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4190 Hwy 158 . rn. r..-,-o,r� «nF4c, ..ti i F i�4•..-`.w,yt;+.•,+�''rr�,rc.+w'=��itP�^^�rix+.r AUTHORVATIOIi NO: 16 1 4,p, DAVIE COUNTY HEALTff DEPARTMENT Environmental Health Section PROPERTY INFORMATION PeRnittee!C n �` P.O.Box 848 " Name: Mocksville,NC 27028 Subdivision Name: '. ,fir �, Phone# 336-751-8760 " Direc ions to property: f / Section: Lot: AUTHORIZATION FOR WASTEWATER moi" Tax Office PIN:# . SYSTEM CONSTRUCTION - Road Name:1 s� Zip:Z 70 •x' **NOT E**.This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any BuildingPermits.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.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) - ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION t y IS VALID FOR A PERIOD OF FIVE YEARS. s- . ENVIR NMENTAL HEALTH SPLtIALIST. DATE.ISSUED t a,J+-[ �,� ,.. q, � f �wr s:"y, ""n'ji'1 ;. .J*'.i a' --J r�"' K'i '�I. �. r -� i'-'.�,j ••FS � ..fi r.. 'rs.`�3",� � ' to "t '�.ri'y w `LL14 DAVIE COUNTY. HEALTH DEPARTMENT n; A IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION :*tom *; '�� Y , f, ; f NarSubdivision Name: 'Directions to property: Section. Lot: IMPROVEMENT „ e PERMIT Tax Office PIN:# - a ,Road Name: Zip:2 X, **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 pen -nit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) u - ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE t% c�J ` . s'i ", .'; ' ` :' ! PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SP IALIST 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 # PEOPLEISHIFr # SEATS ` INDUSTRIAL WASTE: Yes pr No LOT SIZE' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE ye$YSTEM SPECIFICATIONS: TANK SIZE GAL. 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'rELEPHONE # IS (7 Y01'AWx (336) 751-•9760 DCHD 05/96 (Revised) T' y+.:L+`�'t'Y` .'tib '€"e7tie ni d(i+'+�s 4 �'t. z• IrY�� lts� � t; Tvq ,y .t� ✓Y rr-'�.';i r'; J.b.- ,' i b . ..1 .; �Y:='�- •. 'azt"--;Yi+i.; �,, y. > -: , v, DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Name: �X:�: �' + :�F jP Subdivision Name: Directions to property: Section: Lot: EVIPROVEMENT ;,� .'�+►� E , PERMIT Tax Office PINI - - ,' Road Name:J-' Zip:= **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic 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 # PEOPLE/SHIFT # SEATS =.INDUS I; WAS .71, or No , J T• LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE T,E i -7� SIZE GAL: PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. -- SY MS�ECIFICATIONS:'TANK OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER*. ,01SER(S) IF 6" BELGIA FINISHED GRADE* ii c-� vhf.. "CONTACT A REPRESENTATIVE OF THE°DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF STEM ' ' BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # I (P�)5760 OPERATION PERMIT SYSTEM INSTALLED BY: i . s eM AUTHORIZATION NO. / �) " OPERATION PERMIT BY: DATE: ✓ O "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 NQXVAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) 1 N, i • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION, y Property Address: 2 Xh Ue Number:<-�&"' j�X (Home) Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under: 1/ DGv iJ Type Of Dwelling: Date System Installed(Month/Day/Year): Number Of Bedrooms: Number Of People: Is The Dwelling Currently Vacant? Yes No ❑ If Yes, For How Long?, Any Known Problems? Yes ❑ No R' If Yes, Explain: (Work) Please Fill In The Following Information About The New Dwelling: Type Of Dwelling: �Q Number Of Bedrooms: Number Of People: t Owlif P Requested By: Date Requested: (Signature) For Environmental Health Office Use Only Approved Disapproved ❑ Environmental Health '"The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee(extended or limited) that the on-site wastewaters stem AM function properly for any given period of time. Payment: Cash ❑ Check oney Order ❑ # Q C �1 mount: $ , b U Date: 7 4` Paid By: Received By: Account #: G �� Invoice #: *• Fir � APPUCATION FOR SITE EVAL.UATIONAMPROVEMENT PERMFF & ATC .S WDavie County Health Department Environmental Health Section P.O. P.O. Box 848/210 Hospital Street S Mockoville, NC 27026 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED iMPMATIOH IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nass to be Billed William A. Weftk Contact meson Bill Wenk !!ailing Address A I Rrgn Mar T.