1809 Hwy 601S]�ecttufte�es DAVIE COUNTY HEALTH DEPARTMENT
Name: AM WtJ Tr Environmental Health Section PROPERTY INFORMATION
�-i 4.�S P.O. Box 848
Directions to property: Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO. 002640 A Road Name: i 4 gip:
. **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 Forin/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In co, mpl an -4 with Articl I 1 of V"S^ iapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ff ,_, ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
L �i/ IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRON ITA SP CIALIST DA ISSU D
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE— T OPLE # PEOPLE/SHIFI # SEATS T— INDUSTRIALV. ASTE: Yes No
LOT SIZE •�— �T�'PE WATER SUPPLY'X r DESIGN WASTEWATER FLOW (GPD) 32 NEW SITE REPAIR SITE
'YSTEM SPECIFICATIONS: TANK SIZE 1a30GAL. PUMP TANK GAL. TRENCH WIDTH :5( ROCK DEPTH �' LINEAR FT. +1
OTHER /J IO tis l.,i�l'1�+4►P l?1�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMq •�
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AUTHORIZATION NO. OPERATION PERMIT BY: A � DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL IND A THA THE S TEM DESCRIBED�BOVE H�S B EN INSTALLED IN COMPLIANCE v
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900,'SFWAGE �Tv�ENT AND DISPOSALS STEMS'"I;BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SA f�ISFACTO$IL ,F Fifa) ANY GIVEN,PRIOD OF TIME. j
DCHD 02102 (Revised) \1i
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- DAVIE COUNTY HEALTH DEPARTMENT
Namo:. - Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to P;erty: t'Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
" Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
�
r AUTHORIZATION NO: 002640 A Road Name: V;VT1% I �%1p:
**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 compliange with Article 11 of GS -G apter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
i . .� �`' '"f •�'i IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRON TAL AL'fH SPECIALIST DA ISSU D
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
•T�IiJ
COMMERCIAL SiiPECIFICATION: FACILITY TYPE # PEOPLE "'` # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes r No
LOT SIZE
- ` S PE WATER SUPPLY i- Xt""( DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE 1(X0 GAL. PUMP TANK GAL. TRENCH WIDTH "�" ROCK DEPTH. � ` • LINEAR FT.
" OTHER I Jy.�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. Ol THE DAY OF INSTALLATION. TELEPHONE # IS (336).751-87'60.
OPERATION PERMr�'
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AUTHORIZATION NO. OPERATION PERMIT
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**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE'
WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGI
GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT{SFACTORI
Pb— - • � I �. �. DATE:
T THE S STEM DESCRIBED'ABOVE I
EATMENT AND DISPOSAL SYSTEMS
OR` ANY GIVEN PERIOD OF TIME.
DCHD 02102 (Revised)-
kS BEEN INSTALLED IN COMPLIANCE
'BUT SHALL IN NO WAY BE TAKEN AS A
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑
Name: Mi n n i Q. B (A, (►1Q-,-(+ Phone Number:33G - % S'1 -02 55� (Home)
M&&g g Address: 15'0 Mauki req AV L. (Work)
lylor I S Yi I Le N C 7_3021
Detailed Directions To Site: 'I D J�(n n / S
Property Address:
Please Fill In The Following Information About The Existing Dwelling.
1
Name System Installed Under: , Type Of Dwelling: Awl 5
Date System Installed(Month/Day/Year): ? Number Of Bedrooms: AIA Number Of People:ZITY4S
Is The Dwelling Currently Vacant? Yes)4 No ❑ If Yes, For How Long?
Any Known Problems? Yes ❑ NoX If Yes, Explain:
Please Fill In The Following Information About The Newr Dwelling.
Type Of Dwelling k°d5kdJ Number Of Bedrooms: N Number Of People:
(Signature)
For Environmental Health Office Use Only
Approved ❑ Disapproved ❑
Environmental Health
Requested: q- 13' O�,
"The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a I
¢uarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ Date:
Paid By: Received By:
Account #: Invoice #:
{L'i'"4:,w' s ,t�, ',ri/^ ^w. ,t" i y. `.�# .,. ."✓t t ... '4.' r,h". ^:T.w. a : —•, i - > > r - .,..t` t' '1Y-" „a... r,—*r ".ba
DAVIE. COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
" .., Phone: (336)751-8760
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) REPLACEMENT ❑ --REMODELING o RECONNECTION ❑
Name: Mi nn i' Q, � Lc (nc' 1 T J '—Phone Number -.33(c.- '7S-1 -0 2 5 5� (Home)
Address: 15 U 41 a rk I i' AV e '� �'' �'. (Work)
Detailed Directions To Site: ��'� i , (c n / 5
Property Address: ! dy
Please Fill In The Following Information About The Existing Dwelling.
Name System Installed Under: -0 Type Of Dwelling: rLd 5 �0
Date System Installed(Month/Day/Year): - Number Of Bedrooms: l✓ Number Of People: 6yCCS
Is The Dwelling Currently Vacant? YesA , �_No ❑ If Yes, For How Long?
Any Known Problems? Yes ❑ NoX.-...If Yes, Explain: "
Please Fill In The Following Information About.The New Dwelling.
Fcx
' • # : r
Type Of Dwelling: S Number Of Bedrooms: Number Of People:
V .. 1
R e �� I /1 Date Requested: q- i3- 01,
(Signature)
Approved ❑
Comments: -
For Environmental Health Office Use Only
Disapproved�
Environmental Health
o�
Date
grantee extended or limited that the on-site wastewaters stem will function properly for ari &ven a
"The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as
Su ( ) Y P Pe Y Y $1 period of time. •
Payment: Cash ❑ Check ❑ Money Order ❑ # Amount:$ Date
Paid By: Received By:
Account, #: Invoice #:
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: Tax PIN/EH #:
Billed To: ' �eI "-Subdivision Info:
Reference Name: Location/Address: C�o1s
Proposed Facility: Property Size: Date Evaluated:
i
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3 E 4 5 6 7
Landscape position
I L_
L
Slope %
Cm
LT
HORIZON I DEPTH
Texture roup
Consistence
Fr S
Structure
Mineralogy
HORIZON II DEPTH
- --
---- ---
/ �{
Texture group
Consistence
Structure`
-v
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
-
Structure
,
Mineralogy
SOIL WETNESS
2 i
RESTRICTIVE HORIZON
/
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
0
SITE CLASSIFICATION: it
EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: �' 2� OTHER(S) PRESENT:
REMARKS:. V ,Ad \444
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 '
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)
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Parcel #: K5150A0012
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 #: K5150A0012
Account #:64888000
Owner Information
Buildin :
Tax Codes
BXF:
SHEETS JOHNNY& SHEETS JUDY
Land:
ADVLTAX - COUNTY T
Market:
229 US HWY 601 S
ssessed•
FIREADVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 1.420 AC
JERUSALEM
ddress: 1809 S US HWY 601
Deed Information
Local Zoning
Date: 04/2000 Book: 00330 Page: 0868
Plat Book: 0001 Pa e: 097
Legal Description
PIN
OTS 42-45 R P ANDERSON
5746190899
Property Values
Buildin :
14,25
BXF:
Land:
52,58
Market:
66 83
ssessed•
66,83
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00330 0868 04 2000 WD Unqualified Improved 65,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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MYVI
0ut 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/itsnetfView.aspx?prid=1473967 7/14/2016