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2328 Hwy 601SJi HEALTH DEPARTMENT RELEASE dor office use only *CDP File Number 196992-1 Davie County Health Department 210 Hospital Street County ID Number. P.O. Box 848 Evaluated For: HDRMIWC `°- Mocksville NC 27028' Phone: 336-753-6780 Fax: 336-753-1680 PERMITVAUD 0 9 a s a 0 a 0 UNTIL: Applicant: Address: City: William D Gamble 1086 Williams Road Advance State2ip: NC 27006 Phone #: (336) 970-8227 Property Owner. William D Gamble Address: 1086 Williams Road City: Advance State0p: NC 270,016 Phone #: (336) 970-8227 Property Location & Site Information Address2328 US Hwy 601 S Subdivision: Phase: Lot: Road # Mocksville NC 27028 SINGLE FAMILY Township: 'Structure: Directions *of Bedrooms: 2 # of People: Hwy 601 S on right directly across from Church of God of Prophercy. 'Water Supply: N/A Basement: ❑ Yes ❑ No Type of Business: Total sq. Footage: No. Of Employees: _N'Proposed Improvement: Replace home Maintain a 5 foot setback to any portion of the septic system. This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps. Signature; *Date: *Issued By; 2140 -Nations, Robert Authorized State Ag *Date of Issue. 0 9 1 a 2/ a 0 1 5 t **Site Plan/Drawing attached.** `' " @ Hand Drawing OImport Drawing Drawing Type: HEALTH DEPARTMENT RELEASE 196992-1 Davie County Health Department CDP File Number: 210 Hospital Street P.O. Box 848 County File Number: Mocksville NC 27028 Date: _ 0 9 / a a / 210 1 5. Olnch Scale: OBlock Health Department Release ON/A I d. .".' . N (Ne '4 -J/ t Y6(t ...... - Davie County Health Department ponmenta . Health Section P.O. Box 848 RECEIVED 210 Hospital Street Courier # : 0940-06 Dace: Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFI (Check One) Replacement Remodeling Reconnection Name: iCtM Phone Number 3 (Home) Mailing Address: W �� i C W5 a — a�� (Work) A62- , Ax, D tMG Detailed Directions To Site: 6-0 50L'k4in or\ GCA -s. P 39 S u-5 Vioy bol's 1,61 Property " � C-kujzt4 0�-4 &0).S , A-4 O� Please Fill In The Following Information About The EXISTING Facility: I Name System Installed Under: V ( yk1 -i J V l(- E(KType Of Facility: �n /� Ja*1,e �-)z9!►� Date System Installed (Month/Date/Year): -7/1 Number Of Bedrooms:—;L Number Of People:_ Is The Facility Currently Vaca aYe No If Yes, For How Long7���5 Any Known Problems? Yes No f Yes, Explain: Please Fill In The Following Information About The NEW Facility: nh Type Of Facility: J U obl' m42- Number Of Bedrooms: Number of People Pool Size: AIA- Garage Size: 04 Other: N Requested By: —""' IAQ� Q -X --Q Date Requested: tO —1 (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee , (extended or limited) that the on-site wastewater system will function properly for any given period of time. Check Money Order # Amount:$ Date: Paid By: Received By; /96�� ojyl 93�� U15 i+W/ 00 s MOCkt5vi((e f&)(-;r7*-Y Davie County, NC Tax Parcel Report Thursday, July 21, 201E J —1 X21 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: L5150A001401 Township: Jerusalem NCPIN Number: 5746233393 Municipality: Account Number: 8305538 Census Tract: 37059-807 Listed Owner 1: GAMBLE CANDANCE Voting Precinct: COOLEEMEE Mailing Address 1: 2328 HWY 601 S Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27028 Voluntary Ag. District: No Legal Description: 1.002 AC HWY 601 Fire Response District: JERUSALEM Assessed Acreage: 0.98 Elementary School Zone: COOLEEMEE Deed Date: 6/2015 Middle School Zone: SOUTH DAVIE Deed Book I Page: 009900951 Soil Types: CeB2 Plat Book: Flood Zone: X Plat Page: Watershed Overlay: - , WS -IV -P Building Value: 0.