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3868 Hwy 601NY yr 4+*M �'i r� Li3 0 4•�V.:r f+l�lV//_Y� �UTHORIZATION NO: 14 3 2 DAVIE COUNTY HEALTH DEPARTMENT ='. Environmental Health Section PROPERTY INFORMATION Permittee's +; P.O. Box 848 kName:-``�'�1 ri.r- Mocksville NC 27028:Subdivision Name: Phone #: 704-634-8760 Directions to property: 119i 1 N Section: Lot: f 1 { AUTHORIZATION FOR L} 1 M 1 L s l' 1,�' f W1y1. WASTEWATER Tax Office PIN:#.Jc- SYSTEM CONSTRUCTION e�7 &IiLW CL W t-L r>-j &&4 r- Road Name: �1w�1 �a1 Zip: **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/Authoiization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of :S': Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WAS CONSTRUCTION i lr _1 IS VALID FOR A PERIOD OF FIVE YEARS. E14VIROKNIANt4ALTH PE iX7LI DA ISSUED h tt�Y j. u F� t /ti �. 'e �; s' + "�, + w :t .� ♦e "i-:. 4'�� r .. � ���'I � Y n�i�-"�,,,y H, 2tl 4 1 +e fi�'r'� N Fr �:.j tY•,;,'� � :v ��,�.aj. Vi ,y � ,i ,�, tire+. K r }� � :�� �r DAVIE COUNTY HEALTH DEPARTMENT. IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ,5� 1Vam t�e.�s,' r �-'1- Subdivision Name: tDlrections to property: Section: Lot: Li IMPROVEMENT 7 t�lj A.. , PERMITTax Office PIN:# f t':1' . I' ( Road Name " ? : i:l Zip: i -z +f; **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 permit..' (In compliance with Article 11 of G:S. Chapter. 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) y+ f` ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE Y PLANS OR THE P47ENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAE•IfEALTH�PECIALI DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE 4 # BEDROOMS # BATHS . #OCCUPANTS ? GARBAGE DISPOSAL: Yes or 1 ) COMMERCIAL SPECIFICATION:. FACILITY TYPE # PEOPLE # PEOPLEISHIFI• .# SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE r�ii C E WATER SUPPLY - DESIGN WASTEWATER FLOW (GPD) scan NEW SITE REPAIR SITEIt ' SYSTEM SPECIFICATIONS: TANK SIZE -00 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Z LINEAR, FT. OTHER V 1 S-0 REQUIRED SITE MODIFICATIONS/CONDITIONS: r,I STI I Krrt "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. TELEPHONE # IS (704) 634-8760. DCHD 05/96 (Revised) 's APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT, Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 (M E ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNL ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed o ��%J �CG�/� Contact Person ZL 6 GAN -:;-ell l Home Phone q70 Mailing Address /'� 9 ,O 971-11 �j�r City/State/Zip � d 'f A'S j%c.2 SAV l.- �gr Business Phone � � ! / `T 1 2. Name on Permit/ATC if Different than Above Mailing Address . 3. Application For: 4. System to Serve: 5. If Residence: PkVishwasher 6. If Business/Other: # Commodes _ If Foodservice: ❑ Site Evaluation House ❑ Mobile Home # People ❑ Garbage Disposal Specify type _ # Showers # Seats City/State/Zip 40mprovement Permit & ATC ❑ Business ❑ Qdustty # Bedrooms - C ❑ Other # Bathrooms 2' --'Both a-lk-ashing Machine Ll'Basement/Plumbing ❑ Basement/No Plumbing 7. Type of water supply: a-T-0unty/City # People # Sinks # Urinals Estimated Water Usage (gallons per day) ❑ Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Ye s O "Nito tllMK A YLAI UK J11C rLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PkR THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: '7 "i ee 1 WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # Property Address: Road Name 6 d % te 1 /J City/Zip A-7 0 M 1 D A i7 If in Subdivision provide information, as follows: 1 Name: 1 1 Section: Lot #: 1 1 1 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 0; 1 'lm'm rl e- `—Q- to conduct all testing procedures as necessary to determine the site suitability. DATE � / 0 SIGNATURE Revised DCHD (06-96) YOU MAY USE THE BACK OF THIS FORM FOR DRAWIN15 YOUR SITE PLAN. /i � . . �� . . . 1 . . • :' A`` DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation ,NAME 5)1Mm'? (AJOt.S DATE EVALUATED ° b Ly ADDRESS OA00) PROPERTY SIZE 4�45 PROPOSED FACIILTY I qgosg' I LOCATION OF SITE N`)V(-00� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring ./ Pit Cut FACTORS 1 2 3 4 Landscape Rosition L G L Sloe % <d 7o Ar7 HORIZON I DEPTH - Texture groupV [� Cf✓ L Consistence 5$ S < 9S SS Structure C, MineralogX HORIZON II DEPTH - 1$ (B - 12- 2Texture Texturegroup C Consistence 5 l FC S 1p Structure S kSAIL 5 ___5 k Mineralogy '1 11 HORIZON III DEPTH - Iv L - - Texture group C't 0 0 4 G i Consistence r Structure 6k Mineralogy�► HORIZON IV DEPTH 3tv -1- k Texture group 600 SAO �qp Consistence Structure k Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE Sg CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Ps EVALUATED BY: Ew 'tlt1, LONG-TERM ACCEPTANCE RATE: ©OTHER(S) PRESENT: REMARKS: COQ9V C..�S>"is M�1�3�gdd-fX�. F4re- S-i4uvaf,F: t 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 <.lay loam• SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V2 -7y 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 3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mi neralo¢-y 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(01-901 Parcel #: D300000064 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:D300000064 Account #:14017000 Owner Information Tax Codes ADVLTAX - COUNTY T RTNER JAMES HUGH JR E1485 POWELL ROAD FIREADVLTAX - FIRE TAX OODLEAF NC 27054 18,52 arket• Property Information Township Land (Units/Type): 0.900 AC CLARKSVILLE [Address: 3868 N US HWY 601 Unqualified Deed Information Local Zoning ate: 11/2003 Book: 00525 Page: 0098 00165 Plat Book: Page: 09 Legal Description PIN 1.902 AC HWY 601 21824000 5822-11-0150- 1 Property Values Buildin 53,04 0011 BXF• 55 Land: 18,52 arket• 72,11 essed: 72,11 Deferred: 01 Sales Information No. Book Paye Month Year Instrument Quai/UnQual Improved Price L 00165 0432 09 1992 WD Unqualified Vacant 5,000 >. 00165 0436 09 1992 WD Unqualified Improved 5,000 3 00525 0098 it 2003 WD Unqualified Improved 0 l 2003E 0125 05 2003 WL Unqualified Improved 0 i 00515 0747 09 2003 WD Qualified Improved 62,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Page 1 of l o .P n0 rill -1-1 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=1466434 8/9/2016