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250 George Jones RdDavie County~ NC Tax Parcel Report d V 1 b Thursday, September 29, 2016 <. P arc6l In ormation A Parcel Number: 160000001301 Township: Shady Grove NCPIN Number: 5758698329 Municipality: Account Number: 17078620 Census Tract: 37059-804 Listed Owner 1: COOPER VURRALL DELTON III Voting Precinct: WEST SHADY GROVE Mailing Address 1: 250 GEORGE JONES ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 3.022 AC OFF CORNATZER RD Fire Response District: CORNATZER - DULIN Assessed Acreage: 3.02 Elementary School Zone: CORNATZER Deed Date: / Middle School Zone: WILLIAM ELLIS Deed Book / Page: Soil Types: RnC,RnD Plat Book: 11 Flood Zone: Plat Page: 310 Watershed Overlay: DAVIE COUNTY Building Value: 122440.00 Outbuilding & Extra 4680.00 Freatures Value: Land Value: 27330.00 Total Market Value: 154450.00 Total Assessed Value: 154450.00 Davie County, �T l� C All data Is providedas 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 causes of action due to or arising out of the use or Inability to use the GIS data provided by this website. rQ'rr,.-ve2r., t+="x Hra� ='s r�;..t � .,'..;Rrt.,e�i�ryk ri{;,:`K 4: i'F'ae*.F�'P r;t;qui �'`"�• r4'E-;Yrs ,�, '4 'ai�7.'.- J�iti .+'.3 Yrr 'rr :ii'. _^.� 4�}�` � �J�.-a: sa� AUTHORIZATION NO: Q 6 78 DAVIE COUNTY HEALTH DEPARTMENT -I �a Environmental Health Section PROPERTY INFORMATION Permittees' P.O. Box 848 Name:— I Mocksville, NC 27028 Subdivision Name: - � r f Phone #: 704-634-8760 Directions to property: Ci"� L1' f l"--"f!�`'"/' Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Offi e PIN:#:»�0 SYSTEM CONSTRUCTION; e� Road �Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by 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 .�rGG'� f1' rrr J ✓i/ �J�C IS VALID FOR APERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE I,SSUED t4f'7.ywa " ,Mi•..i ti } >'o,.,:r' t.� 97 i1 i. j•'sa J7.+' r, DAVIE COUNTY HEALTH DEP IT, 9 3a IMPROVEMENT AND OPERATION P99MITS PROPERTY INFORMATION ,,., c�;a . • Vit;. Periiutee's N;me: Subdivision Name: Directions to property: : <.'tt . `l Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:#,,P- Road Name �Y t} k't ,. 7i 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 & # BEDROOMS # BATHS - # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE S�rl� TYPE WATER SUPPLY Ille // DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /ffiGAL. PUMP TANK GAL. TRENCH WIDTH,?,/, ROCK DEPTH LINEAR FT.�„� 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 ` SYSTEM INSTALLED Y: " fi c � M < .2= 6- ----------- SYSTEM �L - G N. J45 AUTHORIZATION NOMM A D OPERATION PERMIT BY: DATE: "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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) o �A� -� APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERM a V E V(� Davie County Health Department Environmental Health Section (7� ; P O. Box 848 FEB - 41997 Mocksville, NC 27028 (704)634-8760 �1 