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2358 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002754 Tax PIN/EH#: 5840-41-4595 Billed To: Paul Jordan Subdivision Info: Reference Name: Ken Sales Howard Rea. Location/Address: Highway 158 E-27028 Proposed Facility: Residence Property Size: 3.14 acres ATC Number: 3551 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People _ #Bedrooms_ #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine;, Basement w/Plumbing: 13 Basement/No Plumbing: Commercial Specification: Facility Type . #People #People/Shift #Seats Industrial Waste: Lot Size IoO#G Type Water Supply 67 Design Wastewater Flow(GPD)._42 Site: New Repair O �� System Specifications: Tank Size AL. Pump Tank GAL. Trench Width W Rock Depth /t� Linear FC200 Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: Date: ZZO2'a DCHD 05/99(Revised) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002754 Tax PIN/EH#: 5840-41-4595 Billed To: Paul Jordan Subdivision Info: Reference Name: Location/Address: Highway 158 E-27028 Proposed Facility: Residence Property Size: 3.14 acres ATC Number: 3551 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: - Date: ` CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. W�l Septic System Installed By: ��'�6?h ��h/p/ Environmental Health Specialist's Signature: A' �f Date: DCHD 05/99(Revised) . Ani��W 021UN3 ,7C l ©U'/)'✓� ,QPP ON FOR SITE EVALUATION/IhIPROVEel.M T RWT&ATC P51Davie County Health Department G M A� Environmenta/Hea/th Section ¢..O. Box 848/210 Hospital Street Pot S_ UMocksville, NC 27028 �i (336)751-8760 **IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for it truction/s. (' 1. Name to be Billed. Contact Person C Mailing Address 33 IS j6 VHome Phone City/State/ZIP U J--Z O Business Phone 2. Name on Permit/ATC if Different than Above ;:5 —Er — —E� Mailing Address R �ty/State//zip—n � LTJ Or 3. ARplication For: Site Evaluation Im rovement Permit/ATC Both 4. System to Service: House Mobile Home Business Industry Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher Garbage Disposal Washing Machine Basement/Plumbing Basement/No Plumbing 6. If Bus nese/Industry/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 Well Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? Yes No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: e WRI 'E DIRECTIONS(from Mocksville)to PROPER'L'Y: Ta=Office : # o. Property Address: Road Name `S8 R-ST" _ Z 4 City/zip C /um If in a Subdivi ion provide information,as follows: T� Name:. Section: Block: Lot: Date home corners fl.gged: C,.A 1 This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernift(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 far all charges incurred frau 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 to conduct all testi g pr edures as necessary to determine the site suitability. DATE SIGNATURE THIS AREA NAY B USED FOR DRAWING YOUR SITE PL (In ude all of the following: Existing and proposed property line and dimensions, structures, setbacks,. and septic locations). Site Revisit Charge "F" : Date(s): Client Notification Date: lp 3 EHS: L Sign given U— ) Account No. Revised DCHD(07/99) / Invoice No. r 3 a .. 3.81 8908 j j - 1} f p ga f t xr` �a'�a�9 yA otn �f 7,i 9)XI MANOR. h i x '*6 e '3 r >er yy & 331 f3i"�..,,, nv3,t�ir f o f t ` �3�' 7 wRt .,. § v t f �Tp £ ��� 31 3 iwf��' ff ', �i 1�7f� x 3 83� £i f'� $gli i.fl j L rd #i fit Yfl.k $ i A��' "Oi" —sr�3 'ERF MINION + V� a � e k - s � t s, bf�'a tN a z Ya { aK1aa s" � �r- zf� r f (. t'tsxr N i ,* .r 1 ME . i �{ra Y� If4 yf a ftiz Sb tw�r«rf' e b { sv. �:✓� � >Sa f # if a 16 U9 t a� D.x,7�i}� a� � ! 