—al Some Phone 336-'166-336-0 City/stats/SIP Winston-Salem, NC 27103 m,sinsss Phone 336-766-3383 2. Name on Psrmit/ATC if Different -than Above Mailing Address City/state/Sip 3. Application For: ❑ Site EvaluatiOn ❑ Improvement Permit/ATC IT Both 4. system to service: ❑ House ❑ Mobile Home Ck Business ❑ Industry ❑ Other 5. if Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ garbage Disposal ❑ washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/industry/other: Specify type auto paint& body# People # sinks 2 # Commodes ,2 _ # showers 1 # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of Mater supply: :1 County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes [Me If yes, what type? ***IMPORTANT*** CLIENTS MAST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. see attached Property Dimensions: 5861-26-0667 Tax Office PIN: #_T, Property Address: Road Name 190 Hwy 158 ' City/Zip Advance, NC 27006 If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Highway 158 east of Mobksville (In front of Smith Grove Fire Section: Block: Lot: Date Property Flagged: 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 aU charges incurred from this appUcadon. 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 testing procedures as necessary to determine the site suitability. DATE 711 y- //f SIGNATURE \),) t THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): hp ",- Client Notification Date: L-0 . Loco Revised DCHD (07/99) EAS: 41 (O �� GG Account No. Invoice No. �� 0"o 98.90 of -gyp- + �� P 9�c^ p 100. 00 10' LANDSCAPE BERM AREA MAPLES do BRADFORD PEARS SPACED 10' APART vso 9 G PRS 15 R, P pto 50 25 0 50 100 150 SCALE IN FEET J� CL 00 =o �— N cx Z m O C) NOTE: EXISTING BUILDINGS LOCATED WITHIN PROPOSED DRIVEWAY AND BUILDINGS AREA ARE TO BE REMOVED FROM SITE i i r J P J• SavoINI PLAT OF SURVEY FOR, SnEs dd � IMHTY MAA T, \tIlllll,/// \\\ /// OOC��'. SEAL L-2527 ;�:�•�y o4 Cs)'� I, GRADY L. TUTTEROW, CERTIFY THAT UNDER MY DIRECTION AND SUPERVISION, THIS MAP WAS DRAWN FROM AN ACTUAL FIELD SURVEY MADE BY TUTTEROW SURVEYING COMPANY. ---------------- PR❑FESSIO L LAND SURVEYOR L-2527 TUTTE OW SURVEYING COMPANY 127 LIBERTY CHURCH ROAD M❑CKSVILLE, N, C. 27028 (336) 492-5616 LARRY E WILLIAM HANCO CK A. WENK REVISIONS SCALE 1" — 50' APPROVED BY, rwAuu my. J.S.L G.L.T NE -21-1999 MATE, JUNE -10-1999 BEING 1.328 AC. OF THE BARRY W. RAMSEY PROPERTY (D.B. 208, PG. 860) LYING IN THE FARMINGTON TOWNSHIP DAVIE COUNTY, NORTH CAROLINA TAX MAP REF.= E-7, PARCEL # 5 DRAWING NUMBER - 12799 — 2 UMBER- 12799-2 . I • • DAVIE COUNTY HEALTH DEPARTMENT ' - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000676 Billed To: William Wenk Reference Name: Bill Wenk Proposed Facility: Business Property Size: Tax PIN/EH #: 5861-26-0667 Subdivision Info: Location/Address: 4190 Hwy 158-27006 0.672 Acre Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit 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 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: LONG-TERM ACCEPTANCE RA' REMARKS: EVALUATION BY: 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 DCHD 05/99 (Revised) j` lli aviti Zvelik ADDR DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION / APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)4rr-rzf:-k 4 ��G� ✓�� 4-ntn�!C PHONE NUMBER ` 11117Mf_ SUBDIVISION NAME LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY This Is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges Incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 Parcel #: E700000005 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search iQ View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: E700000005 Account #: 8301452 Owner Information Building: Tax Codes BXF: ENK DONNA 3 Land: ADVLTAX - COUNTY TA Market: EI401 BRYN MAWR LANE Assessed: FIREADVLTAX - FIRE TAX Deferred: NSTON SALEM NC 27103 Unqualified Improved Property Information 2 Township Land (Units/Type): 0.670 AC 06 FARMINGTON ddress: 4208 US HWY 158 Improved 48,500 Deed Information 00208 Local Zoning Pate: 10/2012 Book: 00904 Page: 0333 1999 QC Unqualified Plat Book: 0003 Page: 078 0 4 Le al Description 0548 PIN 10.672 AC HWY 158 STUDEVENT Unqualified 5861260667 Property Values Building: 70,99E BXF: 4,20C Land: 43 78 Market: 118,97( Assessed: 118,97C Deferred: Cl Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00117 0308 06 1985 WD Unqualified Improved 48,500 2 00127 0308 06 1985 WD Unqualified Improved 48,500 3 00208 0860 01 1999 QC Unqualified Improved 0 4 00307 0548 07 1999 WD Unqualified Vacant 27,500 5 00904 0333 10 2012 TD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 Out 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/itsnet/View.aspx?prid=1461178 6/8/2016