Loading...
3604 Hwy 158 DAME COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003878 Tax PIN/EH#: 5851-70-0774 Billed To: Kathleen Hines Subdivision Info: Reference Name: Location/Address: 3604 Highway 158-27028 roposed Facility: ATC Number: 4332 As accepted Syst Ot9 MAY Ad In 15A NCAO SP 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 ge Tr tment and Disposal Systems). THIS AUTHORIZATION FOR WASTE W C N I V ID A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur . Date: /e�g 11)�,64 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 1 I 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. 1 n)�' �►r� 11 -2'7 Septic System Installed By: Environmental Health Specialist's Signature: r Date: 0 DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` P.O.Boa 848/210 Hospital Street `1 r' Mocksville,NC 27028 �I (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003878 Tax PIN/EH#: 5851-70-0774 Billed To: Kathleen Hines Subdivision Info: Reference Name: Location/Address: 3604 Highway 158-27028 Proposed Facility: Residence Property Size: 8.14 acres vemn**NOAlq*%Ishmproet/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 0bl)2--0 #People�_ #Bedrooms ( #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size8- ype Water Supply4�9�Design Wastewater Flow(GPD)_� Site: New Repair❑ System Specifications: Tank Sizel"O GAL. Pump Tank GAL. Trench Width EV" Rock Depth )Z Linear Ft..?W As stated In 15A NCAC 18A.1969(5) �— Other: accepted Systems may also be used Required Site Modifications/Conditions: rJSTp LL-c>-j IMPROVEMENT/OPERATION PER YOUT- APPROVED EFFLUENT FILTER. RISER(S)IF B LOW FINISHED GRADE. ****NOTICE: Contact a esentative of the Davie County Health Department for al inspection of this system between 8:30 a.m.to 9:30 a.m.or 1�O�p.m.to 1: m.o the day of installation. Telephone#is 36)751-8760.**** k�z ` \\p I� 1\ !S&4� y s N Environmental Health Specialist's Signature: Date: D DCHD 05/99(Revised) Davie, County,Health Department Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 February 23, 2006 Kathleen Hines 3604 HWY 158 Mocksville,NC 27028 Re: 8.14Acre Tract/Highway 158 Tax PIN#5851700774 Dear Client(s): As requested, a representative from this office visited the above site February 22, 2006 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit System To Serve: 5i1 - Wastewater Design Flow: 2410 System Type: ZConventional ❑Accepted ❑Innovative ❑Alternative ❑Other System Location: Silt, P17►L71►.�-7 i2WY. Valid: 25"Y'ears ❑No Expiration Site Modifications/Permit Conditions: I CCO ( 1_, i A"k Envuo nta ea cia 's Date ps-i.p.letter 2/06 s r s y ------------------------------- S f , wr � °� a� a�� � X6$4 �.•.a,< �", ` _ A IT �4imo r . _ S me o , ^ N *<' z 41 i rF APPLICATION FOR SITE EVALUATION/IMPROVEMEN ITT RIM E Davie County Health Department Environmental Health Section FEB = g 2006 P.OBox 848/210 Hospital Street.