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749 Fork Bixby RdDavie County, NC Tax Parcel Report 05 G4 Wednesday, September 28, 2016 IC Davie County, NCimplied WARNING: THIS IS NOTA SURVEY causes of action due to or arising out of the use or inability to use the GIS data provided by this website. Parceflnformatiori'-""-, Parcel Number: 170000009401 Township: Fulton NCPIN Number: 5778265687 Municipality: Account Number: 8304396 Census Tract: 37059-804 Listed Owner 1: RCC ASSETS LLC Voting Precinct: FULTON Mailing Address 1: 765 FORK BIXBY ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27006 Voluntary Ag. District: No Legal Description: 0.858 AC FORK BIXBY RD Fire Response District: FORK Assessed Acreage: 0.78 Elementary School Zone: CORNATZER Deed Date: 5/2001 Middle School Zone: WILLIAM ELLIS Deed Book/ Page: 370950037 Soil Types: WeC,PcB2 Plat Book: Flood Zone: X Plat Page: Watershed Overlay: - Building Value: 113030.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 17150.00 Total Market Value: 130180.00 Total Assessed Value: 130180.00 IC Davie County, NCimplied All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the 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 causes of action due to or arising out of the use or inability to use the GIS data provided by this website. ',,r' A T?•+.jORIZATION NO: .0567 _ DAVIE'COUNTY HEALTH DEPARTMENT 4. ` Environmental Health Section , PROPERTY INFORMATION Pe �`,e' •J• ��_ ,� _ P.O. Box 848 ��i �-—f'o?•": '% j p Name' Mocksville, %v�`� NC 27028 Subdivision Name:. t F Phone #: 704-634-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Ta Office PIN:# �i_ i7 - r) L SYSTEM CONSTRUCTION b Road Name: ip: 00 **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) Ulll-r.'""'" in!" Auln"'All"IN r UK WAJICWAI!!.Kl-V1VJ1KUl-1JUIN C�•�.:,, JO -�'j �-^ IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED -Permittee' 1 DAME` COUNTY HEALTH DEPARTMENT p' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION, •' Subdivision Name: n., Directions to property: r..' Section: Lot: - j IMPROVEMENT , PERMIT1 T Office PIN: # d r. �`r� l �drlt3fy. Road Name: ,,A Zip: 1 0 ut 1 **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 �4 .3 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 0Z Q # BEDROOMS 3 # BATHS 3 # OCCUPANTS 1' GARBAGE DISPOSAL. Y sor No COMMERCCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE (! o � TYPE WATERSUPPLYC-0 DESIGN WASTEWATER FLOW (GPD) �4 NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE � GAL. PUMP TANK GAL. TRENCH WIDTH 31 ROCK DEPTH LINEAR Fr.