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4254 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 7 —.3 v ' P.O.Boa 848/210 Hospital Street ' Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001807 Tax PIN/EH#: 5861-27-6010 Billed To: Eugene&Ruth Dalton Subdivision Info: Reference Name: Location/Address: US Highway 158-27028 Proposed Facility: Residence Property Size: see map ATC Nffbfr: 2901 **NOTE** is mprovement/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 #Bedroomsy #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine:.,,e Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New CY Repair❑ System Specifications: Tank Size` GAL. Pump Tank GAL. Trench Width r 1,/ /.01 Depth��Linear Ft./- Other: t./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.**** I �J V A6 N� El 000001 Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) • • r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001807 Tax PIN/EH#: 5861-27-6010 Billed To: Eugene&Ruth Dalton Subdivision Info: Reference Name: Location/Address: US Highway 158-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2901 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,Sgction.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA NS UCTION IS VAL D FO PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: l% � ? V 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. Di �1E��y Joe D Septic System Installed By: Environmental Health Specialist's Signature: oo Date: DCHD 05/99(Revised) i TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department Jug 1 9 20 E17virwmeataiHealth Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTALHEpLTH OU (336)751-8760 ppVIE CNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ) 2Q Contact Person / l� �- Mailing Address // 7/ { 'C e n o o o a ��k'-l Home)Phone (p 2 City/State/ZIP S �v C (/0 3 Business Phone / 0 Y �,- 2. Name on Permit/ATC if Different than Above Mailing Address C:Lty/State/Zip 3. Application For: Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service:--� —House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If esidence: #`People !a # Bedrooms 3 # Bathrooms G_ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/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: VCounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes �No If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST,BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITEDIRECTIONS('from Mocksville)to PROPERTY: ax Office PIN: # 7-6/i� 1� yO �r�^-� � �t�a✓ Property Address: Road Name !'.� — `'Sf 7 t'O City/Zip 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 suitability. DATE Z/6 SIGNATURE 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 jDate(s): Client Notification Date: EHS• Account No. Revised DCHD(07/99 Invoice No. _� DAVIE COUNTY HEALTH DEPARTMENT . - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001807 Tax PIN/EH#: 5861-27=6010 Billed To: Eugene&Ruth Dalton Subdivision Info: Reference Name: Location/Address: USHighway 158-27006 Proposed Facility: Residence Property Size: see map 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 Slope% 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: 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 Moi 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) � 11311 1x61 Nom--� �0 7015 61 26 E70000000901 1106 6010 1 0 5861276010 13 M �6 4922 �o 5898 7818 Parcel#: E70000000901 Page 1 of 1 rll.v Davie County, NC - Basic Estate Search 00� Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel#: E70000000901 Account#: 82519957 Owner Information Tax Codes ALTON ELSIE RUTH ADVLTAX-COUNTY T 254 US HIGHWAY 158 FIREADVLTAX-FIRE TAX DVANCE NC 27006 Property Information Township nd(Units/Type): 0.540 AC FARMINGTON ddress:4254 US HWY 158 Deed Information Local Zonin ate: 10/2002 Book: 2002E Page: 0316 Plat Book: Page: Le al Description PIN 0.536 AC HWY 158 5861276010 Property Values Buildin : 94,6001 BXF• Land: 18,65CI Market: 113 25 ssessed: 113 25 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00149 0214 06 1989 WD Unqualified Vacant 0 2002E 0316 10 2002 WL Unqualified Improved 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=1476550 6/14/2016