4636 Hwy 601Nl
DAVIE COUNTY HEALTH DEPARTMENT tX7
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990003661 Tax PIN/EH #: 5823-11-7993
Billed To: Janice Whitaker Subdivision Info:
Reference Name: Location/Address: Highway 601 N-27028 4049
Proposed Facility Residence Property Size: 1 acre
ATC Number: 4152
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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: Z& /n
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, Sectio 0�ewage Treatment and
Disposal Systems," but shall in NO WAY be taken as a guar a system will nction satisfactorily for any
given period of time.
Z� l
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
• ' ' Mocksviille, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003661
Billed To: Janice Whitaker
Reference Name:
Proposed Facility Residence
Tax PIN/EH #: 5823-11-7993
Subdivision Info:
Location/Address: Highway 601 N-27028
Property Size: 1 acre
ATC Number: 4152
**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 Garbage Disposal: ❑ Washing Machine;, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial13Repair
Waste:
Lot Size G Type Water Supply _ Design Wastewater Flow (GPD) o w:2fSite: Ne ❑
System Specifications: Tank Size MOGAL. Pump Tank GAL. Trench WidtitVL Rock DepthLinear Ft % -,S&
Other:
As stated In 15A NCAC 18A.19S9{S�
=_�Systems -ars- — Q :rQ
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 u 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.****
- r�j 1D �a yor
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6
Environmental Health pecial�'s Signature: �� Date:
1? gn
DCHD 05/99 (Revised)
)N FOR SITE EVALUATION/141PROVEMENT PERMIT & ATC
Davie County Health Department M
EnvironmentaiHeaith Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751.8760
Name to be Billed ^inn f ce
Mailing Address / L n,
City/"State/ZIP
Name on Pegrmit/ATC if Different than Above
Mailing Adc."ess
Application,V_or: Site Evaluation
Contact Perso/n(,!?,:I n I 'L/e
Home Phon/+a
Business Phc'ne
tate/Zip
=ry'iz�-
4. System to Servive: ❑ House 12�'Mobile Home ❑ Business
S."' Type system requeatted: li-"'Conventional ❑ conventional modifVAL-'
'--mit/ATC ❑ Both
-`Industry ❑ Other
�1
E3 innovative Mac�clepted
6. If Runidence: People - # BedroomL / #Bathrooms �l
13Dishwasher ❑(iarba"e Disposal Mashing Machine ❑Bay/ ,ant/Plumbing ❑Basement/No Plumbing
7. If Buciness/Industry /uther: verify type l People # Sinks _
# Commodes Showers # Uri4115 # Plater Coolers
IF FOODSERVICE: #i Seats Estimated 4 -ter Usage (gallons per day)
8. Type of water supply: L-Countyx City (_'�?�� 1 ❑ Community
9.
Do you anticipate additions or exp -.rasions of the facility thihystetn is intended to serve? ❑ Yes
y
If yes, what type? j
13-f4o
***Ilill'ORTANT*** CLIENTS MUST COn�LETE THE QUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MU BE SUBM1 TED by the client with THIS APPLICATION.
Property Dimensions: ' lt- ce, WRITE DIRECTIONS (from Moduvillc) to PROPERTY:`
Tax Office PIN: It 5 c�' -) 3 1 ( -7 9 �I w a (oa l N )6h„ Cy (,Sf- DOS*
n -
w y (,al nl t y
Property Address: Road Name Nod i SS lt� n'�2+ -tU�t� �'1 /1
City/zip ��0 {11t�ckl; (IV ` �Yl f / fG/
0.
If in a Subdivision provide information, as follows: �n 1 _ /�'S l%�t
Name:
Section: Block: Lot: Date home corners flagged: tt- o) -7 -�
This is to certify that the information provided is co: t to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revoca , if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. also, understand that I am responsible for all charges incurred from
this application. I, hereby, give consent to the Autho ized Representative of the Davie County I-Iealth Department
to enter upon above described property located in D vie Comity and owned by
to conduct all testing procedures as necessary to det rmine the site suitability.
DATE (o -0 S SIGNATURE 1" .,JZF C 1--/
THIS AREA MAY BE USED FOR DRAWING YOUR STTE, PLAN ( nclude all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Sign given/
Revised D+((
C� INv
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No.
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—
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Account #: 990003661
Billed To: Janice Whitaker
Reference Name:
Proposed Facility: Residence Property Size:
PROPERTY INFORMATION
Tax PIN/EH #: 5823-11-7993
Subdivision Info:
Location/Address: Highway 601 N-2702 )
1 acre Date Evaluated: 7 16AM
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Public
Cut
FACTORS
1 2 3 4, 5 6 7
Landscape position
Slope %
b
HORIZON I DEPTH
Texture group
Consistence
V
Structure
,
Mineralogy�.
HORIZON II DEPTH
'
Texture group
/7 % _
Consistence1
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
-
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
t .
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY: AZ/
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 7 Clay
CONSISTENCE
Moht
VFR - Very friable FR - Friable . FI - Firm VFI - Very firm EFI - Extremely firm
3�t
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP,- Slightly plastic P - Plastic VP - Very plastic
aStructure
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
lYsztes _ .
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 05105 (Revised)
- - - - - - - - - - - - - - - - -- -- --- - - -
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Environmental Health Section
P. 0. Box 848/210 Hospital Street
Courier 09-40-06
July 6, 2005
Janice Whitaker
270 Liberty Church Road
Mocksville, NC 27028
Re: Site Evaluation/ Highway 601 N
Tax Office PIN: #5823-11-7993 ,
Dear Client(s):
As requested, a representative from our office visited the aforementioned site on July
6,2005. Based on the information provided on the Application for Site Evaluation and
after an evaluation was completed on the site, it was found to be provisionally suitable for
the installation of an on-site sewage system.
Before and Improvement/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RBH/dlf
Parcel #: C30000004601
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 Partel View Tax Bill Information
Parcel #: C30000004601
Account #: 78050000
Owner Information
I Tax Codes
Building:
HITAKER JEFFERY LYNN & WHITAKER JANICE RENEE
ADVLTAX - COUNTY TA
01
636 US HIGHWAY 601 NORTH
IREADVLTAX - FIRE TAX
Market:
OCKSVILLE NC 27028
ssessed•
Property Information
Townshi
nd (Units/Type): 1.000 AC
CLARKSVILLE
[Address: 4636 N US HWY 601
Deed Information
Local Zoning
ate: 06/2005 Book: 00613 Page: 0284
Plat Book: 0008 Page: 188
Legal Description
PIN
1.000 AC HWY 601
5823117544
Property Values
Building:
53,1801
BXF:
01
Land:
12,56
Market:
65 74
ssessed•
65,74
Deferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
1 00613 0284 06 2005 WD Unqualified Vacant 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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0--1-0rj11111:
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=1468313 8/24/2016