� 0 U ' REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT F x "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 SYSTEM INSTALLED BY: � •l i �1 n1�" J-) Z � � Ick ©n q� � �l i LIS j rY•� 1��L.. CE -c. t ' NOS t,G�r^• SIT,. s F AUTHORIZATION NO. OPEJtATION PERMIT BY: �c- DATE: 1A-/0- 7 �7 Si) /7UI D " (U/t?PGfT�T-'TIi ,R L ¢}v Gf %� C��L ,Q "THE ISSUANCE OF THIS OPERATION PERMIT SHA LL AT THE SYSTEM DESCRIBED ABOVE AS 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) �C- cGra*k ,o•+• �-�i�J fdL N APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT � �7 Davie County Health Department L/ Environmental Health Section D R O. Box 848 OCT 2 9 1996 Mocksville, NC 27028 IfiJI I (704)634-8760 ***IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED 9 ALL THE R/EQ.UIRED INFORMATION IS PROVIDED. 1. Name to be Billed 1 9 / Contact Person /V-,/ Mailing Address S _S ZS Home Phone s ; City/State/Zip /� �✓�' _ r �"� 7Ze9- Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation EImprovement Permit & ATC 4. System to Serve: 5. If Residence: JdMishwasher Q—House ❑ Mobile Home # People `-t ❑ Business ❑ Industry # Bedrooms '! ©--Both ❑ Other # Bathrooms 3 9 -Garbage Disposal ❑-Washing Machine ❑ Basement/Plumbipg ❑ Basement/No Plumbing 6. If Business/Other: Specify type # Commodes If Foodservice: # Showers # Seats # People # Sinks # Urinals Estimated Water Usage (gallons per day) _ 7. Type of water supply: Ea'county/City ` ❑ Well I 8. Do you anticipaty additions or expansions of the facility this system is intended to.$erve? If ves. what tvne? I I # Water Coolers ❑ Community ❑ Yes Q -'No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. L%_'7 S �'� 5 / T-�- Property Dimensions: + 'Ar2 1 WRITE DIRECTIONS (from Tax Office PIN: # ��7 7� - . � � - . -24i3 � 1 Mocksville) TO PROPERTY: 1 Property Address: Road Name �% t �j /+ tvre-�1 1 270e C 1 L✓ LLk City/Zip 1 _ 1 al- If in Subdivision provide information, as follows: 1 1 Name: 1 Section: Lot #: 1 1 1 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 Departr and owned by ' h fJ r- /�_� Ii lek-� as necessary to determine the site suitability. DATE 201%,, SIGNATURE Revised DCHD (06-96) to enter upon above described property located in Davie County conduct all testing procedures I j -SCALE • -TOWNSHIP- -COUNTY- - STATE - •DATE 1" 2200' FULTON DAVIE N. C. B -I5-85 BEING THE TRACT OF LAND RECORDED IN DEED BOOK 126, PG515 SuRvEYED1 MArr[D1 FRANCIS B. GREENE Jos No. SURVEYING AND MAPPING CO. P.O. box S01 MOCKSVILLE. N.C. 27020 0 W W 0 N W a __fOVNO R OO .. jIRON i 60 SR 1610 RD.--. FORK RD. WIL� SR. 1611 60' R/ W —_ FRANKLIN EDWARD WILLIAMS —ALMA DEED BOOK 4E, PAGE 298 1 ' I 10 o N 89' 30' 43" E --+- 950.41' I4&74� ' OIRON a; IRON PIPE PIPE N'�PK NAIL IN C/L Ir M41 � t11 U IQ ltl Q W cr tib. W o !� AREA = 8.433 �itRES N id O Q cr tD a co W % Tom- lU O In O j i IRON PI �c I 4— - S 89 ° 02'43"W 1069.20' LONNIE BONCE JONES — MARY LOUISE DEED BOOK 309 PAGE 117 "I. CERTIFY THAT ON AL . . WE SURVEYED THE PROPERTY SHOWN ON 1115 PLATT 4 ...:�.:7e...> ... IRON PIPEI PK NAIL IN C/L y 10.9r 1 1 , .. 