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1282 Hwy 64W DAVIE COUNTY HEALTH DEPARTMENT C Environmental Health Section -� / 30 c) Y • - 7 P.O.Boa 848/210 Hospital Street .J Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT . Account M 990003188 Tax PIN/EH#: 5728-68-7264.BB • Billed To: Brent Brewer Subdivision Info: Reference Name: Location/Address: Highway 64 West-27028 Proposed Facility Residence Property Size: see map ATC Number: 3761 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of 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 4! #Baths_ Dishwasher:/ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply ('70 Design Wastewater Flow(GPD) Site: New❑ Repair❑ System Specifications: Tank Size/Od'UAL. Pump Tank GAL. Trench Width lsi� Rock Depth Linear Ft&P Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"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 in Ilation. Telephone#is(336)751-8760.**** PC7 Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) y–� AA-c%s J 0— DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003188 Tax PIN/EH#: 5728-68-7264.BB Billed To: Brent Brewer Subdivision Info: Reference Name: Location/Address: Highway 64 West-27028 Proposed Facility Residence Property Size: see map ATC Number: 3761 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 CO TRUCTION IS VALID FOR A PERIOD OF FIVE.YEARS. Environmental Health Specialist's Signature: Date: L 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,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. 10 Septic System Installed By: eP y� Environmental Health Specialist's Signature: may%// Date: ';7/ DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department D / Environmental Health Section p p P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760, ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TH INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instruct S. 1. Name to be Billed &y 1)A 3reLar Contact Person Mailing Address 14Z lllkle Qoad Home Phone U4416 City/State/ZIP iY1 oo-V& if me a-402 8 Business Phone 33(a-'�51. 35101 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC 6Pf Both 4. System to services ❑ House Ef Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: 16 Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People 1 # Bedrooms cl�— # Bathrooms l: 3 CJDishwasher []Garbage Disposal IJWashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If'Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply: 46 County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes 91-No If yes,what type? ***IMPORTANT'CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 3/`,, , ( WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: #_ 54a6-(08-r1a(oo . -E-E Nuw led " al Pool mnrlisat Purl- Property Address: Road Name r�1-L') y� o5e CLv 1 d ri 1Jentay nd Q io N - City/Zip C IDP IS Lel')OCLI mi(lOwall CtLle If in a Subdivision provide information,as follows: TPP LiL I P Name: Section: Block: Lot: Date home corners flagged:_� p t0 c( 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 Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE O d as too SIGNATURE ,g&o z} a r THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS• - Sign given Account No. a Revised DCHD(05/03 Invoice No. �' v 4 1306 7289 � 1294 5 6 72S) 14 3 29 216 � 222 C.n121N)N CO v t\J nNi 121 � v 120 ti DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003188 Tax PIN/EH#: 5728-68-7264.BB Billed To: Brent Brewer Subdivision Info: Reference Name: Location/Address: Highway 64 West-27028 Proposed Facility: Residence Property Size: :ee map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �' Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position At— L Slo % HORIZON I DEPTH Texture groupG Consistence ,Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure L- 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 SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slopeFS-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) ■e■sMMM■MM■MMM■■■■MMMM■■MM■■e■■■■M■■■■M■■■■■■■MMMMM■■MMMM■M■■M■■■■ ■■■■MM■■■e■■■■■■■■■■■■■■■■■■■■■■�■■■■■e■■■■■■■■■■■■■■■■■Mee■■■■■■ ■■■■e■■M■M■■e■■■■■■■■M■■■■■■■■e■ ■■■■■e■■e■M■■■■■e■■■■■Mee■■■■■■■ ■■■■■■MMM■■■M■■■■■■■■■■■■■M■■■■■■■■■M■■M■M■■e■■■■■M■■■M■■MM■■■■MM■ ■■■M■■■MM■M■■■M■■■■M■MMM■M■■■M■MM■■■MM■■MMM■MM■■■■■MM■■MMM■M■■M■■■ ■■■■■MMM■■MM■M■■■■■M■M■■■M■■■■■■■M■■■■■eMM■M■MMM■■M■■■■■■■■■■s■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■M■■MM■■■■■MM■■■MM■MMe■MMM■■■■■■■e■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■MMM■■■�■■■■■e■■■■M■MM■M■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■/■■■■■■■■■■■■■■■■■■■■■■■■MEMO ■■■■■■■■■■■■■■■■■■■■■■■■■■■■CGDE■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENMEMEMMIMMMEMME MMEMEM MEMNONEMEMEMMEMEME ■■■eM■MMM■■■■■■■■■■■■■■■SIMM■■■■■■■■■M■�!!■MMM■■■■■■■■MMEMM■MM■E■■■ ■■■■■■■■■■e■■■Mee■■ecce■�i�■■�.._-:■.�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ s■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■Mee■■■■e■■■ee■■■■ ■■■■■■■Mee■■■Mee■■e■e■■■■■Mee■■■ ■■■■ee■■��r�■e■■■■■■e■e■■e■■■■e■e■ ■■■■■■■Mee■■■Mee■■■ecce■■■■■■e■■�■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■ ■■■■■■■■■■■■■■■■■■■e■■■■■■Mee■■■Mee■■■■■■eee■■■■Mee■■■■Mee■■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■■■■■■■■ME■■■■■ ■■■■■■e■■■■■■■■■■■■■■■■■■■■■e■■■ ■■■■■■■■■■■s■■■Mee■■■■■■■■■Mee■■ ■E■■■■■■e■■■■■■■■e■■■■■■■eee■■■■■■e■■■■■■■■eee■■■■eee■■■■■eee■■■e■ ■■■eee■■■■e■■■■■■■■■■e■■■■■■■■■e■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■ ■■■■EM■■■■■■■■■■■■■■■Mee■■■■■■■■ ■■■■■■■■■ee■■e■■■e■■■e■■■■■■■■■■ ■e■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■Mee■■■■■■■■■■■■■e■■■■Mee■Mee■■■eee■■■■■■■■■■e■■■ ■■■■■■■■e■■■■■■■■■■Mee■■■■■■■■■■�■■■■■■■■■■■■■■■■M■e■■■■■■E■■■■■■ Parcel#: I400000093 = Page 1 of 1 oA�f� Davie County, NC - Basic Estate Search °OU14 Davie County Web Site 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#:I400000093 Account#:82522660 Owner Information Tax Codes R EWER BRENT ARNOLD ADVLTAX-COUNTY T T1282 HWY 64 W FIREADVLTAX-FIRE TAX OCKSVILLE NC 27028 Property Information Township nd(Units/Type): 0.680 AC MOCKSVILLE ddress: 1282 W US HWY 64 Deed Information Local tonin ate: 04/2004 Book: 00548 Page: 0808 Plat Book: Page: Legal Description PIN 10.700 AC HWY 64 5728686192 Property Values uildin : 55,91 BXF: nd• 14,51 01 Market• 70,42 ssessed: 70,42 eferred: Sales Information No. Book Pape Month Year Instrument Qua[/UnQual Improved Price 1 00548 0808 04 2004 WD Unqualified Vacant 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 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/itsneWiew.aspx?prid=1469677 6/30/2016