4200 Hwy 158 _ DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
t IMPROVEMENT/OPERATION PERMIT
Account #: 990000675 Tax PIN/EH#: 5861-16-8526
Billed To: Larry Hancock Subdivision Info: / Zoo
Reference Name: Larry Hancock Location/Address: AM Hwy 158-27006
Proposed Facility: Car Storage Property Size: 0.656 Acre
ATC Number: 2120
**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: El Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: 0
Commercial Specification: Facility Type�People #People/Shift #Seats Industrial Waste:
Lot Size Type Water Supply_� Design Wastewater Flow(GPD) Site: New 2""Repair
System Specifications: Tank Size/
fL GAL. Pump Tank GAL. Trench Width 14( Rock Depth /,��Linear Ft✓d0�
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.****
nDl
r� eL;era,, pert
off' sy
li Si ��`c' Date: 6�S
Environmental Health Specialist's Signature:
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
y (336)751-8760
Account #: 990000675 Tax PIN/EH#: 5861-16-8526
Billed To: Larry Hancock Subdivision Info:
Reference Name: Larry Hancock Location/Address: 4190 Hwy 158-27006
Proposed Facility: Car Storage Property Size: 0.656 Acre
ATC Number: 2120
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 WASTEWAT4FR 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.
r �S�
I
Septic System Installed By: -
Environmental Health Specialist's Signature: Date:
DCHD 05/99(Revised)
r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT (9 LSU .
/¢ i Davie County Health Department D
Environmental Heald►Secdon
P.O. Box 848/210 Hospital Street JIIZ 15
P Mockaville, NC 27028
(336)751-8760
***nW0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Nam to be Billed Larry E. Hancock contact person Larry Hancock
336-998-8849
Mailing Address 1 9;1 T7 Rermuda R1.1n L)=j — Ems Phone
City/state/ZIP Bermuda Run, NC 27006 Su.i1ess phone 336-725-2306
2. Name on Permit/= if Different than Above '
Mailing Address City/State/Zip
3. Application For: 23 Site Evaluation B Improvement Permit/ATC :0 Both
4. system to service: ❑ House 0 Mobile Home 0 Business ❑ Industry 18 Other car storage
5. If Residence: a People a Bedrooms f Bathrooms
❑ Dishwasher O Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type car storage 6 people t sinks 2
# commodes 1 • Showers 1 i urinals # Water coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of Water supply: F3 County/City 0 Well 0 Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes T I 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: see attached WRITE DIRECTIONS(from MockrAlle)to PROPERTY:
Tax Office PIN: # gRA1-76-RSg6 uI.71Z 1c;8 aaatnf ]a4a.^ksville
E7 5.01
Property Address: Road Name 41 A n Nwv 1 5 R (j n f rn n+- rif cmi th arGu® Fl re �ePar tTMen t)
City/Zip AcIvantea,, Tr 770n6
If in a Subdivision provide information,as follows:
Name:
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 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 by
to conduct all testing
procedures as necessary to determine the site sultabill
DATE �/ 1�f SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include 11 of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
ERS:
7S�
Account No.
Revised DCHD(07/99) Invoice No. _�G21
00
98.90
P
100 00 ,,1 �
V �I •.�. 0 10' LANDSCAPE 5ffF5
BERM AREA
`� Vb 009p (YZ MAPLES h BRADFORD
+
-s)
,30 OO Yi,j 99.50 PEARS SPACED 10' APART
Y `•'` AO NOLO.