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCES�ED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. n �- 1. Name to be Billed ! r, 9191 Z- f�• C- D D 1% %f � Contact Person - /a � Mailing AddressHome Phone / City/State/Zip Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address A City/State/Zip 3. Application For: bite Evaluation ❑ Improvement Permit & ATC Both 4. System to Serve: W- house ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 3 # Bedrooms _ # Bathrooms f 016ishwasher ❑ Garbage Disposal 8-'—W—ashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City Z -Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 61—No If yes, what type? INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. . Property Dimensions: oc lqC Tax Office PIN: # / S O - & 9 - a Property Address: Road Name c-2 So Q SOJ✓e5 city/zip /YIo ,�' S!/. `J Je D /• C If in Subdivision provide information, as follows: Name: Section: Lot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 'e Cf 0 / C.01W,'H2 X */ �rA% 4-a FAl rl AY,z,L r L,- -Af- '-.ave / 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 to enter upon above described property located in Davie County and owned by L i/I/& -19A eS (-OOR Z !/G���`f�� L 4&er-V to conduct all testing procedures as necessary to determine the site suitability. DATESIGNATURE Revised DCHD (06-96) •'cJ. -AI- i d77 +Ig si ,; n p s, 62,990 i ro X 4 '4711, _ fi� - ° • F '� „` rQl .p `, �; ,.e t s &44t > ,� arts ` ei , k€ + " s,� c n a"r; ` a aw •' Ci' C'`vhi'ar " �1* "Z'40 rxy».��7 ,' , p ,� fl cq sh .� f 'V; •� N �.0 a�.yy{{�� `/tel W i k IV^: d T s ZA e'� r x,x r � ' , "figsaaA y A, f a� 140) it`s".-, � w: � W 8 �` p d i .A� t Yf` >�x�3 Y �°g :� £ f '✓ ,� �, /gyp �! Lam} • y,��/{y� g h 9 61N� sPi n ,+ ykb tea. T i J� l� 33MF' #T i N �Cy Y Y ! i OD 117- 4t Cb ,`Sy _ \ f ���� £LN ` �� .Y,.,�p$.A K.r • r'� b � r,Y. w�+�"�." ' u � �A�+ ��, � �M��y t .s'J` } K "1, � N �' ,� � n �t ��Q "f"*,° x y'` � .'""et �. , }.�n f• ;a"" � 1" 1(XO4 i l} g• $ � 32"1 � 4 � ��Y *x ,� d � ,�+{ �, 9�a. 7 ,°�` ,��,� ' \\ ,_ I �••' O 1��' "� �y.. 'T.. c�6 ,(Y awi �.. x' M A':: �� i�y r� r � ;��' �xn S✓',�,' _ „ �i 'o, Yet j �. � �° � r •� 792 "r ' ch" i 0) N r i e �,ay 06b S ,i li' S<zi h�J qx �\� � y�'t�µT�� "fit "`�a.. vat'„�`�'�•��.�r �"�*'p# T m '„��,, '1 � t 4'r...'� }.� ,p � 's Dfit Of, 4+44. O Q tt7 ,y'� 7j vt t i w�m ra Yro+y' 4 r+ 1 1060 t . • - TkS b „.` t Y 'F'�� s y"}`F t.X Fl {' 1SF'1. •, q� '1 _k •� fr 4-- Je.h 44" 5 '_T Al f 1 f y ' 4 �9 �K t Wl Oj n 3 i d77 +Ig si ,; n p s, 62,990 i ro X 4 '4711, _ fi� - ° • F '� „` rQl .p `, �; ,.e t s &44t > ,� arts ` ei , k€ + " s,� c n a"r; ` a aw •' Ci' C'`vhi'ar " �1* "Z'40 rxy».��7 ,' , p ,� fl cq sh .� f 'V; •� N �.0 a�.yy{{�� `/tel W i k IV^: d T s ZA e'� r x,x r � ' , "figsaaA y A, f a� 140) it`s".-, � w: � W 8 �` p d i .A� t Yf` >�x�3 Y �°g :� £ f '✓ ,� �, /gyp �! Lam} • y,��/{y� g h 9 61N� sPi n ,+ ykb tea. T i J� l� 33MF' #T i N �Cy Y Y ! i OD 117- 4t Cb ,`Sy _ \ f ���� £LN ` �� .Y,.,�p$.A K.r • r'� b � r,Y. w�+�"�." ' u � �A�+ ��, � �M��y t .s'J` } K "1, � N �' ,� � n �t ��Q "f"*,° x y'` � .'""et �. , }.