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A ORIZA"TION NO: DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittees" P.O. Box 848
Name: ' Mocksville, NC 27028 Subdivision Name:
ry
Phone #: 704=634-8760
Directions to property:;. Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# '*
SYSTEM CONSTRUCTION d' -
Road Name: Zip:
**NOTE**.This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior,
to issuance of an' 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 l l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
r ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH ECIALIST': DATE ISSUED
��,;-�f Y- :'tea 6,:4'�.y ��"`g.f'"'aLtiawvL,�Y'r.n..V•h...:'''�s .. �'1�^}�`*'=-*�-c-.e.+",. �* s7.�.,:� ,.-� - _ ^ .. L
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DAVIE COUNTY HEALTH DEPARTMENT
1 6
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Perms
Subdivision Name:
rT `Directlons•to-propeity.",. Section: Lot:
t x» . �.,• w : EWPROVEMENT
PERMIT Tax Office PINI . e. -
Road Name: Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic 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)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
f PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH PECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM. �}►
:RESIDENTIAL SPECIFICATION: BUILDING TYPE -LL # BEDROOMS 2_ # BATHS A # OCCUPANTS 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) NEW SITE C` REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE/11;12d GAL. PUMP TANK GAL. TRENCH WIDTH -1�� ROCK DEPTH /Q LINEAR FT. QO
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**CONTACT 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.
OPERATION PERMIT
1` AILED BY:
Io,
YAP
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r
AUTHORIZATION NO. V OPERATION PERMIT BY: DATE: v
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 WELL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
• y
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERN
� V R
Tax Office PIN: -# f '119 - '74)
._ .
Davie County Health Department
Mocksville) TO PROPERTY:
Environmental Health Section
r-
Property Address: Road Name Re k1 nj 1 a 4
APR -9 10
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P. O. Box 848
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A fC COSS TO
Mocksville, NC 27028
.
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s� (336)751-8760
1
If in Subdivisionrovide information, as follows:
p
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
1
ALL THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed
� r
D w a U w f- w ► S V�'E Contact Person
Mailing Address
�S al Jl e 9 dVIA G & 1ZJ - Home Phone 9
City/State/Zip
NQc-k t 1 l 0'C
NK `a r)o al _ Business Phone y-er
Cw.///NtekjyMaro�+ 7jm-s'as l
°� S �S ��
2. Name on Permit/ATC
if Different than Above W y JAS W
Mailing Address
�t 3 of die a d IAAot\ Pc� . City/State/Zip V 6 5- CSU M K— C 7D3
3. Application For:
Ae Site Evaluation ❑ Improvement Permit & ATC Both
4. System to Serve:
❑ House I Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence:
❑ Dishwasher
6. If Business/Other:
# Commodes _
If Foodservice:
# People 3_
❑ Garbage Disposal
Specify type _
# Showers
# Seats
# Bedrooms ,
`'Washing Machine ❑ Basement/Plumbing
7. Type of water supply: County/City
# Urinals
# Bathrooms .1
❑ Basement/No Plumbing
# People # Sinks
Estimated Water Usage (gallons per day)
❑ Well
# Water Coolers
8. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Community
❑ Yes & No
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A P, ?66M THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 3 �-®' •
1 WRITE DIRECTIONS (from
Tax Office PIN: -# f '119 - '74)
1
Mocksville) TO PROPERTY:
14W & y
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Property Address: Road Name Re k1 nj 1 a 4
Yylz S
1
X
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C S
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A fC COSS TO
City/Zip (,�
.
1 /ltro"+ C7 k
1
If in Subdivisionrovide information, as follows:
p
1
1 tt i
Lo
Name: -
1
Section: Lot #:
�—
1
1
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 kJW/ Vve to conduct all testing procedures
as necessary to determine the site suitability.
DATE q-9 " 9 � SIGNATURE
L
Revised DCHD (06-96)
YOU MAY USE THE BACK OF THIS FORM FOR DRAWINC� YOUR SZTE PLAN.
V1 n
n
The Davie County Tax Administrator's
Office assumes no liability for any
information contained on this map.
Public information sources should be
consulted for verification of
information.
April 09,199810:51 AM
Parcel Identification Number
5769-88-7070
DAVIE COUNTY HEALTH DEPARTMENT
- Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME c ,�L,S�I •/
PROPOSED FACILITY ��% Z/V
SUBDIVISION
DATE EVALUATED
PROPERTY SIZE
ROAD NAME l�
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring L/
Pit
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
+
d r
Texture group
Consistence
i
Structure
Mineralogy,'/
l • /
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 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 I 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 (01-90)
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MEN
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Parcel #: H30000005804
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 #: H30000005804
Account #:72336500
Owner Information
Tax Codes
Building:
WISHER HARDING DWAYNE & SWISHER CYNTHIA S
US HIGHWAY 64 WEST
OCKSVILLE NC 27028
ADVLTAX - COUNTYITAJ166
READVLTAX - FIRE
3,060
Land:
24,300
Property Information
Townshi
Land (Units/Type): 3.333
ddress: 2165 W US HWY 64
CALAHALN
Deferred:
Deed Information
Local Zonin
ate: 11/1997 Book: 00198 Page: 0537
Plat Book: Page:
Legal Description
PIN
13.333 AC HWY 64
5719746371
Property Values
Building:
64,09
BXF:
3,060
Land:
24,300
Market:
91,450
ssessed:
91,450
Deferred:
Sales Information
No. Book Paye Month Year Instrument Qual/UnQual Improved Price
00198 0537 it 1997 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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vP.7t�
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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=1464676 7/14/2016