400 600 III A 11 FOR POTTS REAL ESTATE, INC -SCALE • -TOWNSHIP- -COUNTY- - STATE - •DATE 1" 2200' FULTON DAVIE N. C. B -I5-85 BEING THE TRACT OF LAND RECORDED IN DEED BOOK 126, PG515 SuRvEYED1 MArr[D1 FRANCIS B. GREENE Jos No. SURVEYING AND MAPPING CO. P.O. box S01 MOCKSVILLE. N.C. 27020 DAVIE COUNTY HEALTH DEPARTMENT • 1 Environmental Health Section Soil/Site Evaluation NAME �R A\4 ADDRESS PROPOSED FACIILTY v s I.4Q- 9 - DATE EVALUATED �� 6 PROPERTY SIZE • LA �V� LOCATION OF SITE �`� t"—\<` Water Supply: On -Site Well _ Community Public l/ Evaluation By�-�,l- Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S S' Sloe -0 - I HORIZON I DEPTH Texture groupZ.L Consistence ':�- Structure "�' Mineralogy HORIZON II DEPTH Texture group Consistence Structure Bim. Mineralogy'. HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE — — CLASSIFICATION .S. LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE. 1 —4 REMARKS: DCHD (01-901 EVALUATED BY: OTHER(S) PRESENT:R- 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- V+--. -y friable FR -Friable FI -Finn 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 3C --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 ■■■■■■■.■■■■■M■■■■O■■■■■■■■■■■■■■■■■■■■■ ■MM■■.■■■.M■■ ■■ a ■..■ ■■■■■■■■■■■■Q■■■■■■■■■NM■■■■■■■■■■■EMM■ ■■■■■MMMO■M■■■■■■■EE■■s■■ ■■■M■■■■■■■■ ME■■■■■■■■■■■M■.MM■"■■■■■E■■■■■■■M■■■■E■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■MME■■■■■M■MMMMM ■■■M■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■.■■■■■■■■■■...cS■M■■■■■■■■M■QQQQQMME■■■■M■■■M■■■■■■■■■ ■■■■■.■..■...■■ !!■■.■■■■■■■►.■■...■.■■■■■■.�.■.■■.■■ moms ONSON ME MEMO MEEMEMMM ME ■■■■■.■MiMM■■■■E■■■■■■\■■/1■■■■.■�N■■■Ms■■■■NOM■OM MMMEMEMEMEMEM .E.oMM.■■■...■ ■■■oimm■■■M■■■■■■■■■■■■riiM�■■■■■■■■l/.■.■mN...■�... ■ONE�.■o.NOME ONEmoon ro ON M so PEP ■■■■.■IIM■I/s�\■■■■■■■M.■■■■■MNmsO�M.Eml�l■..M.■■■mM■.O..N■ OMMEME MONOMER= ■■■■■■■11■��■'.■■■■■.■■.■■■■■■■■■■1 ■■■MIS\ANN■■■■.■M■■■MO■ME■EM■■■\1■ ■Mmo■N■I■r�..►1...■...■.....m■l�.■■.■1. ■Q.Mm..\`�.M.N.■■■■■■Q■Q.ONES MEN �� ■■■..■■!1i�'►J■■N■■1�\■.■■■.MMM■IM■■MIIMNMM■NI�MM■.■��.■■ ■ MM■■oMN■ ��■ ■■■.■■■X11■■■■■.■■.■■■■■■■■■/1■■■■��■■MMNIMM.�■.�N■...o■O■■►.%.■m■■ --- _m MEN aONEMMMONO MENQ ■■■M■■■I�fEM■NNII �QQmmQ■NM■N■■NQ ■■■■■■.! . ,■■■.r■■..■■/�...■►�■■..■■��m■f�m■m.t�■■MIEN ■ .■ ■■ ■■■■■■■ .....N.■.I/■NOON■m■MMI/...I,.......I..11\IONm. 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M■ ■r/MN■MM■ MMM ■MM Ell No MEN MMMEMOMM ■ NOW MEMOEN ■■MMI.MIMIEm.■.tiQ�000QQQ%1000QQQQQ./� QQ ■M.OMMOME ■M.■■■■H■■■■�Q�QQQr%QQQQQQQm/ � �Q�■.000QNQ ■NE�NM■ QMM MMEMMEM%QQQQEMQQtI� ME ��Q:•0 NNE m■mQQMMMM■M■MHMMMMMMMIAMMM OQ N�■MIMIHno QQQQQQQQ�■�QQQQQQQQ��Q■�QQQQQQ��MQQQm ..Nm■�.�MEEN Q•NQQ Qi��■�QQ�Q��QQQQQ�Mi�iQQQ��QQ�Q QQQQM ■ ■ MMMOMMOMMEMEM QQQQE QQ ■QQ��QQ N�� QQuQQ��JQQQQ��NQIQ■■ QQQ ■ Q ■EMMM■ .. EME■N E EMENEMENMEN■M■ .. ONE M■ ...