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5347 Hwy 601N'. f;� 8. .eµ, —^4CA xt "r, Y` r� �y ♦p i.. � t x aY: .�, i` ;/ rjk.. Jr� GO I oil AUTHORIZATION NO: DAVIE COUNTY. HEALTH DEPARTMENT . t i Environmental Health Section PROPERTY INFORMATION +Permitte. ' ' P.O. Box 848 Name: ��1fr\ 'Mocksville, NC 27028 Subdivision Name: Phone #: 704-63478760 Directions to property: .. W Section: Lot: AUTHORIZATION FOR W ` r.- WASTEWATER r Tax Office PIN:# 03 _ - Nlp+ SYSTEM CONSTRUCTION //�� rr c� v� CC : Bi /j - �i+x R 10-7 7 6_ 161k ad Name: 0 ! A ' Zi P:4x !6 �tia c p **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 Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION `. �, ,, •_```= ry JJ�.7�, " IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED -**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An 1 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/mstallation 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) ***NOTICE*** THLS PERMIT IS SUBJECT TO REVOCATION IF SITE !� .� �', y� �.. r4 , �► PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER:- ENVIRONMENTAL ASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE �1 INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE• �i�nA # BEDROOMS # BATHS 3 # OCCUPANTS 4 GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) G� NEW SITE_ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE !O -O GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR F JJ ^ OTHER i REQUIRED SITE MODIFICAT IS/CONDITIONX\fwu Ru. vim-. IMP OVEMENT.PERMIT LAYOUT ' ! NO N o rm a _ po lie 1 IV l 6L**XNTACT 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. s� J�JPERATION PERMIT SYSTEM INSTALLED BY: a, Ed of s a7h -Yyf-0-<9Q- r/ fod jn. 1A n,`LyJ NO v fr , / �i 14k i Aif DMS �.; ,9 /44190 '! p A AUTHORIZATION NO. OP RATON PERMIT BY: /— DATE: **THE ISSUANCE OF THIS OPERATION PEIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, S CTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BETAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUN ON SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. r ---r DCHD 05/96 (Revised) � jj1A /C /S,AkqT i APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC q • Davie County Health Department %19 I� Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 A� ****IMPORTANT****. THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed T w" LLl IN -1) J -A -V Contact Person f,)� Mailing Address 5 q r.a Gha�\a s c4- Home Phone -] 7 d —b ac7 City/State/Zip Business Phone S A ,-NL5- 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [ ] Site Evaluation City/State/Zip [ Q-Ifnprovement Permit & ATC [ ] Both 4. System to Serve: [ ] House [+'Mobile Home [ ] Business [ ] Industry 5. If Residence: # People # Bedrooms # Bathrooms -5 64*ashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing r 1 Other [v]Dishwasher [ ] Garbage Disposal 6. If Business/Other: Specify type # People #Sinks # Commodes — # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [JWell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **3T OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. i Property Dimensions:-. a-Lrc S 'WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # � ' 13 �9 - 3 8�� ; 60 t Da. Property Address: Road ame k-, \ City/zip Yom+\�ksy�\\c_ ' I If in Subdivision provide information, as follows: Name: i Section: Lot #• ' 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 I 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 R /3 / 9 % _ SIGNATU Revised DCHD (06-96) THIS AREA MAY $E USEI) FOR I)RAWINC7 YOUR SITE PLAN: APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE T &ATC Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed 0 7 e v SSC L' 4 1 C S �� Contact Person 0 e Y Mailing Address , 4' 0, S . 14 w u 1 S'� � " �-q 41110me Phone 9 773 S--' City/State/Zip 2. Name on Permit/ATC if Different than Above _ Mailing Address ,Co c 9S� X33 y � mousiness Phone uSS City/State/Zip /11 o 2)&V/ I )e Al, 01 17d2 9 3. Application For: [WSite Evaluation [ ] Improvement Permit & ATC ( ]Both 4. System to Serve: p(] House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People .J # Bedrooms 3 # Bathrooms_ [yQ Dishwasher [ ] Garbage Disposal W'Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ 1 County/City LVWell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ J Yes L)] No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: ,2 A C v e S WRITE DIRECTIONS (from Mocksville) TO PROPERTY. Tax Office PIN: # .x'813- R 4 - 3 g �14wq 601 /V -0 Y4 Property Address: Road Name ly lO V (o O J W O ✓ I 1 City/Zip M D Lks V, `l /e Al,(P 270x8' If in Subdivision provide information, as follows: ' I Name: Section: Lot #• ' � I 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 Daviel County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE Revised DCHD (06-96) .O.J �'"Y V� '��.ar7.d\.!�.1•�;`.� �F: � h.� �?^t rUSw�"" a y,1 ��' y� n � a�/�a�,� ^�� ,� � '♦I �'�"t� r�^�4 a � "Fk$t�`f Kt f� ° I 4 � N� CJ��,7'.� 'C � 0� 1 Q�' I`I.� li�� •y b �� tel'�It�.c�r"` r Oua'•fh' � P,�"1 `�' *�r� +fit`' �,.�'r.—» tyrht�rh��, •i. �r .ti �.by �'� 1 r<��-�t��,py�, r Fp 4i1 r MOOT O a F M K at6 �e�wyr 'fid P� ya a Fs4y �.. kOF QQ tJh,+,9;� y� ti71 '�` 'tr^'h `i4`. w 1• �" kSA' VI 10'9 , � °' l�4'S.t Lr�' F+�•" Cf r eJ � .�x� �. 1. v.t ,1..��j:.�'+e"?, { r` �, V ,'a'7..,rt °1fy,.kEr �Y �� G �,a LS- ,y ''Jo 1► :I)V\ �I n fir S y ;,r`� na ..�.i ,3.. a� �:r• 6 Z \h9 03? R«�,�y.,.:f�rw+r ?,wriw. •y( _ t + V .tit+ a �" � Eb: 7 �d�' ., �•_ ,•Y't � h Nw b r FI L nC rt; R` ,�''i�' �y a f X14 •1�•. h M+` f, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Q Soil/Site Evaluation Q' NAME L� �< DATE EVALUATED ADDRESS i % SL PROPERTY SIZE PROPOSED FACIILTY \ Cj%j S 4 LOCATION OF SITE / O [ N Water Supply: On -Site Well f' _ Community Public Evaluation By"--V-L- Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S S' Sloe Z - O -IRO O - HORIZON I DEPTH '' & It Texture group CL Consistence Structure Mineralogy HORIZON II DEPTH 1` Texture groupC 'L Consistence Structure Mineralogy 1V. I I 11 I HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S _S RESTRICTIVE HORIZON --r — SAPROLITE CLASSIFICATION .S_ LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � J EVALUATED 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 Moist VFR- Vcry 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 Mineralo¢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 ■■■■■■■■/■■■■■■.