2521 Hwy 64EPermittee' '... y _ VIE COUNTY HEALTH DEPARTMENT
Name: �-�' �� �C1 Environmental Health Section PROPERTY INFORMATION O�
P.O. Box 848
Directions to property: Mocksvifle, NC 27028 Subdivision Name: " \1
Phone #: 336-751-8760
Section: Lot:
�/ AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION �5-� '
:AUTHORIZATION NO: Q Q 2 � � O A Road Name: ! ~ Z " Zip:-)
**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 Fonn/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)
17 or
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 1-1 # BATHS # OCCUPANTS 1 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
G
�J e 114 -114 -LOT SIZEy �� TYPE WATER SUPPLY �G �O
DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANKGAL. TRENCH WIDTH_ ROCK DEPTH4r we 'LINEAR FT. a I CJ ,
nTUFR 1 't C-' 1Cr �.1� . �n 1 �� O 1A k �� 'i 14 '1 is ✓t- Ci 1'e,,4% u• a , r -* 6 1 CL C -e
REQUIRED SITE MODIFICATIONS/CONDITIONS: _
IMPROVEMENT PERMIT LAYOUT
O�
464
tA
h J
V
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 PERMIT
C- Q ��
1t
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C1 L7 t,, SY �EMr � '�ALLED BY:
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L67,nV%1�It t
70 Nl O'c%Su ill -e 4— 6q
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102 (Revised)
..r,� ..r. i e �,.,- , � .:.:.t i „�;;"�.r .'a�a`w .�. r �' e;:_ .5 `:1, s ..tr -. ,,,. •. ^ . kyr-:-.., _, i . :r+m 'k:e" �''S
Permifitec',.t" x f ` DAVIE COUNTY tIEALTH DEPARTMENT
Name:= "�_ %4 ri-t ►`" Ott t(' Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
'Dire°tions�to prop y: �c= Mock'syille, NC 27028 Subdivision Name: `t
-{-1� Phone #: 336=751-8760
�,�.'. �''1 �,,, . C -►`'-t �d��� r Section: Lot: z
AUTHORIZATION FOR
X r/Cj ✓ .r -f 4- WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
i E AUTHORIZATION NO: D 0 0 A Road Name: t ��� � L Zip: 7e%)
;**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 11 cif G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ti
— ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
hoe
LOT SIZE V 4 TYPE WATER SUPPLY w DESIGN WASTEWATER FLOW (GPD) �2 qO NEW SITE REPAIR SITE L/
�� r
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANKA/ %/T i GAL. TRENCH WIDTH �� ROCK DEPTH LINEAR FT. I CJ +
17—
OTt4PR T- 4 --Yr ~) �R 1 'O t4 k ,I IA '1 t % vt c i r r:.n . U n , f –e d I A G -E
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT Ala
dA,
krh ki
V
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 PERMIT �� I
C�d�
0
y -a
SYSTEM INSTALLED BY:IU
4
Wit'
�e,K
16
to 1
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 01102 (Revised) JU14-
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Jai 4 y ca) kv � cta-t—
Water Supply: On -Site Well
Evaluation By: Auger Boring
Community
PROPERTY INFORMATION
P-1704
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L
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
_a
SITE CLASSIFICATION: EVALUATION BY:
r-- �
LONG-TERM ACCEPTANCE RATE: a ` ! OTHER(S) PRESENT: A 0 U V q a
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
ONSISTENC .
Moist
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
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)
T TA T) T
qb� Lrum
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME V G1 t V !'XV ttV-+ PHONE NUMBER jl � q` o
ADDRESS Z� L4S SUBDIVISION NAME '0I A
G (h q
I DIRECTIONS TO
INDGro V—P,A
LOT #.
DATE SYSTEM INSTALLED JINAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS Z NUMBER PEOPLE SERVED
n
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING Gc h
f1t 4A
�L 6�t
DATE REQUESTED INFORMATION TAKEN BY 'e
This is to certify that the information provided is correct to the best of my knowledge, and that I understand 1 am responsible for all charges incurred from this application.
SIGNATURE OFOWNER
OR AUTHORIZED AGENT A�
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GoMAPS - Davie County NC Public Access
i
Davie County, NC - GIS/Mapping System
Page 1 of 1
QRS t Click Here To Start Over Quick Search: (Count} ID c
•' EF f L! Clu Active Layer. ZUse Map Tps GIsQ
� �, �
PARCELS (Map Tips Available) YO
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http://maps.co.davie.nc.usIGoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=4129... 9/2/2008
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Parcel #: J700000014
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #:3700000014 Account #:24890000
Owner Information
Tax Codes
ADVLTAX - COUNTY TA
EVERHART DAVID WAYNE
521 US HIGHWAY 64 EAST
FIREADVLTAX - FIRE TAX
MOCKSVILLE NC 27028
16 32
Market:
Property Information
Township
nd (Units/Type): 0.800 AC
FULTON
ddress: 2521 E US HWY 64
0
Deed Information
Local Zoning
Pate: 11/1990 Book: 00156 Page: 0880
1962 WD
Plat Book: 0003 Page: 044
Vacant
Legal Description
PIN
LOTS 31-37 KNOLLWOOD
5767396515
Property Values
Building:
84 31
BXF:
8 59
Land:
16 32
Market:
109 22
ssessed:
109 22
Deferred:
Vacant
Sales Information
No. Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
l 00062
0311
04
1959 WD
Unqualified
Vacant
0
>_ 00066
0241
11
1962 WD
Unqualified
Vacant
0
1 00108
0699
08
1979 WD
Unqualified
Vacant
0
1 00156
0880
11
1990 WD
Qualified
Improved
71,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
0
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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=1489814 6/23/2016