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 14750.00 Total Market Value: 14750.00 Total Assessed Value: 14750.00 v� All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the Davie County, NC implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold � !, harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or °c h, causes of action due to or arising out of the use or inability to use the GIS data provided by this website. Parcel #: L5150A001401 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 #:L5150A001401 Account #:8305538 Owner Information Tax Codes AMBLE CANDANCE ADVLTAX - COUNTY T E328 HWY.601 S FIREADVLTAX - FIRE TAX OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 1.000 JERUSALEM [Address: Deed Information Local Zoning Date: 06/2015 Book: 00990 Page: 0951 Plat Book: Page: Legal Description PIN 1.002 AC HWY 601 5746233393 Property Values Building: BXF• Land: 14 75 Market: 14 75 assessed: 14 75 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00990 0951 06 2015 NW Unqualified Vacant 0 View Property Record for this Parcel View Map for this Parcel View Tax Bili Information 1" Return to Basic Search Page 1 of 1 ON -47 ®rn,-,,6 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 h4://maps.daviecountync.gov/itsnet/View.aspx?prid=1481630 7/21/2016 J a. r� DAVIE COUNTY HEALTH DEPARTMENT0f �� - '' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION x i *NOTE: Issued in Compliance With Article If of G.S. Chapter 130a ` Sanitary Sewage Systems Permit, Number Name 16 a,I Date -L U N- J 1 j 0 z 655 Location; `S`:, Subdivision Name O Lot No. Sec. or Block No. i Lot Size House Mobile Home _ Business Speculation No. Bedrooms 3 No -Baths No. in Family — Garbage Disposal YES ❑ NO Sp ecifications for System: Auto Dish Washer YES NO ❑ ! 6 o o Auto Wash Ma shine YES p' NO ❑ C Type Wa er Supply j' *This per it Void if sewage system described below is not installed within 5 years from date of issue. r This pe'r it is subject to revocation if site plans or the intended use change. 0 0 *Contact a representative of the Davie 9:30 A.M. or 1:00-1:30 P.M. on days,o .A moo~ Final Installation Diagram: 17, 3 Improvements permit by HealWerartment for'final inspection of this system betwe6h :8:30= letion. Telephone Number 704-634-5985. EuEN System Installed:b u Y Certificate of Completion ��''=� 1_ Date - j Li i 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. s APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT °Q.d` Davie County Health Department Environmental Health Section • P. O. Box 665 �) ko ZJr (-� MocksvilN.� 27028 �—ai S d t CONSTRUCTION SHALL NOT _B�ECINN N TI�,..,1NAPROVE�MENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested By PG Business Phone 2. Address 3. Property Owner if Different than Above Address 4. Permit To: a) Install v Alter Repair * b) Privy Conventional Other Type Ground Absorption c) Sub -Division Sec. Lot No. 4 _�_lU. B— 7.'o .2— 5. System used to serve what type facility: House Mobile Homes Industry Other b) Number of people 6. ay If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes 'Z' urinals garbage disposal lavatory 2, showers Z-- washing machine dishwasher Z sinks / 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions -:7— , %; -T, �- b) Land area designated to building site ,x c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is corre o the hast of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: •u, rix. ',�ti I Yf'W" Cry, >H.. ^,� +b w..e .