148 Garden Ln%
,-..._e's.,. DAVIE COUNTY HEALTH DEPARTMENT
Pernuttee's r
Name: ,t �" l lt'i!:e �`e^ i' Environmental Health Section
P.O. Box 848
Pd
PROPERTY INFOR1�iI
Mo
Directions to property: - �*�` Mocksville, NC 27028 Subdivision Name: r
Phone #: 336-751-8760
C., Section: 1� Lot:
AUTHORIZATION FOR ...
.-K _ i Cs (' �, q^( WASTEWATER
Tax
SYSTEM CONSTRUCTION Office {ce PIN:# -
AUTHORIZATION NO: 002030 A
/5-&1
Road Nalme:f! z cl .r 4� rt Zip: .0
Fi
**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 I 1 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
t
RESIDENTIAL SPECIFICATION: BUILDINGTYPE —0 V u'# BEDROOMS 3 # BATHS # OCCUPANTS ` GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
1� QCV-,e
LOT SIZE ' "I TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 4 NEW SITE REPAIR SITE
/ �- 300'
SYSTEM SPECIFICATIONS: TANK SIZE ` GAL. PUMP TANK 1 %` AL. TRENCH WIDTH ROCK DEPTH LINEAR�F)T.
OTHER N (E CU C:"f cd (? `� Io i { , C. , I A i- Is
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
J.
C cmL` k- C)"i �4'`� G u d -e tt g Lt d � � 4 � r r' a J .� tj'l O �AO C L C. cyo -e 5 6 1 W . 5 r- ¢9 V c..
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11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BET)dEVK- 9:30 A.M. 04 TI5-HAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
� � t
SYSTEM INST LED BY:
c ,G (moo o -c( is
t a� d 5 it e 5, dQ
ahC� d 6S`�i�c I iG.-�S
AUTHORIZATION NO. OPERN PERMIT BY: a �.
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
DCIiD 02102 (Revised) j� �] L_ //(! q f!
Owl, V ,
Permittees ', DAVIE COUNTY HEALTH DEPARTMENT Pd
Name: r .l �! �� % ' "� Environmental Health Section PROPERTY INFORI�IA�T�� jg
P.O. Box 848 (( f
Dir6d18ns to property: � � ~> r I "� !� Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760 -
t,+. r �, �A }t' Section: / r `- Lot:'
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# S �� t tt U / � Cr
SYSTEM CONSTRUCTION 1- —
r 1 i,t /,'✓ri r Lit
AUTHORIZATION NO: 0 0 2 .:� � A Road Nami�e:
Zip:
**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 Fonn/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)
fj *-$!,VOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/ /'r��/ '% •--" {' �� :7��� IS VALID FOR A PERIOD OF FIVE YEARS.
r —
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
4� t
RESIDENTIAL SPECIFICATION: BUILDING TYPE — f -r C # BEDROOMS � # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL S',P'tECIFICATION: FACILITY TYPE # PEOPLE T # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
10Cr•� i,�
LOT SIZE ' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
.a.��{ ire 0c,
SYSTEM SPECIFICATIONS: TANK SIZE k I TIAL. -PUMP TANK _-/AL. TRENCH WIDTH ' ROCK DEPTH LINEA/R FT.
j y �� �� W�/rttUC'�GiI
nTHFR (A N U 1 1 C, l C: l C,>c,>,-Cil'-f-. `-, d',) .y I ,C t f I yi C �,
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
'j : � is C �+-� •e '� u, u k (�<.. � `+.`� U r (' C C"t ✓ d it U �j l G C '� C., `i' {' S � � W
4
'����,^a✓� r3 Y1G ��GC�C''C r r<t1'Celt jCI�JSj�)� r ✓'C.
:5 kyl , C , CCY' CGt� 5i s rU c .(
t,)I 1
Lj
F,`
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1 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETW EN8: 0. 9:30 A.M. O THj,DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
/. / r
OPERATION PERMIT
SYSTEM IN LED BY: INN +<'� ! n f S
\�j
0
/ r
vi
fZGtv��•5 r' mss ��, ��'��
�\`'y 1, �^ �r,i �, �1�•G
AUTHORIZATION NO. OPERATION PERMIT BY: w' ^y !��1� l I 5 DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIkED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMSi, BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02/02 (Revised) n((T-i/ /-/I/(l Owl, e 6-3Vq
4
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Pe-K Pj ou.-�� 5
l u q �v�c G r 5—Cn
Water Supply: - On -Site Well
Community
Evaluation By: Auger Boring Pit
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L --
Slope %
HORIZON I DEPTH
Texture groupSG
f^
Consistence
r
Structure
J '
Mineralogyiv
L=
HORIZON II DEPTH
Texture groupr'
Consistence
b r
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:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY: ky' \0' elm'y,f,_
16
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
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 05/05 (Re.visedl
Name of Complainant
Address N2CIO
Y
Complaint
COMPLAINT FORM
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
Date Received 1 Z ^ —0
ut S Received By ZTPc� CCL__
1_ 11'AA �. V Af I t
► ' Y1 a. elephonp r�-.�VJLIS
A,.,1 1AU11 n A ' 1 ,n ni .,n ..n G
um
Person Responsible for Compla
Address —
Directions to Complaint
Date Investigated _
Complaint Justified
Action Taken
tri, k—J to z g U y yrs . r c
Telephone
Investigated By
Complaint Not Justified
Date Environmental Health Staff Signature
(DCHD 1/85)
. Reports
Davie County, NC
Tax Parcel Report
Page 1 of 1
*WARNING: THIS IS NOT A SURVEY!*
Friday, 12/28/2007
This map is prepared for the inventory of
found
NV
real property within this10
g F
jurisdiction, and is compiled from
JIBOWERS THOMAS
recorded deeds, plats, and other public
IBOWERS KAREN H
records and data. Users of this map are
O U N�
hereby notified that the aforementioned
ir
public primary information sources should
MOCKSVILLE
be consulted for verification of the
information contained on this map. The
1127028
County and mapping company assume no
2.140 AC MCCLAMF
ROAD
legal responsibility for the information
2.14000000
contained on this map.
11b20061026
Notes:
1OF06850554
Parcel Number:
IG50000009404
PIN Number:
115840601562
[Account Number:
11000008970000
Listed Owner #1:
JIBOWERS THOMAS
Listed Owner #2:
IBOWERS KAREN H
IMailing Address 1:
11148 GARDEN LN
Mailing Address 2:
ir
it
MOCKSVILLE
State:INC
JZip Code:
1127028
Legal Description:
2.140 AC MCCLAMF
ROAD
crea e:
2.14000000
Deed Date:
11b20061026
Deed Book and Page:
1OF06850554
Plat Book:
Plat Page:
Buildin Value:
1 10620
utbuilding and Extra0
Features Value:
Land Value:
123500
otal Market Value:
34120
otal Assessed Value:
34120
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