■NEMMEM■M■NOM .::::..::.■■QQriR�QQQQQQQ::QQQUNQQ■.■Q ENEM Q■IOQQQQQQQ�QQQQQQQQQ NOMMEMEMEN MOMERENEME momommommommommm :=QQQQQUQQQQQQQQQQQQQQQQQ MOQQQQQQQQQ:QQQQQQQQQ�Q:QQ.�:Q QQQQ:QQQQ':�QQ:000QQQQQQQQQQQQQ .............■................ ..■MMM.■O■■■■■NM.1MM■■MMM■■ME■■■■ •AUT-h'04i2 A TION NO: 0 5 .5 7 DAVIE COUNTY HEALTH DEPARTMENT bra Environmental Health Section PROPERTY INFORMATION Permk&e\t "VTN XV' P.O. Box 848 " Name:.— _NMocksville, NC 27028 Subdivision Name:. Phone #:704-634-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER 417ax Office PIN:# _71 _30ASYSTEMCONSTRUCTION .1 6 L L4)a Road Name: **NOTE** [his Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance off' any Building Permits. This Forn-dAuthorization Number should be presented to the Davie County Building Inspections Office when applying* for Building Permits. (In compliance with Article I I of G.S. Chapter I 30A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATERICTION Co',� A.L IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED '."RESIDENTIAL SPECIFICATION: BUILDING TYPE vyQ #BEDROOMS #BATHS # OCCUPANTS 4 GARBAGE DISPOSAL Ye No COMMERCIAL SPECIFICATION: FACILITY TYPE VPEOPLE— #PEOPLE/SH]IFT— #SEATS INDUSTRIAL WAS Yes. or NO -LOT EZA TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) REPAIR SITE S NEW SITE..e�- GAL PUMP —GAL TRENCH WI SYSTEM SPECIFICATIONS: TANK SIZE DTH ROCK DEPTH LINEAR Fr. OTHER -.,REQUIRED SjTe.1MQDIFICA77ONS/CONDMONS: **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR. FINAL INSPECTION OF THIS SYSTEM BETWEEN 00 - 9:30 A.M. OR-I;P0.- 1,30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE IS (704) 63478760.. OPERA31ON p3 PERMITo 41 SYSTEMINST tD t tic, jq%� J- VC r4 NZI, in �� �` J EPP - *i7ifflISSUANCE OF_THIS UPE WEATION PERMIT SHALL INDICATE T1JAT`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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME IXHD 051% (Revind) _?7 '•�AU•ThD412 ATION NO: 0 5 6 7 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permh ae' % � -, \ _ Y .� P.O. Box 848 Name: N\1 d�4>�C� � ��k�'� Mocksville, NC 27028 Subdivision Name:. �L_ Phone #: 704-634-8760 Directions to property: �� t4c� o r %— Section: Lot: { AUTHORIZATION FOR WASTEWATER_ �• � '`'�'�" SYSTEM CONSTRUCTION y.qrii'ax Office PIN:# l�} +��a��.t^J' R� i Z Road Name: To t' Zip; (A **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Sectio,I prior to issuance ot-any Building Permits. This Forni/Authorization Number should be presented to the Davie CountyBuilding Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 1.30A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWkTER CO"i� n. \.g. - o`'�ac . �•_ �b ' �'^ _ IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ' 'RESIDENTIAL SPECIFICATION: BUILDING TYPE + 0$2 # BEDROOMS 3 # BATH # OCCUPANTS 4_ GARBAGE DISPOSAL Ye or No COMMERCIA:. SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE,: Yes or No LOT SIZE_ TYPE WATER SUPPLY Q DESIGN WASTEWATER FLOW (GPD) NEW*= I` REPAIR SITE ' SYSTEM SPECIFICATIONS: TANK SIZEI`.