■■■■■..■■■■■■■■■■■■■■■■■ ■NEN■EENNN■■ ■N■ ■NOON■■ ■■■■■■■..■■■..■■.■■■■■■■■■11■■■■■.E■NOON■e■■■■■■■.■■■■■...■■.■■■■.■ ■■■■■■■.■.■■■■■■■.■■■.■■■■■■■■■■■■■.■EE.EE..■■..■E■■ ■■.■■■■11■■OE■ ■■■■■■■■.■■■■..■■■■■.■■■■t.■■t■■11■■o■.11■e■m■mmN■■■■ ■■■■■■■■■t■N■ ■.■■■■■■.■■■N■■.■1111■■■■■■■■.■■■.■■■■■■.■■■■■■■■■■.._ m11■11m■NN■■t■■ ■.■■■■■■■■■■■■■.■■■■■■■■■.■..■■E .t.E.N■...■.■.■.■ ■■..■.■■■■■■.■ ■■■■■■■■■■..■■■■.■■■■■■■■■■■■■■■ ■■■ENE■■..■■■..■■.■■.■■■t■■■■■■■ ■■■■■■■■■■■■■■■■.■■■..■■■e■�■.■■■■■■■1111■■■■NE■■�■■■■�■■■■■■■■■■■■■ ■■■■■■■■■■■■■■..■■■..■■■■■■ ■..■■.■■■■..t■■■■■. 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ONES ■ ■11....■■■..■.■ ■■■.■■..■■ ■O■ ■ ■OHE■N s::::: ■ommoommomi■momomO■E■EH■■ . . . 1111 11HE■�■HEOE■E■■ mem■mm■mmmt■m■■m�N■�MEN ■mN� ■■E■EEEEEE■■■■E■ XENON ■■ EE■EEEE■ ■E■ENE■EEE■ ■ ■■ ■momm■m .■E■N■H■■EENN■■■ .■11....Ns.N■■e..■■E■■E■■■■■■■■E ..■■�t.■■■■■■.....■.EEN■E■■■NNE■ ■1111■.■■NNE■H■■..NNEEE■■■■ENENEENNEEN■ ■.■■E■■EE■■EEE■EEE.■■NEEM■ ■■/■.■■■■.■■■E■/■■■■■■■■■■■■■■■■■EEEEE ■tEEEEN■O■EO.ON■■E■■mo■■.■ ■■t■■■■EENN■■EE■■■■■/■■■■■■■■■■■■■■■■■■■EEE■■■■N■■■■/■■■■■■■■■/■■■ ■■■NN11.■■.■.■m■...■■..■■■t■■■1111■■■■1111■H■11■11■■..sm11He..e.■■11■■.t■ ■■■.t.■NENENEENEEEE■■■■■■ENE■■■■■■■■N■■...■■■■.■■.■111111N■■■.N■■■.■ iii ■ iiii MENEM 0 MEMMEMMMEMEMMEMEMMERM■■■■E■EE■E■■■■■■■■■■■■EEOE.■■■ ■ ■EEEE■NEEEE■NNE■E■■■■■■■ Davie County Health Department and Home Health agency Environmenta(Heaf& Section P.O. Box 848 / 210 HOSPITAL STREET COURIER #09-40-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 August 28, 1996 i Boger Real Estate 4j 5248 U.S. Hwy. 158 togp j Re: Site Evaluation/Highway 601 North Tax PIN: #5813-89-3844/Russ, Steve Dear Mr. Boger: As requested, a representative from this office visited the aforementioned site on August 23, 1996. Based upon,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. If you have any questions, please feel free to contact this office. Sincerely, I Charles E. Little, R.S. Environmental Health Section CL/wd Enclosure(s) Parcel #: B30000000602 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Prooerty Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:830000000602 Account #:82525290 Owner Information BXF• Tax Codes Land: E'WELL ANDREW S& RAULSTON EWELL ALICE A Market: ADVLTAX - COUNTY TAX ssessed: 315 US HIGHWAY 601 NORTH Deferred: READVLTAX - FIRE TAX OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 1.000 LT CLARKSVILLE [Address: N US HWY 601 Deed Information Local Zoning Date: 02/2016 Book: 01011 Page: 0969 Plat Book: Page: Legal Description PIN 1.000 AC HWY 601 5813893844 Ej Property Values Buildin 0 BXF• 0 Land: 16,00 Market: 16,000 ssessed: 16 000 Deferred: 0 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00347 0495 10 2000 WD Unqualified Vacant 25,000 01011 0969 02 2016 QC Unqualified Vacant 0 3 00632 0080 10 2005 WD Qualified Vacant 5,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oN.Y. r,; Uri � ' 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)1753-6120. 1.5.9 1 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1475906 i 8/23/2016 I