35Y�� atE r�c a � #f f i ,fl aRAQzr� a �" �i �* s��� { 4' rc t£kp yf t e m }I t' t i Tt a� '� - '€ 52M 0 � 3 ft IRt �r f M "AA 51,1 (3.84A) ;3351 (15.6 82; 76J ^o N 300 ^o� N • , ' ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME VDD JCA/ DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME ' Water Supply: On-Site Well Community Public (/ Evaluation By: Auger Boring Pit Cut FACTORS 2 3 4 5 6 7 Landscape position Slope% v HORIZON I DEPTH Texture groupG L Consistence Structure Mineralogy - HORIZON II DEPTH '/ Texture group Consistence Structure krc /✓ Mineralogy !i 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: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: 44 " ielq C 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 DCHD(O1-90) ■■■c■■■e■c■■■■■■■■■■ecce■■■■■■■■■■■■■■e■e■■e■■■c■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■s■■■■■■■■■ecce■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■cc■■■■■■■■■■■■■s■■■ ■■■■■■■■■■■■ceec■■e■■■■■■■■■■■■■■■■■■■■■ecce■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■c■■eec■■■■ccc■■cecc■■■■■■■■■■■■■sc■■■■■■■■■■■■■■■■■■■■ MENNENMEMNONiiiiii ■■■c■■■■■■■ri■■■■■■■■■■■■■■s■ecral��ne��■�i■■■■■■ee■■■■■■■■■■■■ccc■■■■ ■ec■■■■■c■��■■■■■■cc■■■■■■c■�,car.•.u���►�i�■�i■c■■■■■■■■■■■■■■■■■■■■■■ee■ ■■■■■■■■■■■■■■■■■eee■■■■■■■■r�=:�....A��■■■cc■■■■■■■■■ec■■■■■cc■■■■ ■■■■■■■■■■■s■■■■■c�■■■■■■■■■■■■■■■■■■■■■■■ccs■■■�■■■eecc■■s■e■■s■■ ■■c■■■■■■■eee■■■■■■■e■■■■■■■■■■■■■■■■■■■■e■■■■e■■■■■■■■c■■■■c■■■■■ ■■■c■■■■c■■■c■■■■■e■■■■■■■■■■■■■ ■■■■■■■■■■■ccc■■■■c■■■e■■■■■■■■■ ■■cs■■■■■■■■■■■■ec■e■■■ccc■■■■c■■■■■cc■■■■■■■■■■■■■■■■■■■■■■■■■■e■ ■■■■ccc■■■■■■■■■■■■■■■■■■■■■■e■■ see■■■c■■■■■■■■■■■■■e■■■c■e■c■■■ _I CCNU LTHbi ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 w, .. x. b... .. ph (436)751„8760 _...., _.. . .�. .._..... May 13, 2003 Paul H. Jordan 330. Salisbury Street Mocksville,NC 27028 Re: Site evaluation/Highway# 158 E Tax Office Pin : # 5840-41-4595 Dear Client(s): As requested, a representative from this office visited the aforementioned site on May 13 , 2003. Based upon the informatio0 provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, Robert B. Hall, Jr.,R.S. Environmental Health Specialist RH/df Parcel#: G500000088 Page 1 of 1 vA.v„r'z Davie County, NC Basic Estate Search o o U 13C • Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:G500000088 Account#: 8304155 Owner Information Tax Codes ILLARD CHAD M&DILLARD KELLY E ADVLTAX-COUNTY T 358 HIGHWAY 158 FIREADVLTAX-FIRE TAX MOCKSVILLE NC 27028 Property Information Township nd(Units/Type): 2.880 AC MOCKSVILLE ddress: 2358 US HWY 158 9 Deed Information Local tonin ate: 09/2014 Book: 00969 Page: 0745 Plat Book: 0004 Page: 033 Legal Description PIN 13.084 AC HWY 158 5840414595 Property Values Buildin 115,68 BXF• 3,30 Land: 34,13 Market: 153 11 CCCIII ssessed: 153,11 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00123 0243 01 1900 WD Unqualified Vacant 12,000 00125 0243 06 1984 WD Qualified Improved 12,000 00490 0230 06 2003 WD Qualified Improved 48,000 00618 0705 07 2005 WD Qualified Improved 142,000 00969 0745 09 2014 WDualifiied Improved 129,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search 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.aspx?prid=1468577 6/15/2016