�n f• ;a"" � 1" 1(XO4 i l} g• $ � 32"1 � 4 � ��Y *x ,� d � ,�+{ �, 9�a. 7 ,°�` ,��,� ' \\ ,_ I �••' O 1��' "� �y.. 'T.. c�6 ,(Y awi �.. x' M A':: �� i�y r� r � ;��' �xn S✓',�,' _ „ �i 'o, Yet j �. � �° � r •� 792 "r ' ch" i 0) N r i e �,ay 06b S ,i li' S<zi h�J qx �\� � y�'t�µT�� "fit "`�a.. vat'„�`�'�•��.�r �"�*'p# T m '„��,, '1 � t 4'r...'� }.� ,p � 's Dfit Of, 4+44. O Q tt7 ,y'� 7j vt t i w�m ra Yro+y' 4 r+ 1 1060 t . • - TkS b „.` t Y 'F'�� s y"}`F t.X Fl {' 1SF'1. •, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT µ Soil/Site Evaluation APPLICANT'S NAME ' 1N DATE EVALUATED PROPOSED FACILITY ! IT PROPERTY SIZE/ SUBDIVISION ROAD NAME— Water Supply: On -Site Well c/ Community Evaluation By: . Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH D F 6 �- Texture group Consistence 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: t LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) EVALUATION BY: &4Z 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 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 SOME ■■■■ ■E■■ NONE MEMO ■■MM■MM■■MMN■■■■MMN■ ■■ME■EMM■■E■ME■EM■■■ ■■ME■EMS■ME■■EM■ ■■ ■■MN■M■MM■■■■■■M�■■ ■■MEMS■MEM■■E■EMEN■■ ■MM■Mm■■MM■■M■MEMMM■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■E■■■■■■■■■■■■■■■ ■■■■■MEN■■■Mmn■■■■■■ ■E■■■■NN■■■M■N■■■■E■ ■■■■M■NE■■MN■■■■■E■■ ■■■■■■■■■■M■■■■■■■■■ ■■■MEMEMEMEMEMENU■■ ■■■■■■■■■■■■■■■■ on ■NN■N■■■■■■■■M■■■■■■ ■■■■■■■M■■■■m■M■■■■■ ■■■■■■■M■■■M■E■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■n■■■■■E■■M■■■■■■ ■■■■■■M■■■E■■■■■■■■■ ■■■■■E■■■■■■■■■■ ■■ ■■■■■■EN■■■■■■■■�■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ MEME ■■�i MEMO NONE ■■M■ MEMO ■E■■ so ME ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■M■■■ ■N■■■ ■■■■■ ■E■■■■EMEN■■ ■■■■■■■■E■■■ ■■M■NM■■N■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■MM■■■■■■■M■ ■■■■■■■■■■■■ ■NE■■■MM■■E■ ■■■■E■EEM■■■ ■■■■M■■■N■■■ ■■E■■EE■■■E■ ■■■■■■■■■■■■ ■■N■■■■■■■■■ ■■■■■■■■■■■■ ■N■■■■■■■N■■ ■■■■■■■■■ ■■■■■■ ■N■■■■ ■■■■■■ ■■■■n■ ■■NEEM ■■MONS MEMO■■ ■N■■E■ ■■■■■■■■■■■■ ■NEEM■■■■■E■ ■N■■■N■■EMN■ ■■■■■■■■■■■■ ■■■■■■■■■M■■ ■■■■M■■■M■■■ ■EEN■■■■N■■■ ■■■■■■■■■■■■ ■■■■■■NM■■■■ .. .:;,�;dww ,.a:f t+r'�{�kr "t��s.�.4�iM;4"twv+�r r„w..x.�?ea i1t" rti?-iX .k` .^v:4t ,..r..w .�a�'�.G., ii `�::yv,+t� 'M � a.:t+z. �, -.. �nt•... .-+ ,�7iF , r- f k., �.,.;. . ' � " . � , . ; _ .s"=d�"�d µ �=�::��; � � �,� � ,. .. �� . AUTHORIZqTION NO: ����Af DAVIE COUNTY HEALTH DEPART ENT �.---�--�-=t-t :�, �� � : , � `�; ,, Environmental Health Section � PROPERTY, INFORMATION Permittee ti -,',^`,� ,-�. P.O. Box 848 � Name: � � � L-� �"?"'����"" 'Mocksville, NC 27028 , Subdivision Name: � � Phone # 336-751-8760 Directions to property; •� f�� lr '��'c� �•., Section: : Lot: , r � AUTHORIZATION FOR : �^ � � WASTEWATER t.,,.�L�`�'./� � e� �;,�.., ���.- )C,7 tJ Tax Office PIN:# - SYSTFM CONSTRUCTION -; � /� �� 4 �.� � r� C�;;-�l;Ci��.