■■■..■■�M■.■■.l.■■■■■■■■■■■■■■■■■■■■■ ■■■ ■■.■■■■■..■■0110■■O■OON■■.■■■■■.■ .■■.E■11■■■■■■.■■■■■■■E■.■■■■■..■ ■■■■.■■■■■■■■■■.i.■■■e■■■.■■■■■■.999!■-■='====::::■■■■■■.■■.■■■■C■■■■■■■■ ONEEME EMMOME� ■■■■■■ ■■■■■■ MEMNO■■M■■N MEMNON■■■■■■ ■MEMNON ■■■■■ ■■■.■■■■■■.■■■■.!■■.■■■■11■■■■■■■■■■■■■■■■■■■��■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■..■.■■.■.M■■E■■■.■1.■�■■w■Neo■===■■■.www■■■■■■ .■■■■■■■■■■■■■ ■■■.■■.■■■■■.■//■N■■■■■■■!.N■■■E■..■■■■■■■.�t■■■■■1� No ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■.■■■■■■■■■.■■■■■■■■.■.■■■■■.9.■.■ ommu 1\L■ WM■■E■MM NOME MANSOMMI MMEMAME MWEEM MEMEMEM 0 ON ■.■■■■■■ ■■■ ■■■■■��■■■■■■■■■■■■■■■■■■■■■■■■11■■■.■MI■■■■M■H■MM ■■ ■■■■■■■.■■■■■■■■■■■■■■■■.■■.■■■■ .■■■■■■ .11■■!■■■■■■■■■■MEMO OMEN ■EEEOONN.■OONNM■■.■■■M■N.ONMOO■■N■.00H■M.EO■.■■■N.■O■■■.■N■HO!■E ■■■■NM.■■■■■■.ON■■■■ NNE■■■■■■■■ ■■■■.■ONMEI�N!■.■■■.ENN■■ON■ON■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■■■■O.■■EO■■■■■■■■■■■■N■■■�N■■OO■.O■EOE■.■.M■■■■N.■■■.■■..■ ■■■O■..O■.■■■O.O..OM■O■■.■.EN..■ ■.EEN.E■■E■■■.O■■.NEE■.E■EO■■N.■ r a,' _ • . -.. T��-�. -�.f.....,,.c._.�ti a��..,-:-.:-::r,-v....r +r'�.`�✓.' .-"`t^r:.�' ..y -y'-,- _. �-t.-•eti-••�. `-`_i....y.... __, =.xssxV-,�...;«-J,, Y).y_ � ".-t.r+,�.-,. ,,r'-e_$>.4....,...y •.F ..", �-µe —_ 'fix° 50.0 0 DAVIE COUNTY HEALTH DEPARTMENT l ; p a IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION. *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Rysterns 7 U Permit Number Name t�N Q Date N_ 7169 _ r. Location ��- o x Li 5 r o Os's 'J, e 1 N �. d 8 Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile HomeBusiness __' Speculation �. No. Bedrooms No. Baths — "�` No: in Family _ Garbage Disposal YES ❑ NO ({" Specifications for System: `Auto Dish Washer YES'❑ NO Auto Wash Ma^hine YES NO 5 Type Water Supply a *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. f �. 14 'ra NN � t Improvements permit by`'\* *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 day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by G� Certificate of Completion �\� Date -2S -93 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. - •. r a. '. r L. v DAVIE COUNTY HEALTH DEPARTMENT ) f ; o 6 ',;,IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a x Sanitary Sewage Systems Permit Number Name _ _ Date 7169 Li Locatio Subdivision Name Lot No. Sec. or Block No. I Lot Size House —�— Mobile Home T Business -- Speculation No. Bedrooms No. Baths No. in Family — Garbage Disposal YES ❑ NO ❑ . Specifications for System:.. ; r Auto Dish Washer YES ❑. NO ❑ Auto Wash Ma thine YES EJ NO 1-1_ Type Water Supply __— *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. rTT' a _ c kl- Improvements permit by _--_-- *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 day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by S\�6W\--) Certificate of Completion -" " ' Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. VA- _,�.n � DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME PHONE NUMBER ADDRESS !J �s X yS�\ I SUBDIVISION NAME h e \K-5 a l l a i 1�' LOT # DIRECTIONS TO SITE - I-, ` rl� �� ' A DATE SYSTEM INSTALLED 7 7 NAME SYSTEM INSTALLED UNDER TYPE FACILITY . �4 "- �" NUMBER BEDROOMS !a NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED 3 INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledg Zsndthat I understand I am responsible for all charges Incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT.r�� Rev. 1/93