` Mocksville,NC 27028 ENVIRONMENTAL HEALTH (336)751-8760/Fax(336)751-8786 DAVIE COUNTY Application For: ❑ Site Evaluation/Improvement Permit . ❑ Authorization To Construct(ATC) Both ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed �a-1-��P 1P✓, lk- 44✓1e 5 Contact Person Billing Address 3Lv6y t-Ew(-i 1'5'9 Home Phone City/State/ZIP M o CX,0v is t L-e AJ(— 0 z'�- Business Phone 33&, T-1/ C/05- Name 5"Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE, A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan,no expiration with co m Tete plat.) _f Street Address 3 cv O y ou /5K Ci u cy r l Ca. Tax PIN# -5337Z 251 Subdivision Name Section/Lot# Lot Size 3. 111 a e v eS Directions To Site: /S$ oryoss 1)M R LMrpt dglltz F Date House/Facility Corners Flagged 4 If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? Dyes C(No Does the site contain jurisdictional wetlands? Dyes DNo Are there any easements or right-of-ways on the site? Dyes gf to Is the site subject to approval by another public agency? , Dyes 5 Will wastewater other than domestic sewage be generated? Dyes ClNo IF RESIDENCE FILL OUT THE BOX BELOW ltixc{t7 #People #Bedrooms #Bathrooms / Garden Tub/Whirlpool ❑Yes No Basement: ❑Yes [ To Basement Plumbing. ❑Yes LNo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: Pv&nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: VCounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ,?1G0 If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I understand that 1 am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to. conduct necessary inspections to determine compliance withapplicable laws and rules on the above described property located in Davie County and owned by Site Revisit Charge Prop rty owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given Dyes ❑No Account# CJ�70 Revised 2/06 Invoice# V - (5.09A) si �a 2158 co M (5.60A 9003 o° M (823) 623 (8.14A) co 0774 , , 7620 1° 22g M 3 (1016) c (19.62A) 7196 (aljj (280 l . '. -� d� 't' � �' ZX ,� � , \ , ��-.. , io d � � . .� . . . . � � � � � � . � ., 1 _ � a� {�- � .� ,, �, .�. �..� � -� . -� � <� Y'. � ��\� .� - '. . �� ' �''`� � , ., .. .\\ .� ,[ �+� l .y ' DAVIE COUNTY HEALTH DEPARTMENT „ Environmental.Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account;#:- 990003878 Tax PIN/EH#:• 5851-70-0774 Billed To:,' Kathleen Hines Subdivision Info: Reference Name: Location/Address: 3604 Highway 158-2 028 Proposed Facility: Residence Property Size: 8:14 acres Date Evaluated: 2 d Water Supply: On-Site Well Community Public ./ ,6 ;. Evaluation By: Auger Boring Pit Cut FACTORS 1 , 2 3 4 5 6 7 Landscape position L- L. Slo a %,; Lo HORIZON 1 DEPTH Texture grow Consistence r`5 SS 5 'Structure t ;. :., Mineralogy HORIZON II DEPTH Texture group C_+ C- Consistence Structure 5 4- Mineralogy HORIZON III DEPTH Texture rou Consistence Structure Mineralogy = HORIZON IV DEPTH Texture group Consistence Structure Mineralogy- SOILWETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: A> EVALUATION BY: `:FZ) LONG-TERM ACCEPTANCE RATE: �,Z�� OTHER(S)PRESENT: c=� f CA 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 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 lYate� ' 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 05105(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■�■■e■■■■■■■■■■■■■■■■■■HDD■ ■■■■■sDD■■■■■comm■■■HDD■■■■■■■■■�■■■■■■■■■•.