2615 Hwy 158 • 4 • 1. r �� � - r / yi ^_ , :� �.vY�:.it.� .r'�x�.! 'h.'i�:Ar. �:.,.i.��»�. ,'; ej:
Permittee's �-� DAVE COUNTY HEALTH DEPARTMENT
Name: a-�* -� uC`� i Environmental Health Section PROPERTY INFORMATION.
`` �l i P.O. Box 848 f
_ Mocksville,NC 27028 Subdivision Name:
Directions to property: 1-4 i
Phone#:336-751-8760
. tt
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION yy
AUTHORIZATION NO: 002303 A Road Name: =/'��"' . }t Zip: �� Z}
**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 l l of-G.S.Chapte>`130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
f ) �j ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
C� / IS VALID FOR A PERIOD OF FIVE YEARS.
``^-ENVIROIrVM,9ET.Y EALTH SPECIALIST 1 DATE SULD
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
St�vcals�'
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS �� INDUSTRIAL WASTE:Yes or No
LOT SIZE " '-&PE WATER SUPPLY `-X Vr%�FtESIGN WASTEWATER FLOW(GPD)�w NEW SITE REPAIR SITE ✓
SYSTEM(SPECIFICATIONS: TANK SIZE I Ct.)c)GAL. PUMP TANK GAL. TRENCH WIDTH, ROCK DEPTH i z r, LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: 'tJ�T\LL or), �--C J-Mye,����F I�t^fit. L1 C.
IMPROVEMENT PERMIT LAYOUT F-SS u 12f-
Fopk �
I J) J? G t
U' u�1c�
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT �►OLA-WSTEM INSTALLED BY:
sT �4ic `y/y
N
AUTHORIZ OPERATION PERMITBY: 3 �2' t DATE: /v
k 7
**THE ISSUANCE O
F 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 NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. fat
`
DCHD 02102(Revised) / t/I/ / eye S
Permittee,s '` '~ ,` _► ;DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
..Directions to property'. 1�� Mocksville,NC 27028 Subdivision Name:
;�. . I
..,.�. •- ,.', i; Phone#:336-751-8760
a r ` �► t f Section: Lot:
_ AUTHORIZATION FOR
_ WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: 002803 A Road Name - ' Zip: •' J'
**NOTE**
�r-t NOTE This Authoriiation 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 1 I of,G.S.Chaplet 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)--.
,.r'/ ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
` / IS VALID FOR A PERIOD OF FIVE,YEARS.
'�iNVIR lhh -NTI'EAL"rH-SPLCIALI T'`` DATE SU D
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #,PEOPLE #PEOPLE/SHIFT #SEATS —`"12 INDUSTRIAL WASTE:Yes or No'
LOT SIZEr �-t'4PE WATER SUPPLY �DESIGN WASTEWATER FLOW(GPD) t0 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE f CL.C.�GAL. PUMP TANK 1t` C�GAL. TRENCH WIDTHROCK DEPTH (t LINEAR FT.
OTHER �—'f K �" �I I t
REQUIRED SITE MODIFICATIONS/CONDITIONS: 1t-V'111-\lL C4,) r . �L �L�, C% t H—0f. L l J
IMPROVEMENT PERMIT LAYOUT
VE
40
Uj
+i
f
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT1 S _ �ISTEM INSTALLED BY:
U,� - -i,2AKI W082— Tip ) C E 1. -t
I ,4 tr sG-F`r 1 C
ST 'L-)rCi C LIENIlk
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WiL.TC►Tuo, CWICY LA ST6 c>• AM&Q,, zo
s1%
S
c7`
o M -
` L
AUTHORIZA OPERATION PEITY 4�� 0 Z 141 U DATE: �4&
**THE ISSUANCE F THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTE DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT ANP 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 662(Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
/A'/ //jPPLICCA/TION FOR IMPROVEMENT PERMIT(REPAIR) z
NAME �S f ila I llLj-,e, PHONE NUMBER
ADDRESS l�`J U s f1yV y 15-9SUBDIVISION NAME
LOT
DI R TIONS O SITE V V , S
r ,
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY *NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED /0-7 INFORMATION TAKEN BY-
IfG
This is to certify that the information provided is correct to the best of my knowled e d deratand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93fitae
� n S .
