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4361 Hwy 64W (2)10DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street (� Mocksville, NC 27028 (336)751-8760 Account #: 990003466 Tax PIN/EH #: 4798-60-3827 Billed To: David Stroud Subdivision Info: Reference Name: Location/Address: 4361 US Highway 64 W-27028 Proposed Facility Residence Property Size: 1 acre ATC Number: 3973 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). TIES AUTHORIZATION FOR WASTEWATER CONST IU IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: Z A� 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT -i' Environmental Health Section P. O. Boa 848/210 Hospital Street 71 Mocksville, NC 27028 _ a (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003466 Tax PIN/EH M 4798-60-3827 Billed To: David Stroud Subdivision Info: Reference Name: Location/Address: 4361 US Highway 64 W-27028 Proposed Facility Residence Property Size: 1 acre ATC Number: 3973 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a 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 #Baths Dishwasher: Pl*�' Garbage DisposalZ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _41 Design Wastewater Flow (GPD) `� Site: NewJ6e Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench WidtIj';F `-'/Rock Depth Linear Ft._�W Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a r=XLMjajjye of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. o ._.. p 0 .m. on �e installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: G�� L DCHD 05/99 (Revised) ECEEWE APPLICATION FOR SITE EVALUATION/IAlPROVEAIENT PERNII I RDavie County Health Department Environmental Health section JAN 19 2005 P.O. Box 848/210 Hospital Street , Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH DAVIE COUIM I ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I ti INFORMATION IS PROVIDED. Refer to}the INFORMATION BULLETIN for instructions. 1. Namo to be Billed DA ✓ / STi� d (lb contact Person Mailing Address 3Gl 67 VV Home Phone City/State/ZIPrIJoCKsyile NC Z70Z� Business Phone ?!j �%UZ- /%77 2. Name on Permit/ATC if Different than Above Mailing Address City/Stato/Zip 3. Application For: Ck Site Evaluation ❑ Improvement Permit/ATC Bloth 9. system to Service: House' ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: bg Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People Z # Bedrooms Z # Bathrooms Z Dishwasher 120arbage Disposal ®Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Businoes/Industry /other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Typo of water supply: ❑ County/City Do Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 11 No, If yes, what type? ***IA1P0RT1iN7'*** CLIENTS AIUST COAIPLETI THE RL•QUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AfUST 6ESUBA11TTED by the client with THIS APPLICATION. Property Dimensions: I ��K-� WRITE DIRECTIONS (from Mocicsville) to PROPERTY: Tax Office PIN: # % / 66 3 �Z %Ale �oS/W Eton, lnoc�4lv�� ( ry� /Oni✓J, Property Address: Road Nanzc a �l3G h(WV 6 VW -*91y LOA ew Alves a n City/ZipA�OCKr(Ae IVC Z7dZr 14we s 2) tewMQ�/ If in a Subdivision provide information, as follows: Qi2 40 rec -o &U_ hovft` .rlee if Name: ow aAe4 frD t7cat-.,/uakrtir �ey717� . r^ Section: Block: Lot: Date liome corners flagged: 1 1 D This Is to certify that the information provided is correct to the best of my knowledge. I understand that any persnit(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 than aur responsible for all charges hicurred front flsis application. I, hereby, give consent to the Authorized Representative of the Davie County IIcaltlz 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 7— Z do S SIGNATUIZE TRIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensignh structures, setbacks, and septic locations). Sign given Revised DCI1D (05/03 Datc(s): Client Notification Date: EI:IS• Account No. Invoice No. ac/6 � Wd 6Z:Z L66L X90 AeW Cott i Le1yN0 Q3X34N1 �� '�o r orlb (a 9LEL IYUJ sect LLCiF 0°; Cr�-p'�b«, 'rJQ► MOO rwc' WOO 10 it � iOZZ �M t c,w � J Legs rrcCLq k4w ccss rres¢�u lru-ul . � r r • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003466 Tax PIN/EH #: 4798-60-3827 Billed To: David Stroud Subdivision Info: Reference Name: Location/Address: 4361 US Highway 64 W-27028 • Proposed Facility: Residence Property Size: 1 acre Date Evaluated: Water Supply: On -Site Well t/ Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L r _ Slope % HORIZON I DEPTH �� < Texture group,G Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy N - 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: ba" LONG-TERM ACCEPTANCE RATE: < 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 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 - gaUday/ft2 EVALUATION BY: OTHER(S) PRESENT: DCHD 05/99 (Revised) ■■■■■■ ■E■■■■ neem■■ MESE■■ MEMS■■ ■■■■■■ ■■■■■■ ■■■■■■ MEMO■! ■■MMES ■■■■■■ ■■m■mui ■ ■ no ■EMME■ ■MEMS■ ■E■NE■ ■E■NE■ ■E■■E■ ■E■ME■ ■EMEM■ ■■m■■■ ■■SOME ■■■■■■ ■Ent■■■ I■EMMEM I■■■■■■ MONSOON IE■■■■■ ■■ OMEN OMEN NONE i ■O■■ ■■■■ ■O■■ MEMO ■ ■■■■■■■■�mm■■■mem■■■m■■ mommommilmoiiMENNEN�i ■■ ■■■■■■■■■■■■■■■■■■■ ■■M■■■E■■■■SE■N■■■■ ■■■■■■■N■■■■■■E■■S■ ■m■■■■■■■m■m■■■■■m■ ■■■■■■■■■■■■■■■■■■■ ■E■■■■■■■■E■N■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■NEEM■N■■■■■■E■ ■■■■■■■■■■■N■■■■■■■ Parcel #: J100000019 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 #:7100000019 Account #:8304898 Owner Information Buildin : Tax Codes BXF• ROUD REBEKAH CHRISTINE [361 Land: ADVLTAX - COUNTY T Market: US HWY 64 W essed: FIREADVLTAX - FIRE TAXCKSVILLE Deferred: NC 27028 04 2015 WD Unqualified Property Information Township Land (Units/Type): 2.751 AC CALAHALN [Address- 4361 W US HWY 64 Deed Information Local Zoning Pate: 04/2015 Book: 00985 Page: 0119 Plat Book: 10 Page: 237 Le al Description PIN 12.751 ac HWY 64 Lot 1 4798603827 Property Values Buildin : 48,95 CCCIII BXF• 3,80 Land: 33,90 Market: 86 65 essed: 86,65CI Deferred: 3 00985 0119 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00076 0228 07 1966 WD Unqualifled Improved 0. Z 00858 0695 05 2011 WD Unqualified Improved 0 3 00985 0119 04 2015 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 YI 0z 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=1450653 7/13/2016