��. � �ty ���.5 ' �i�' Road Namet:�X: � ��'��p. _'� �;,� . � **NOTE** This Authorizat►on for Wastewater System Construction MUST,BE ;ISSUED by the Davie County Envuonmental Health Section prior to issuance of: any Building-PernvtS. This: Forni/Authonzauon Number should be presented to the Davie Counry Building Inspections Office when applying for Building Permits.' �. . : ' (in compliance�with Anicle 11 , f G.S. Chapter 130A; Wastewater Systems Section .1900 Sewage Treatment and Disposal Systems) , :, -;,.�� , a,, . , .. . ,_. . ; , � ' —� *** TICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION � NO ,_„�,�., ��;y;, ,� � IS VALm FOR A PERIOD OF FTVE YEARS. ENVIRONIvIEr TAL HEALTH SPE IA�IST': .. D r E SSUED ' k � ti i 1:745/1DAVIE, COUNTY HEALTH DEPARTMENT;0 '�. JMPROEMENT AND OPERATION PERMITS PROPERTY INFORMATION . Permittee's;'� �> Name: 1 i_ �'- "� �=" Subdivision Name: Directions to property: . L L t Section: Lot: ' IMPROVEMENT r r..r r*\ ! 4 }s: , f..: ,: •.� PERMIT Tax Office PIN:# _ *4-1 Road Name t , i . p r= tp !: �k **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 I l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) w r' ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE -.. ,r . % :. / }., . `�— .'',r 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 tj OLT> # BEDROOMS 3— # BATHS 2 # OCCUPANTS �`r GARBAGE DISPOSAL: Yes o No COMMERCIAL SPECIFICATION: FACILITY,TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE"'- TYPE WATER SUPPLY CCL. DESIGN WASTEWATER FLOW (GPD)�C NEW SITE REPAIR SITE - t 'r SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH I L. LINEAR Fr. 301) OTHER A v,� C-OA-rot)4 CCUT oFF tr )(IST, REQUIRED SITE MO IFICATIONS/CONDITIONS: fJ SY L 1.. � A& 1 L1.t L t._ �cS IMPROVEMENT PERMIT LAYOUT *APPROVED LlENT FILTER* *RISER(S) IF 611 BELOW FINISHED GRADE*. 7 J t,x1Z I *"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. XXXXXHHXH OPERATION PERMIT z SYSTEM INSTALLED BY: �^� 7 W*I t'iA ►LIZ �T IaAov " a �oosS a s� 0 12,L� K13 1 �,�, AUTHORIZATION NO. I "'r" ' OPERATION PERMIT B . DATE: "*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBEDOVE HAS BEEN INSTALLED IN IOMPLIANCE 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. DCHD 05/96 (Revised) Accr�� o.�:_,,,i:e �. •sy �. i'i iiY ^�.yJ., Z,'t7''_-�'�^t"..y -54 DAME . OUNTY HEALTH DEP AR ENT i IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permlttee's Name: L `` �� " Subdivision Name: Directions to property: ` ''i k� Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# - r.. A ` 1. Road Name: . t:- �f r L Zi **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) ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE l- 'r . # BEDROOMS, _ # BATHS # OCCUPANTS "-' _ GARBAGE DISPOSAL: Yes oe,o) COMMERCCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE�—el �LI LTYPE WATER SUPPLY(AjLj - DESIGN WASTEWATER FLOW (GPD)7si L1 Q NEW SITE.