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND',CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name ' sZ-zz`�. :: ., Date —
N_ 6695
ion
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms .No. Baths No: in Family _
Garbage Disposal -AYES ❑ NO ❑ Specifications for System: Jj ✓ .,,
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma shine YES ❑ NO ❑ j v X j ){ ; I'
Cuvt��
Type Water Supply 'y� _
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This:permit is subject to revocation if site plans or the intended use change.
Com,"
r
V �.
\ 6
0
Improvements permit by
*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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by
77 1 oo
T]
Certificate of Completion C � � Date 3 - I -
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
�,77 101
Water Supply: On-Site Well Communis Public /
Y
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L, 1—.
Slope% ,. -S `S
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON H DEPTH
Texture group
Consistence
Structure
Mineralogy04
HORIZON III DEPTH 2r7kar
Texture group
Consistence
Structure
Mineralogyv
HORIZON IV DEPTH CP
Texture group C-
Consistence t
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON 32. 2-
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY-
LONG-TERM ACCEPTANCE RATE: 1 OTHER(S)PRESENT- f
REMARKS:
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 F
SC-Sandy clay SIC-Silty clay C-Clay
CONSISIENCE
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
Mineral=
1:1,2:1,Mixed
ISH
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(Revicedl
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DAVIE COUNTY HEALTH DEPARTMENT
1 IMPROVEMENTS PERMIT AND'.CERTIFICATE OF COMPLETION 76i ao
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name RS' s S2s. ' `� �' � �.. Date —3 ` 1 U - 9 D.. NO
6695
�a-1!r6
Subdivision Name Lot No. Sec. or Block No.
Lot Size -sem p _ House Mobile Home _ Business Speculation
No. Bedrooms - .No. Baths No. in Family' _
Garbage Disposal, 'YES ❑ NO ❑
Auto Dish Washer YES ❑ NOSpecifications for System:
.E3
Auto Wash Ma. E]hine YES- ❑ NO � b Q ,
Type Water Supply C b Q Nt
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This:permit is subject to revocation if site plans or the intended use change.
G
u
0
Improvements permit by
*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 day of completion. Telephone Number 704-634-5985. ,
Final Installation Diagram: System Installed by
IT
VQ
"S
Certificate of Completion C ��� Date 3
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function
satisfactorily for any given period of time.
;a DAVIE COUNTY HEALTH DEPARTMENTS
;• �� ` fi'= IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
'NOTEAssued in Compliance With Article I I of G.S.Chapter 130a
. Sanitary Sewage'Systems Permit Number
Name �' 1 s `ice-2.. �`�: ��� � Date NO �+
- _ 2 C�
% fi 9
Location _
Subdivision Name Lot No, Sec. or Block No.
Lot Size D, House Mobile Home Business Speculation
No. Bedrooms .No. Baths No. in Family,-
Garbage
amily,-Garbage Disposal IYES ❑ NO ❑ Specifications for System: U - �•�
Auto Dish Washer YES E] NO ❑ t, - I
Auto Wash Ma thine YES ❑ NO ❑
Type Water Supply u t:'; 'y
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This,permit is subject to revocation if site plans or the intended use change.
is
. 0 •1 }
Improvements permit by
*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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by
FTJ
P
-i
' i a
v ` �
Certificate of Completion Date
,*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but%hall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
Parcel#: F50000003001 Page 1 of 1
oA Mrs
Davie County, NC - Basic Estate Search oo
u tt
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View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel#: F50000003001 Account#: 50756000
Owner Information Tax Codes
ILLER ELVA G ADVLTAX-COUNTY TA
07 SALISBURY STREET FIREADVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Property Information Township
nd (Units/Type): 0.650 AC MOCKSVILLE
ddress: 2615 US HWY 158
Deed Information Local tonin
Pate: 01/1987 Book: 1987E Page: 0161
Plat Book: Page:
Legal Description PIN
1.25 AC HWY 158 5840641462
Property Values
uildin 47,98
BXF• 81
Land: 31,94
Market: 80 73
101
ssessed: 80,73
eferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 1987E 0161 01 1987 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnet[View.aspx?prid=1474889 6/9/2016