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a►iTiOaA?`AT>oN No: DAVIE C LINTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittees_ �1 P.O. Box 848
Name .. ,r `f e' /t ! .&717 � Mocksville, NC 27028 Subdivision Name:
l-
�%J
)Phone # 336-751-8760
Diir;yctions to property: 1rs Section: Lot:
AUTHORIZATION FOR
WASTEWATER x Office PIN:#
SYSTEM CONSTRUCTION 4Z
l V/V N(EIrr�/%� Road Name: Zip:G�0
**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/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.'
(In compliance with Articlel 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH S CIALIST DATE ISSUED
DCHD 05196 (Revised)
APPI.IC1111ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT
Davie County Health Department
` EnvImmenta/ffea/th S&Won FEBP.O. Box 848/210 Hospital Street EB 8 1999
Mockaville, NC 27028
(336)7S1-8760 ru%nen&u.r.ne1 ur.Iru
I ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I
INFORMATION IS PROVIDED. Refer to
the INFORMATION BULLETIN for instructions.
L 1. Name to be Bilie ���'i�_1 �/�f i/�� Contact Person :5:, 7d
Nailing Address &0.—X Home Phone h'�2 • �0� �3
City/State/ZIPQ�i�Xe?Q�X Business Phone
2. Name on Permit/ATC if Different than Above
Nailing Address — City/state/Sip
3. Application For: USite Evaluation 0�Improvement Permit/ATC 0 Both
i�J
4. system to service: House 0 Mobile Home ❑ Business 0 Industry 0 Other
a. If Residence: f People / Bedrooms �'� I Bathrooms
8'Dishwasher 0 Garbage Disposal 8 Hashing Machine U Basement/Plusbing 0 Basement/No Plumbing
6. if Business/Industry/other: Specify type f People # sinks
f Commodes f showers f Urinals # Nater Coolers
Ir FOODSERVICE: g Seats Estimated Water Usage (gallons per day)
7. Type of water supply: Bounty/City 0 well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 8.1'to
If yes, what type?
***IMPORTANT'** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Eitber a PLAT or SITE PLAN MUST BESUBIIIITTED by the client with THIS APPLICATION.
Property Dimensions: ,.41d `zs WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: # "2;7, dlo ol y12
Property Address: Road Name
City/Zip se46 . /%
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot: Date Property
This is to certify that the information provided is correct to the best or my knowledge. 1 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 lncuffedfrom
this application. I, hereby, give consent to the Authorized Representative or the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testin procedures as necessary to determine the
� site sitbi t .
DATE �/SIGNATU
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).
Revised DCHD (07198)
Account No.
Invoice No.
1 �
APPLICA
• 1 U l f'� """r
JUN 2 9 1998
EVALUATIONAMPROVEMENT PERMIT & ATC
e County Health Department
vironmental Health Section
P.O. Box 848
Mocksville, NC 27028
(704) 634-8760
NEW PHONE NUMBER:
EFFECTIVE MARCH 22, 1998
336 751-8760
****IMPORTI" THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed '{�t�.t Ct /(. c lU �, \ r C-ont�t Pers O
Mailing Address �I� �ft i��� -cam Home Phone
City/State/Zip ,�� f'�—��� t-' ` P j /U L� stir Business Phone
'2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: Site Evaluation [ ] Improvement Permit & ATC [ ] Both
4. System to Serve: Ouse [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 1-t,tc -LXS
5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ J Garbage Disposal
[ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Sh-wers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: [ ] County/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ( 1 Yes [ 1 No
If yes, what type?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***-\PEAT OF THE PROPERTY MUST BE
5,14 c 4ze J '�! r SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 2 D N.".rs f-o-,CICA ; WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
1.
Tax Office PIN: # 5 ` Z Z 0664 t _ , D ) ; (�� X n P Ca CS ) R, Ilat1►c�
Property Address: Road Dame [ > d b I l � ° `Z �'� S i (', t % '(p A1Nz 4,.Ac 7- rr1JT- -S
City/Zip We /Q v i z le , V L Z7 c2.`t
If in Subdivision provide information, as follows:
Name: '
I S ✓.tion: v.- Z
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
as necessary to determine the site suitability.