� • � _•ilk„ .�, ,i - �: •� -. ^'J a • tt 8� f a ay{. vy , A �`,% e ,�Q,r >� Ai f Y.1, �� },•, 14�`. :t.f g' ".!"'ti.; ,rA _ 'k.. +.l` �•t'J pr 0 V ' Y•.b �. 1. •. .1 9 r s �` 1� ��' r� _ tt 1/ r� Y .l � •. co CI1 is y CID �e,9 {" i ("i�°�,'�. ^i.1 ♦ yr „� a• n'J >p �c' ', � ;-itis �'� '�,�. ` . `4'�•. l� _ / Nom' Fyt_ '` s �'•��` �' , ,AAr' �►1 •,i � 11.4'14 t a 305.51 Ilk co10 y • j•''...P �:�, `' ,tea. , `>� i�.T rR �, -'E 'F f M I �'! •,,1 �"'W.. s: r.. e¢t,.. J Tye t a; , ; �. kt ti'.7y.: ` �\ • _ Y . m OD AHjH4 '+,! �, .: �r� �. 111!!!^^^•••/// ��•.��ei{ / .� r„y yl�. k:+wwj~'"s! �ti � a•nY �"'r A"� 100 • r �.. � 4 � � �j�y�{}���� � I• ;�' �• '• \ / Tri'. ._ 84.,x., yJ �`� __r-•� '_ •��"•.. gyp, � � ��', i;. ( �,i , . •t`, � a"�''q; � Y-41 - w'`� mow.• ,. •.A.' \. ;'.� � _ Pe) t7��J�(,r � rvj� '111 19 32 Y'3 j4: r �r' r� � � � ' •ham � ( � ? �'"� �! /i J li �� t •. ' r �„ . '�Q�'�,�� t I,� � � •tom- �,� r`' trn -.b S OD �7' ;� aN• t�� ef� � �\� � �1 � � � r I • f. is w 2 5 S 44 a -S 1 9 I, ►95. _ J, 90 co tl (NJ 1 � O IN 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE . �s PROPOSED FACIILTY `� ` " "" LOCATION OF SITE Water Supply: On -Site Well Community Public ✓ Evaluation By:C _'F_'fS-Auger Boring 1✓ Pit Cut FACTORS - --1 2 3 4 Landscape position S -5 s Sloe 7. -15" - —O 9 -YS° -1 — HORIZON I DEPTH Texture groupC L CC L Consistence P7 I FT V Structure CK I C Mineralo { '. l , l ,1 1 HORIZON II DEPTH 4a 40" Texture group Z__ Consistence i Structure A Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS 5S SS SS - RESTRICTIVE HORIZON -- SAPROLITE - -- — _ CLASSIFICATION S S S S LONG-TERM ACCEPTANCE RATE - 1;-, o 5-, -.40 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: C OTHER(S) PRESENT: o a 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 watef 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 ■■■■■.■■.■.■■■■■■■■■■■■■■■■■s■■■■■■■■■■■.■■e■■e.■■......■■ ■■■■■tee ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■.■■N■■■.■■■■■■■■■■■■■■■■■■■ ■■..■■...■.i.■.■e..■■■..■..■�■■■ .....■.........■..........■....■......................... ........ ■■■■.■ ■■■..■ ■■.■■■ ..■■.■ ' ■...■■ MMEMEMSEMERIMEM ■■.■■■ ■■■■■.■■...■■■■e'w�l.■■e.■■■■.■■■■...■■.■■■■■■■■..■..�■e■■■..■■■■.■■ ■.■■■.■■.■■■■.■■1'�il� .f .■...■■■..�■■■.M■■■.■■■■■■■■■e■■■■■■■■ .■.■ ■■■■.■..■■■■■■■■11/IL•.■a■■■■..■.■■■■■■■■■■■■■.■■■■■i■■■■■■■■■■■ ■■■■ ■.■■■.■■■■■■.■■■�i�i■■i.■■■s■.■■■■i■■..■i■■■■■■.■ to ■■■■■■e .■■■■■ ■ ■■■■■■..■■.■■■■■■c:at.�■■■■■■.■■■viii■■■i■t ■■■■■■■■.�.■■■■s■■■■■■■.■ ■■■■■■■ ■■■ .■■■�lili ■\■■■■.■■■■■.■■.L\l�■e■■S1l�\■■■�I.■■■■■■■. ■■■■■ ■■■■■■e ■■■ ■■■■Ali'�r■���■■■■■■■■■■■■■■ic:�■■■■■�,��■■■��■e■■■.■■■s■■■e■■ ■■■■■■■■■■■■■■■■■■.■■■��■■■■■■.■■ ■■■■■■..■■.■.■■.�.■■■■.■.■■■�■■■■ ■■.■■■.■■■■■■■■■■■.■.■■.■■.■■■■ue.■■■■■■■■■e.■■■■■■■.■....■...■■■ 9 `fro 3 0 v mm IV 505'5 � 1 . to cj to O cp i `L• 1 ci r f1r) �q-7.46 32 I 44 204 204 J 54.