��' 'GAL. PUMP TANK GAL TRENCH WIDTH ROCK DEPTH_ LINEAR FT.;, _ ;:' 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.IP -1;30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (7(4) 634-8760.. OPERA31 OPE RMS f s6 + 0Z lD ry ;1 40 0.q to T f - SYSTEM INST C � lr \� T � U C N **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THATTHE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COUPLIANCE 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) r2,—t-q7 ' �AU•ThDRI2 AT1ON NO: 0567 DAVIE COUNTY HEALTH DEPARTMENT 60 Environmental Health Section . PROPERTY INFORMATION Permh:Le' .� � \ ^', � l P.O. Box 848 Name: �� d adt�V ��` ti'+' Mocksville, NC 27028 Subdivision Name:. Phone #. 704-634-8760 Directions to property: i,� �r` C' o r�.%. Section: Lot: AUTHORIZATION FOR WASTEWATERL rt '.�j - �� ,�. r � ,�z, '•. -v,. �g4raxOffice PIN:# - -�', - ! e SYSTEM CONSTRUCTION -1*9 ,Kb LAM,. Road Name: e t' '. 'Zip; o **NOTE** Ibis Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Sectio,i prior to issuance of any Building Permits. This Fomi/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 1.30A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CO!-,'. I.UCTION �.5),. a '�vr ._� Io ' 3 I'� _ IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ' "RESIDENTIAL SPECIFICATION: BUILDING TYPE 605A # BEDROOMS 3 # BATHS # OCCUPANTS I_}" _ GARBAGE DISPOSAL Ye or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOTSIZE&'A3 TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �� NEW SITE � REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZd(--t0GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR F1736o' OTHER_ i 'REQUIRED SITE MODIFICATIONS/CONDITIONS: " r "*CONTACT A REPRESENTATIVE OF THE DAVIE.COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 -. 9:30 A.M. OR.I X -1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760... ' OPERA ON PERMIT, jA it `A >61, DO 00667 NO. SYSTEM INST e-5� in WIN **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT'THB 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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAMSFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) C APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT ��7 • ' Davie County Health Department IE ow R Environmental Health Section D P. O. Box 848 ! OCT ger,`} Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEDLUN16EB ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed '� J a I - r Contact Person Mailing AddressS , Home Phone City/State/Zip Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 