Revised DCHD (06-96)
T11ZS AREA AMID BE USED )-Olt I)RAtVINC I1011R SITE PLAN:
6, +151,,d
T Vf
fJcet�5
AILI✓.
36
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1 052 7" „{M ,_.•
ci i r:
ro
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200 • »��F' t ' ' 35
580
i ',ti', '.N 400 .._w'^f+r C •-+..7Q• ;• s+•! A6
i7
.` Lp3:g , ♦ + ..�«i 760LO
tilh, t �
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�1
-3:5
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k }
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skit.r
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473... '_ _ • ��.
to its / 36
3- 0.3 / 100
�• j
is o-
36.04 1641
7;,7.3 Ac
Ot` y
r / •!; p) /
60.7
55.
4 etc.;
32.01 !3 r.
i
8.73 Ac
t� th t
OE
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62.7
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tot t 1 t ' P+ r{ts+ ' ;r►�a _ t
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. ..tt• � }ry 1' r-_ r <•, t•s �+.����', �+•3' 'i.t �� '�' .. ��� ;�'��'k�• �' � `36
IN
'* ky .s:. ♦ Tit
815 ..T '.r +' �► IE T •t
�, L, �. r 4
e 's=i rt 198
CO T tia z 'cOl3�m Y�6
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' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT'S NAME
PROPOSED FACILITY
SUBDIVISION
SECTION LOT
DATEEVALUATED
PROPERTY SIZE
ROAD NAME �� J
Water Supply: On -Site Well 7 Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L G
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: K ems'/ S lD'a P
LONG-TERM ACCEPTANCE RATE: - -1
REMARKS:
DCHD (01.90)
EVALUATION BY: L- I�'!l/
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
rn>`reTem>cwTr>c
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
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DAME COUNTY HEALTH DEPARTMENT
Environmenbi Health Section
P. O. Box 848/210 Hospital Street
Courier 09-40-06
Mocksville, NC 27028
(336)751-8760
July 30. 1998
Kyle Swicegood (Re: Stacia McGrifl)
854 Valley Road
Mocksville. NC 27028
Re: 4 Site Evaluations/18.29 Acre Tract
Tax Office PIN: #5822-06-6412
Highway 601 North
Dear Client(s):
As requested, a representative from this office visited the aforementioned sites on July 29, 1998. Based
upon the information provided on the application(s) for site evaluation(s) and after an evaluation was
completed on each site, the sites were found to be provisionally suitable for the installation of an on-site
sewage system on each site.
SPECIAL NOTE. *Before any permit can be issued on any specific lot, a map (one that will be or has
been recorded with the Register of Deeds) must be provided to this office.*
Before any permit(s) can be issued the appropriate application(s) must be filled out and the house/mobile
home location(s) staked off.
If you have any questions, please feel free to contact this office.
Sincerely.
Robert B. Hall. Jr., R.S.
Environmental Health Specialist
RH/wd
Enclosures)
cc: Zoning Officer
Parcel #: D30000003401
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search
Sales Search 0
View Property Record for this Parcel View Man for this Parcel View Tax Bill Information
Parcel #: D30000003401 Account #:82527300
Owner Information
Buildin
Tax Codes
BXF•
REEMAN CONNIE S
Land:
ADVLTAX - COUNTY T
Market:
255 NORTH HIGHWAY 601
ssessed:
FIREADVLTAX -FIRE TAX
[Deferred:
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 14.760 AC
CLARKSVILLE
liAddress: 4255 N US HWY 601
Deed Information
Local tonin
ate: 11/2006 Hook: 00690 Page: 0128
Plat Book: Page:
Le al Description
PIN
14.758 AC HWY 601 N
5822068492
Property Values
Buildin
245,87
BXF•
50,61
Land:
g9,86
Market:
386 34
ssessed:
386 34
[Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00204 0440 07 1999 WD Unqualified Vacant 0
00344 0432 08 2000 WD Qualified Improved 175,000
3 00690 0128 11 2006 WD Qualified Improved 379,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1463668 8/17/2016