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4205 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002602 Billed To: Michael Prince Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5822-05-2628 Subdivision Info: Location/Address: US Highway 601 N-27028 Property Size: 5 acres ATC Number: 3544 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 Hou C. #People 4 #Bedrooms 4 #Baths 2 Dishwasher: Garbage Disposal: ❑ Washing Machine: Me, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial13 Waste: Lot Size SAC�QType Water Supply - Design Wastewater Flow (GPD) 4 8D Site: New T1Repair ❑ System Specifications: Tank Size LDCOGAL. Pump Tank GAL. Trench Width--5L-� Rock Depth 2�� Linear Ft. �OC� Other: 5 ►715T6&Vrlo.3 —6pys--S Required Site Modifications/Conditions: Y 4:'� & -sg cv-- 14�x% 1-J'STO U- pa Go- ID'g, Via -'�6 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.**** Environmental Health 9 �a' t2-09 i7C I I/C Date: DCHD 05/99 (Revised)14 r o: Account #: 990002602 Billed To: Michael Prince Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5822-05-2628 Subdivision Info: Location/Address: US Highway 601 N-27028 Pro osed Facility: Residence Property Size: 5 acres ATC Number: 3544 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 WASTEWATER ONST VAL FOR PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: te: Z CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in complianc ' Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in ken as a guarantee that the system will function satisfactorily for any given period of time. -T4wI 3 -7 Septic System Installed By: Environmental Health Specialist's Signature.' DCHD 05/99 (Revised) &Q.>t , L, 4 &X--V-oei > Date: o AUG 08 '03-10:15 TO -7518786 FROM-JOCKEY-COOLTEX T-215 P.02/,02 F-291 CO r Ln W U') .t OM ��en.t��loYi� 0100- 3, P9- 132 vey reierenGe) C o CD LiJ 4.. : o p o� r N C Lf) _ a� l (1o1QI) L-6 25.00-125-00' "Mew Line" g N 0804.9'25"E 452.19'x' b�'—c h r� ANeN pn i /n c �G. I 1' 25' P 0 Lr) o 5.000. Acres i �1 By C inose Computation �.n �.Vb tIa' � e•_ � � I~ 50' ell i 23 -- S 08°49'25"1N 392.26' -� "New Li«e,, S 0849' L-4. n. In i J 3:98 APPUCATION FOR SITE EVALUAHON/IMPROVEJNENT PERMIT & N Davie County Health Department Envltwimenfal Healf t Section P.O. Box 848/210 Hospital street Mocksville, NC 27028 (336)751-8760 E C E 0 W E l FEB - 4 2003 ENTRONMENTAL HEALTH DAVIE COUNTY ***I2.P0RTAN7*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. game to be Billed ► I 1 i C hn Q e- L �rvi c a 1 � � u1 c Contact Person Pr; Vic -e- Hailing /�, Hailing Address P._BOX �rj oZ name Phone 6 - 79/ - A! 3 6 City/State/Z11# I h 00CS V '. I I f. ) NC p�.7DaV Business Pho�ye/ y r Z. Name on Permit/ATC if Different than Above Hailing Address _City/State/Zip . /a 3. Application For: ld site Evaluation `T'Imprdvement Permit/ATC :', Both 4. system to service: I!r House 0 Mobile Home 0 Business 0 Industry ❑ Other S. If Residence: # People # Bedrooms # Bathrooms o% 9 Dishw asher 0 Garbage Disposal fd pushing Machine 0 Basement/Plumbing V Basement/No Plumbing 6. If Business/industry/Other: Specify type # People # Sinks # Commodes ^a. # Showers Od^- # Urinals # Nater Coolers IF FOODSERVICE: i) Seats Estimated Water Usage (gallons per day) vNoed0eo- wyi pecSGc u+tfeR, 7. Type of water supply: ❑ County/City Well 0 Community e. Leo you anticipate additions or eipans!ons of the facility this system Is intended to serve! 0 Yes 1U1' Dyes, o;:: jpe' *"�Il feVRTANT**" CLIENTS AIUST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIAN AIUST BESUBMITT'ED by the client with THIS APPLICATION. Property Dimensiear: ,ac'' . W &1=14 FID Tax Office PIN: Property Address: Road Name 06 &JU 661 Al City/Zip alOd(51/1 Ile -AL ' If in a Subdivision provide information, as follows: Name: n%1b WRITE DIRECTIONS (from Mocksville) to PROPERTY: 7A d ,. a : _ ► ► ' to /l J/ . esti. 11.I �. _. Section: Block: Lot: Date Property Flagged: 02 /a 1 0:2 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, alss, understandthat I am respomOlefor all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie Coun96(yu Health Department to enter upon above described property located in Davie County and owned by to eanduct all testing procedures as necessary to determine the site,,"itability. DA'Z'E 11A 106 SIGNATU THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the foliowirg: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Call APP11na.4j8jgeK f6v- 0,pp6,n-1men4 - .turd h d a,+ propeH f Revised DCHD (07/98) ,. -7 i"" \ 6J1,� lvclL Account No. --�" Invoice No. �� Jan (34:22p D Prelim Not For A or C ' CA Le R/ P. 1. 