4. System to Serve: 5. If Residence: .B -Dishwasher 6. If Business/Other: # Commodes If Foodservice: ❑ Site Evaluation •@—House ❑ Mobile Home # People L) 2 -Garbage Disposal Specify type _ # Showers # Seats City/State/Zip &I -Improvement Permit & ATC ❑ Business ❑ Industry # Bedrooms ': ❑ Other # Bathrooms Both ❑- Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals Estimated Water Usage (gallons per day) # Water Coolers 7. Type of water supply: ®�ounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Q --No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 7, y3 nf�P rP S 1 WRITE DIRECTIONS (from Tax Office PIN: # 3 1 Z Mocksville) TO PROPERTY: X52 1 Ae -A A 1 Property Address: Road Name I w'—e— 1 / i City/Zip i l/ w 1 YAC _ %% j ;;�� ,� 4 :4 If in Subdivision provide information, as follows: 1 /"� o4�Q _21 ; _ Name: 1 Section: Lot #: 1 1 s 1 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 and owned by _2� V)4 '4 e/ov LQJ as necessary to determine the site suitability. DATE �C) ' l.�rY' X91 SIGNATURE Revised DCHD (06-96) to enter upon above described property located in Davie County conduct all testing procedures ,,,1111111,I,f,, � SEAL: 9 Vol L-1761 = w it .• YSON ffffII111111>>, ,•,,} 'I. CERTIFY THAT ON , • , WE SURVEYED THE PROPERTY SHOWN ON •4IS PLATT 0. .. 400 ... �O�rout, `+ IRO N F o 3 60 1610 •R�.. ! AMS RD FORK RD. W1LL1 SR. 1611 60' R/W FRANKLIN EDWARD WILLIAMS —ALMA j I DEED BOOK 4E • PAGE 298 I o N 89° 30' 43" E --',- 950.41' 14a'?41 IRON PIPE IRON PIPE N� PK NAIL IN C/L 1_ "' f t V 9 Q w a ti. k W —� — !*� --AREA = 8.433 ACRES - i� cc a r0 e 2V o M ' W C s � a C m i IRON PIPE IRO N PIPEI PK NAIL IN C/L :E Ix S 89 ° 02'43" W 1069.20' 10.9 f LONNIE SONCE JONES — MARY LOUISE DEED BOOK 509 PAGE 117 I . ,,,1111111,I,f,, � SEAL: 9 Vol L-1761 = w it .• YSON ffffII111111>>, ,•,,} 'I. CERTIFY THAT ON , • , WE SURVEYED THE PROPERTY SHOWN ON •4IS PLATT 0. .. 400 ... • DAVIE COUNTY HEALTH DEPARTMENT 3 4 • ` Environmental Health Section .S LJ 11r, Soil/Site Evaluation HORIZON I DEPTH NAME '7 i�1J �- (�� l ,p \ A `Ail 1 > U JZ DATE EVALUATED In i ` 7l ADDRESS S A e PROPERTY SIZE F Structure y � O k PROPOSED FACIILTY n U s� LOCATION OF SITE 4:0, 14:L" Texture group (I°L Water Supply: On -Site Well Community Public Evaluation By: C F.L Auger Boring V Pit Cut FACTORS 1 2 3 4 Landscape position S .S Sloe Z 11r, HORIZON I DEPTH So IN Texture group Q. L. L Consistence T F Structure Mineralogy l 1"t 1 HORIZON II DEPTH 4:0, 14:L" Texture group (I°L Consistence FTa Structure G V1— Mineralo Mineralogy ',1 I HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S5 S RESTRICTIVE HORIZON -'— SAPROLITE �-- CLASSIFICATION • S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION:S EVALUATED BY: Q:9"e� LONG-TERM ACCEPTANCE RATE: �C OTHER(S) PRESENT: OWL REMARKS:_ LEGE 