—REPAIR SITE r , SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH I L? LINEAR FT.?e,t, OTHER (�h,Q�l• 1.t T( 161)TIC a lxY r REQUIRED SITE M ODIFICATIONS/CONDITIONS: ��-)I ALL. U..1t C&Al Ut� l i:.IVZ t>FF t X1 ST"�n1C^ `1 n1( L t ,� fi "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. XXXXXXXXX OPERATION PERMIT r4 T- r}a�ss SYSTEM INSTALLED BY: 1 W+� ITA 1� ►yam 3� g- sc��y�iTg a C> I t�3 x C,04. PL, LT DA /—j spa C X AUTHORIZATION NO. OPERATION PERMIT B i DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED INOMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) y�� d AiJTHQWATION NO: Q 6 7 8 DAVIE COUNTY HEALTH DEPARTMENT q ►y �� Environmental Health.Section'',. ` PROPERTY INFORMATION '. Permi[tee's P.O. Box 848 Nam--.Mocksville, NC 27028 .'_'Subdivision Name: - - r r ln+ !f % Phone #: 704-634-8760 'Directions to property: �c"c3 Section Lot:' AU i'HORIZATION FOR Q• !� WASTEWATER Tax Offi PINI SYSTEM CONSTRUCTION e a� Road Name:.Zip: R $ **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.Buildu�g 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) 4' "N'0. ' ***NOTICE*** TEAS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 7 i 4 ^ i } • ` s ' I „� (kt� ►'' �+ * ' k t r� �' e. RESIDENTIAL SPECIFICATION BUILDING TYPE # BEDROOMS S„�_ # BATH5� iI OCC[Jl'AN IS 4 < GARBAGE DISPOSAL. Yei o f 1 t y f �: -. t• 7 777 ���rilty:,gr.+rr�, y s....: «L.e.ry.+..c,....x+ � t . +i ��.� [ � t � • + ; COMMERCIAL SPECIFICATION PACILITY TYPE # PEOPLE : M PEGPLElSi1>P1`: x # SEATS y _ `. INIIUSTRIAL WA$T$. a br oto t LOT S12E %L� TYPE WATER SUPPLY Me Z/ DESIGN WASTEWATER FLOW (GPD) _ y +y ' 4Ea! S `REPAIR STfB '.!�' 1'i ,:�( xy '. , ei � i1 '. .: . :$ .:.� i `� S 4Ar iY �'i..°"'t x 1!.ttiFit�h'tt�� ,' �..;�. p-:;�t �rxr •: x ,.a , SYSTEM SPECIFICATIONS: TANK SIZE 1�_GAL. , PUMP TANK GAL..' TRENCH WIDTH +r ROCK DEPTH,_ LII.AIL FT. ��� ' V 117010 . a+1 ,s - t (•„r at ly r. a r ;:; � ;..�x'�S �.i1.<7, �i1I}�iej� .'«r( l✓,t�«ifrxLrLl�,;ii� ti i"t.,I�Y i + • REQUB3ED Sri E MODIFICAmomiCOmmoNS: IMPROVEMENT PERM LAYOUT i�e 1f,i •17 Y�' l�d'"Y9 t « �,.t;w .y r.� { . Af :.... r: ,.. ,. ,-r ,'..R d .;p-+ yr Y'+r.Y¢><+eWwd.Mr/><Fn -+tier T r*'+r,+ w "r!•1 t. .w;p+nr! +i ii d r e '. . i1r.�'� �1 tl'Zly' i .' ✓� G K�l'N�g} � C 7 iA 1 r 2 9' i ' ' :... 7-s �i'E4��,S'►`.�$C� �1 �I'�rA���tJiF� z y� �iS � r ' Y f I t' - l' ^ OPERATION PERMIT %#c' (•. r re x , ' K SYSTEM INSTALLED Y a AI � tat a, a ... . . -r �., n ... ... � .. �:.. ., xi Y .w 1f4'� a �•� .v� +w.rna n p n;.t,+. Fn,l+ati.�iQ Ji .y .Ksa 4. Witv,.eid..perye.Y^w'w:+�r• +u,.,Ni..>a.,wrrw w:..a+Sr. t tw.. t:q g C • i �"' i{ � t '+�, lai'}f i5xh ; x.t .rifr'�i'it''�iUS?<I i'4 �tCY} tH'iis +� y i,'1 'z t is • . � � •NQ ��\•' .Y, ,+;` :rr at�'�iti�kl�'� J3'3;i �t *�� 1; �.f+ sate )xE'Fa• f.`i'ti1`�f t.* ISs ' � t•, � .ri;'i I ; 5,r1,.? �" C Y�,�.rC`si.....r•:,.«tir t.�i'L"' t Z c:i �i" Y. I' . i a('il"`' t•' • p � �r AUTHORIZATION NO. V� D :' . OPERATION PERM BY. DATE v " - • **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 130Ai SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME D= 05M (Reviled)