48K6 � ♦(tea � � � � �• � _ " Y ��'� Y d' w a^ A �'' •;; rx tat` ? y 1 y 4 zr t } C ( * A a J �� w � . k .'200 IT.Ac sac) N a } x 73Q r ? "76034 — w 18.29Ac o t _ 33q, l3Q- 71 .a, 5 ., ,. 4 9 � ... .5 5 •� f 1 .J, 2 �� � .t�7Aq 4QQ 7!18AQ, , ." 22 VIM h Ui j OD m S 1 to = r M �4I to to, �4Z82A � h i Orr; 2 013 19 8 —�k x N I a co x (61Ac) � t i 3�1 , {` r 88,5 Ac. 1152 0 46 28 c- •r`�'� 7'!f C{ I, l .Y . `#fid' --�_` j �, u --�-,� 41 A c eh ate" Co � i;lo. ter"< w05 k APPLICANT INFORMATION Account #: 990002602 Billed To: Michael Prince Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5822-05-2628 Subdivision Info: Location/Address: US Highway 601 N-27028 Property Size: 5 acres Date Evaluated: Z 2S- a 3 On -Site Well Community_ Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slo e % . 6, HORIZON I DEPTH 0 - tobo-12.- - %i Texture group Texture Gi- G t L Consistence ✓ yw — : S Structure 5 A5k k- L Mineralo 1 � 0 Mi xLTO HORIZON II DEPTH 0 - 2 — Texture groupc d,� Consistence `S Structure Mineralogy ,;P , HORIZON III DEPTH 3 Texture groupr L Consistence Structure Z" 6ce Mineralogy 11.. av HORIZON IV DEPTH Texture group I Consistence l•1a� Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION -Sll4 SHA 0j - LONG -TERM ACCEPTANCE RATE V76 I SITE CLASSIFICATION: OS LONG-TERM ACCEPTANCE RATE. REMARKS: EVALUATION BY:-F''��"� OTHER(S) PRESENT: LZ 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 I 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) iii MEN mom NNE ■■■ ■E■ ■■■ iii ■■■ ONE ■■EM■■■■■ ■■■■■■■■■ ■■■E■■■■■ ■■■■■■■■■■■■■■■■■■■EE■■EMs■■■■■E■■■■■■■■■■■■■■a�ss■n■ ----------------------------- ■■■■■■■■■■■■■■■■■■■E�Ti■■■■■■■■■iiiiiiiiiiiiiiiiiiM■■ ■e■■e■ee■e■■e■■E■■■■■.vee■■■e�■■e■e■■■■■■eeeee■ee■�■■ ■e■e■■■e■eee■■■■■■■■■■E■■■■■■■ee■■■■■■■■■eee■■E■eee■ ■■■■■■■■n■r_�■■■■■■■E■■■E■n!�■E■■■■■E■■E■E■■■■■■■■EEE■ ■■■■■■■■■■■■■■■■E■■■■■■ire■r!\M■■�rzu■r�.■■■■■■■■■■■■■■ ■eee■■■■■■■E■■■■■■■■■E■ie�■ea■�■■EnrEe■rn■EE■■■eEE■■■ ■■■■■■■■■■■�t■■■■■■■■ tt■■Era■■■■r.�n■EM■■E■■■■■■■■■■■■ ■■■E■■E■■■■EEEEE■eee■■E■■■ME■■■■■■■EE■■■■E■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■ecce■■■■■■■■■■■■■■■■■■■■Ee■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ OMEN MENNEN iiiiii ' �MEMEEK �iMENNENEMMONSMENNEN ■■■■■■■■■■E■■■■E■■G!�iieeeeee■■■■e■ee■■eeee■e■e■e■.■e■ ■■■■■■■■■■■■■■■■■■■■ ■■■7■7■iii■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■E■■■■■■■■■■E��■���■■■■Ee■■■■■■■■■■■■eee■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■■■■ MESON ■E■■■ ■■■■■ ■■■■■ ■EEE■ ■EEE■ ■EEE■ ■■■■■ ■■E■■ ■EEE■ SOMME ■E■E■ ■■■E■ ■■■E■ ■■■E■ ■EEE■ ■E■■■ .-q■■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336) 751-8760 / Fax: (336) 751-8786 February 26, 2003 Michael Prince PO Boy: 612 Mocksville, NC 27028 Re: Site Evaluation - 5 Acre Tract/HWY 60IN Tax PIN#: 5822-05-2628 Dear Mr. Prince: As requested, a representative from this office visited the above site February 25, 2003 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. Before a representative of this office will revisit the site to issue an Improvement PermitMuthorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, lap Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s) Parcel #: D30000003205 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 Paicei #: D30000003205 Owner Information PRINCE MICHAEL WAYNE& PRINCE KAREN R PO BOX 612 MOCKSVILLE NC 27028 Property Information Land (Units/Type): 5.000 AC [Address: 4205 N US HWY 601 Account #:82520624 Tax Codes ADVLTAX - COUNTY T FIREADVLTAX - FIRE TAX Township CLARKSVILLE Deed Information Local Zoning Pate: 03/2003 Book: 00473 Page: 0758 Plat Book: Page: Le al Description PIN 5.000 AC OFF HWY 601 5822050517 Property Values Buildin : 202,65 BXF• 1 00473 0758 03 2003 WD nd: 2876 arket: 314I ssessed: 231 41 Deferred Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00473 0758 03 2003 WD Ouallfied Vacant 32,50o View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 -0 r 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/itsnetfView.aspx?prid=1463837 8/23/2016