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- V+:. -y 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 3C --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(01-901 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■M■■M■MOMM■■■■■■ M■ /■■■ NOON/■■■■■■■ /■■■■■//■■■■■■■■/■■�■■■/■■■■■■■■■■■■■■■■■■■■/NOON■■■ ■■■■■■■■■■■■■■■■■/■/NOON■/■■/■■■■■■■■■/■ ■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■It■YI■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■NMN■■■■■■■■■ ■■■■■■■■■■■■■/■YIN■■■■■■■■■■■■■■■■■■!M■■■■■■■■■■■■■■� ■■■■■■■■■■■■■ ■■■//NOON■■■■I■■■I■■■■■■■■■■■■■/■■ ON■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■!■■■■■■■■ I■■.■■■■■■■■ ■■■■■■■■■■■■■■■■■■■_■■■:_■■■■_■■■■■■■■ ■■■■■■■■■■■R■!r�■I■M7■■■■■!■■ ■®!'�C=!!■!■■■■■■■■■■■ NOON NOON ■N!■■■!N NOON■■■ONO■(►' ■■gill!\i1i■■!■■■■■■■O■■■■■O■■O■O ■NN ■s■ ■■N ■■■NON ■■ ■■■■■■■■■■■��■■��■■■i■NN■a■■■■■■■■■■■■■■■■'!■■s ■ I:■N■�■!■■■■N9■■ ■■■■N■■■■■!■■. ■■i■■■i■M■■■■■■■■■■■■■■■■■!■■■��■■■■■ ■■■N■■■!■■M■■■■■ OMEN No NOON■!■■■■■■■■■■■■a■■■■■i::�--- ■■�■!■M■■MNNN■■ M■■■N■■■■■■■N■ ■■■■■■■■■■■■i�_�t■■■■■■■■11■■■■■■N!�= :l■!■■■ ■■.■■■ ■N■■■ ■ NOON■■ ■■■■OO■■■O■■■IOO\ll■■■■■■■■YIN■■■■!■■■ ■ 1M■■■■■sO�NM■N■■O■sO�iOM■OO=: ■■■■■■NOON■■■i■■e:::�==����■■>,n■■■■■ ■■u■■■■■■■� ■■■!■�■■■M■! ■■■�_ ■ mom ME ■■■NOON■■■/■It■■!■/NOON■■/1■■/NOON ■■■■N■■ �IO�NM■NO■■MMM■■■■■■■ ■■■■■■■■■■■■!�■NOON■■■H■11■■■■■■■■■■■/■■■■■■■■ ■ M■■■ N■■■■■■■■N■ ■■■■■■■■■■!■■■■O■■■■■■NIS/■■■■!■■�//�■OH■■■■■■H ■N■ M■■ ■NN■■■ :ssisis:s::::ss�::ss::��s:i:�sis:s:s::uiY�:�i:: ■ ■s:::■sN:isssi:i ■■■!!■■■■■■■■■■.■■■!■■I■! ■!!r!■r� ■■■!N■■N■u�H■■■■■N:■■■■■■■■ ■■H■■■■NOON■!!\\■■■■OY7�1■I►If1►J!'�O: !■■!N■MO■O■ NOO ■■O NOON!■■ ■::: i :::N■�i■i:ii� N■ :MEMOMM �IMENME■N ■!■■■■■!■■■■■■■■■■■■Ye`// OrJO■%■■■i.'*7 ■ mmomo NOON ■ F ■■■u■■■■■■: M so M MI d::::::s:::i:::::■i ea■i■■NN■■M■■Y�m■■ ■ M MEMO ■ u� u■■ ■ ■■■■■: MEMMOMMMEMEME MEMEiiIM=■■■■NI■■■■ ■u.■ ■■i:"i■■■■O■ NOON■ NOON ■■!■ NOON■■ ' ■■■■■NOON■N■■■!■■■■■■H■O:■!■■■!■■■■■ ■ss::l:::ssoNO ■■■■■■■NOONNMHO■■■MOOOOHN■!■NNO■NOON NN ■■■■■NOON■■■N■■■■■■■■■■■■■■■■■■■NM■N ON ■■■■■■■■ ■■■■O■■MEMMORM■■■■NN■■■■N■■■■■■■ NME No � mommommm ■ HO I■ M!■!O ■■ MINMEMEMMOMMEMME ............ ■u■NHO ..■ ... 0HOMEMEMERM ME::■M■ MMUMMEMI ■■■■■■■■■MNMOlOOOMO!lOOMOOOOOO ■ ■ j MEMNON ■■■NON ■■MM■MMMM■MOMSEE■MOMMMNMMM:NOME ssN ■: 1■L�� tIHOM■N FAMMEMME ■■■■■■■NOS■■ : q:::s:::ss� �> ■ Ems M■MNON ■■■■!NOO■■■ N OMMmSEEM =NNO ` ::� :s:::moMEMMMCC . :lMUMMEMUM ■ , ONE■■■■■■■■■■■■■■!■■■NM■M■M■■■■■■■■ ■ Ms::iM■■M ■■■■■OOOONOON■OO■■OOOOO■■■■■OO■!OM■ H MMY■OM ■■OOOO■■■■■■O■■■■■■■N■■■■■NO■OO�■■■ MEMO !■■ ■■N■■■■■■■■■i::►��1\■■■■■■■■■■■■■ MOM M■MOMM■M■■ ■■_■■■■!■NH_��a!�.iwi■■■■■■■■■■■�ONOOO u■■■■N■■■!■I :s■:: ■/::NN■►/NtSOMMEMENI:::s:::s•• • ••■H ■N■■■N ■N■■■ ■■■■OY.1O■�1`II■■■■■:OO■■■MOO . . . 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