+ 4.30 97.70 �
� $ 0
+ .so 97.20 + c6 i
96.40NOT TO SQA1 P
�a 2 0 _1. POPOSOO 0� 96.20 13 0 �P a V 9cTmT ll MAP
�O 94.a p" 39A p• F' tl�p + P v j ,�' Q • QG' m
R� �.A 6' 97.00 •� y
O A`t ,.\ �O o
�tc� �h9�0 '�C� it
+ 95.20 NOoS� �p 0 1O Zo
0
p/10
I`S PA94p.3e40, 4t� ryA + o
+9A4. +9z . e Otiao r _ �•0''?`,.(�TIAF11E1CS11q1�t?�
?�OA9�'09I- ,• P �
9 93 50
+ QS/p
94 77
+ 92 383.90 SEAL
+ .E:
I
6 y N
91. 0 O P%�. N a L-2527
9001, 0¢ per., + vo
:9,
•50'0E' �t0 1601 i / 89.40 'i!O' SURV ••.•'Q;C
0 F. ON(P'06 'P C�'6 88.10 1/111111/1111
`t0 PrP'1'� f" + LARGE HARDWOODS
W/ UNDERGROWTH NOTE: EXISTING BUILDINGS LOCATED I, GRADY L. TUTTEROW, CERTIFY THAT UNDER
WITHIN PROPOSED DRIVEWAY MY DIRECTION AND SUPERVISION, THIS MAP
AND BUILDINGS AREA ARE TO WAS DRAWN FROM AN ACTUAL FIELD SURVEY
BE REMOVED FROM SITE MADE BY TUTTEROW SURVEYING COMPANY.
s 50
9e 3o e N� AREA= 0.672 AC.
(WILLIAM A. WENKI
y
A - m w�• J� __ _ _ L______ _ _
�o PROFESSION LAND SURVEYOR L-2527
�p� g6 F AREA= 0.656 AC. 'o'
y Q4 (LARRY E -tANCOCK) ` TUTTER W SURVEYING COMPANY
a( 127 LIBERTY CHURCH ROAD
OPt�R 30$ 16
\x S��pE;Z MOCKSVILLE, N. C. 27028
0 t�0 ; �• 2 (336) 492-5616
010 Pjuse u 10 Q�RR(1bg PP•
e'3"-O%'G O ITTe. �O R
A0.O� TO
�6 85 L o Pe` L,1 I
. A
vS N g I PLAT OF SURVEY FOR, LARRY E. HANCOCK
t 0 I
Zoof V 33
P GPR-0(15 R PP I WILLIAM A . WF, NK
O ON`O REV I S IONS SCALE. 1 =
i DRAWN BY.
50BY. S.Lpm G Li
JUNE-21- 1999 VATE. JUNE- 10-1999
BEING 1.328 AC. OF THE BARRY W RAMSEY PROPERTY
50 25 0 50 11)0 150 (D.B. 208, PG. 860) LYING IN THE FARMINGTON TOWNSHIP
DAVIE COUNTY, NORTH CAROLINA
DRAWING MJKKR
SCALE IN FEET TAX MAP REF.= E-7, PARCEL # 5 12799-2
I e
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000675 Tax PIN/EH#: 5861-16-8526
Billed To: Lary Hancock Subdivision Info:
Reference Name: Larry Hancock Location/Address: 4190 Hwy 158-27006
Proposed Facility: Car Storage Property Size: 0.656 Acre Date Evaluated:
Water Supply: On-Site Well Community Public 4/
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 6
Texture group
Consistence i r
Structure 2 K
Mineralogy P
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:
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)
■ecce■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■e■■■
■■■■e■■■et■■ee■■e■■ecce■■■■■■■■■�■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■es■t■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■t■■■■■■tae■■■■■e■
■■■■■■■■■■■■e■st■■e■■■■■■■■■■■■■■ee■■■t■s■■ee■eat■■s■■■a■■■■a■e■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
MENNENiiiiiiiREiiiiiiiiiiiiiiiiiiiiiiNON MEESE
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
Parcel#: E70000000503 Page 1 of 1
Davie County, NC - Basic Estate Search °
Davie County Web Site
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel#: E70000000503 Account#:46883000
Owner Information Tax Codes
ALLORY PAUL 3 SR&MALLORY SHELLIE M ADVLTAX-COUNTY TA
82 LAKEVIEW ROAD READVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Property Information Township
Land(Units/Type): 0.660 AC F- FARMINGTON
ddress:4200 US HWY 158
Deed Information Local tonin
Date: 05/2006 Book: 00664 Page: 0482
Plat Book: Page:
Le al Description PIN
10.656 AC HWY 158 5861169672
Property Values
uildin : 86,32
BXF: 4,97
nd: 43,12
000111
arket: 134,41
ssessed: 4,4101
41
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00307 0551 07 1999 WD Unqualified Vacant 27,500
00664 0482 05 2006 WD Qualified Improved 85,000
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/itsnetfView.aspx?prid=1480023 6/15/2016