■■■■■■■■■■a■■■■■■■■■■■■ ■■D■■■DDD■■■■■D■■■■■■■m■a■■■■■■■I/I■■■■■■■■■►■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■D■■■■m■DDDR■■■nDD�D■�■■■■■■■■■■■1■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■D■■■■■Dn■DDD■■c■aD■■■Ii■■■■■■■■�■n■■■■■■1■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■��■■■ ■ ■�IIJ■■■■■■I■nD■■■■■■■■■■■■■■■■■■ ■■■Donn■oD■s■■m■DDD■■■■o■o■■I■■i■al�i■■■■■■■■■■■■■w■■■■■■■■■■■■■e■■■■ ■■■■e■■■■■■■■■■■■■■■■■■■■■■■n■a■■■■■■■■■■■■ori■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■r.� ■■■■.■■■irlrlu■■■■■■■■■■ori■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■e■■■■■■■■■I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■mono ■■■■■■■■■conn■■■■■■■Deo■■■DD■I■■■■■■■■■■■■■■D■D■no■eD■■s■■a■■■D■■n■ SIiiieiiMEMNONMEMiiiEMNIMME"Mmomom MENNEN MEMNON° MEMNON ■■■■■■■■D■■■■■■■■o■■■■■■■■■■II■■■w■■eau■D■■■■■■■■■■a■■ea■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■aneD■■no.r�■■*r+;:!�Dn�n■n■■■■■non■■■■■■■■■■mon■■■■ nDD■D■■■D■moon■■■■■■■■■►inn■■nes■■■■■■��■■m■■s■ns■■■■■■■■s■■■■■■■■ ■■■■s■■■e■■■■a■■■��■■■��D■■■c■■■■■■DDa■��►■■■■■n■■■Dn■■■■noon■■■n■o■ D■■■■■■■DD■■■■■ft\Ilnilllm■■■n■■■■■■■ ■■■■■C■\1:7■■■e■■■■D■■■■■■■■■■■■■ ■■■■■■■■■■■�a■�■�i.a■r�.�i■■■■■n■■■■n■o■■■o■n►t■gin■■■■■n■■■■o■■■■n■o■■■ SEEN ■■■■■■■■■■cDa�■■t�D■■�1■�■a■■■■■DD■■■■o■■■■m■■►�o■■s■mom■■■■DD■■■n■■a �:■��■■enc■■■■■■■■■■■■■■D■■■■■■■■■s■D■■n■■■■n■am■■nn■m■mnom■■■■■■■ Bio■moo■■■■■■■■■■DD■■■■■■■■■■■■■■■■��■ca��■■■■�nDD►�G�nD■■m■■D■■D■■■ ■■a■■■a■■■■■■■■D■■■■■n■■n■n■■■/�D■■■■■moon■\■■\■■nn1\nm■n■■■■n■■■■■ ■■■■■■■■■■■D■■■■■■■■n■■■■■s■■■�■■Ds■■■DD■■■c■■o►t■■■��■■■■■■■■■■HDD■ ■■■■■■■DD■■■■■■aD■■■■s■■■■c■►■■■■■■■■■■■■■o■■mom■■►tea■►�■m:�w■■��■■■■ ■■■■■■D■■D■■■■■■DD■■e■■■■■■■D■a■■■■■■■■■Da■■■■\\n■��■■i1■�it�■ 517■■■■ ■■■■■■■■■■■DD■■■Homo■■DD■D■■■■■■ ,�1■■■X11►t�luDD■DD■■■■■w■nD■■■■■■■■a■ ■■D■ooDDDD■■■■■o■■■■m■■■■■nau■eon■■■�■■■n■■■D■■■��DD■■►■■■■■■■DD■■■ ■■■D■■■■■■■■■■■■■■■■■■■■D■■■ISD■■■■■■■■D■■■■��cD■■■■■■nD►tno■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■D■■■■�■D■■■D■■Dei■rnvu,n■o■nl■■■aD■►t■D■■D■■■n■ ■■■s■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■r■�\►gas►D■�r�■■■■nl�►v■■Dm■■D■uD■■■D■ ■■■■■■■■■■■an■■■■■anon■■■■■■■1v■■�■■■Ili■■■■■■■■e■■111■■It■/i%■■a■■■■ ■■■■■■■■■D■D■■■■■n■■■■■n■eD■■►�■■ ■■■■■non■■■■■s■�n■■c�.■►.■■■a■■■■s ■■nsD■■■■■■■DDDR■■■■D■■■■■DD■■iow■■■■D■D■n■■■D■m■D■v■■■■■■■■■■n■■n■■ ---- t Parcel#: F6OOOOOO53O2 Page 1 of 1 Davie County, NC - Basic Estate Search ®rio Davie County Web Site " Basic Search Real Estate Search Tax Bill Search Sales Search I� Vigw Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel#: F60000005302 Account#:67207500 Owner Information Tax Codes SMITH GEORGE TIMOTHY I IC ADVLTAX-COUNTY T 2270 N ROCHFORD IFIREADVLTAX-FIRE TAX LEAD SD 57783 Property Information Township nd(Units/Type): 8.140 AC FARMINGTON IiAddress: 3604 US HWY 158 Deed Information Local tonin ate: 01/1900 Book: 00146 Page: 0599 Plat Book: Pa e: Le al Description PIN 35 AC HWY 158 5851700774 Property Values Building: BXF: 3J52 Land: 9 Market: 13ssessed: 13 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00146 0599 01 1900 WD Unqualified Vacant 0 View Property Record for this Parcel View Map 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/itsnet/View.aspx?prid=1464536 6/15/2016