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147 Hampton Ln18',t"S- 2 0 AUTHORIZAf -Y's° TION NO: .: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's P.O. Box 848 Name: 'C Mocksville, NC 27028 Subdivision Name: Phone #: 704-634-8760 Directions to property:. Section: Lot:. AUTHORIZATION FOR WASTEWATER SYSTEM CON TRUCT,IO14 �pT�x Office PIN: --13 Ram oad Ne:Zip:—AAA 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 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) �/ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEAL' SPECIALIST . DATE ISSUED, . 020 DAME COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PO RM ITS PROPERTY INFORMATION s'' F *'� ✓��%,,[>✓t +�' Subdivision Name: 'Name �Tr Directions to'pr4erty: r`r� / Section Lot: IMPROVEMENT PER+MTT , Tax Office PIN: 16 &,R ad �Name: �►�" 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/mstalla6on of a system or the issuance of a building permit. (In compliance withArticle 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ox" i ` �" ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE V �t�cti 1 _,fr��'", , ��; `,t ,s ; ,jd PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEAL ` SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE _L7' # BEDROOMS # BATHS # OCCUPANTS % GARBAGE DISPOSAL: Yes or No , COMMERCIAL SPECIFICATION: FACILITY TYPE% # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WA : Yes or No LOT SIZE G' TYPE WATER SUPPLY C D DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR S SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �G7 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. DCHD 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC T Davie County Health Department � � � 0 �1 � 2 r D L/ 15 Environmental Health Section P.O. Box 848 AUG Mocksville, NC 27028 2 1997 M (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed rr- 4 Contact Person lh2I&I filh)X,,4 Mailing Address �� S - L,-, �wt/ ('�. Home Phone n —9,3--2u City/State/Zip %.A •P N L_ "Doly Business Phone v 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [wIlSite Evaluation [ ] Improvement Permit & ATC 4. System to Serve: [LMouse [ ] Mobile Home [ ] Business [ ] Industry 5. If Residence: # People -L— Bedrooms # Bathrooms. [q-Oashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing [ ] Other [ ] Both [t4-Oishwasher [ ] Garbage Disposal 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: [tIrcounty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [tylCo If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** ACF.JAZOF THE PROPERTY MUST BE SUBMITTED WITH TrS APPLICATION. Property Dimensions: c �� 'WRITE DIRECTIONS (from ocksville) TO PROPERTY: Tax Office PIN: # .�%� - - �0 ! Lo Property Address: Road Name T d City/Zipv ` �• If in Subdivision provide information, as follows: lJ a Name: Section: Lot #: ; 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 bye DATE 0 ' ��— S SIGN -t all testing prN ures as n/e/pessary to determine the site suitability. Revised DCHD (06-96) THIS AREA MAY BE USED FOR DRAWINQ yoUR .SITE PLAIN: r'�-} DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY YV— SUBDIVISION Water Supply: Evaluation By: On -Site Well Community Auger Boring - Pit DATE EVALUATED PROPERTY SIZE ROAD NAME e MZ Public 4Z Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence / Structure <4 5h 11 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: REMARKS: LEGEND DCHD (O1-90) Landscape Position EVALUATION BY:i� OTHER(S) PRESENT: 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 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 Parcel #: H300000049 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search V1ew Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: H300000049 Account #:63570000 Owner Information Built Tax Codes BXF• SCOTT DWIGHT A Land: ADVLTAX - COUNTY T Market: 147 HAMPTON LANE ssessed: FIREADVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 4.850 CALAHALN Address: 147 HAMPTON LN Deed Information Local tonin Date: 09/1994 Book: 00176 Page: 0360 lat Book: age: Legal Description PIN K.85 AC HWY 64 5719827506 Proa Values Built 175,82 BXF• 18,80 Land: 47,90 Market: 242 52 ssessed: 242,52 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00176 0360 09 1994 WD Qualified Vacant 24,500 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 wrl"S Davie County Web Site All Information on this site is prepared for the Inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, Its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or Implied, in fact or in law, Including without limitation the Implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnetfView.asvx?prid=1458695 ,7/12/2016