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1510 Hwy 801NNo f IN CDP jDvie County Health Department 4sjGr�vironmental Health Section P.O. Box 848 G 210 Hospital Street p II A Courier # : 09-40-06 Mocksville, NC 2702E Plione: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION (Check One) ReplacementO Remodeling❑ Reconnection[Z] Name: Southern Energy Management Mailing Address: 101 Kitty Hawk Drive Morrisville NC 27560 Em (336) - 753-1680 Number 919-836-0330 (Home) same (Work) Detailed Directions To Site: follow US -158 E . Turn left onto Redland Rd. Turn left onto N Carolina 801 N. Turn right. D ion on Left (11(D 0001)(Y) 117 an Address: ;1510 NC Hwy 801 N Advance, NC 27006 - - Please Fill In Facility: Name System Installed Under: Mark H Holshouser (homeowner) Type Of Facility: single family home Date System Installed (Month/Date/Year): n/a Number Of Bedrooms: n/a 2 Number Of People: n/a Is The Facility Currently Vacant? Yes❑ No❑✓ If Yes, For How Long?. Any Known Problems? Yes❑ No(] If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: pole mounted 24 panel solar array Number Of Bedrooms: n/a S Number of People n/a Pool Size: n/a Garage Size: n/a Other: see attached document for set backs 8/10/12Requested By:t (Signature) For Environmental Health Office Use Only Ap ro Disapproved 4V/I1111C:11 Environmental Health Date: *The signing of this form by the Environmental Health Staff is in 19 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. Payment: Cashheck Money Order # f)23D/y Amount:$ tUU-U/ Date: I (/ Paid By: Received By: Account #: Z Invoice #: Z y Y is f eYw IY pvOi.. l T p rbs Go earth 51( (-spn t bt u gspgt suz rr) of 261( Cspn opsui qspqfsuz njof 311( Cspn xf t u gspqf suz rrj of 611( Cspn t pvui gspqf suz nj of feet 800 meters 200 0 •. k rr i.� - �'�'t `" 'may � .. .\ f., 'fd lit• �., ' T is f eYw IY pvOi.. l T p rbs Go earth 51( (-spn t bt u gspgt suz rr) of 261( Cspn opsui qspqfsuz njof 311( Cspn xf t u gspqf suz rrj of 611( Cspn t pvui gspqf suz nj of feet 800 meters 200 0 -: •- DAVIE COUNTY HEALTH DEPARTMENT P Ole Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002384 Billed To: J.M. Builders, Inc. Reference Name: Qoa?-o,e- 7`- 14-0X Proposed Facility: Residence ATC Number: 3361 Tax PIN/EH #: 5852-79-3029 Subdivision Info: /6/v Location/Address: Highway 801-27006 Property Size: see map 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 WASTEWA O STRUCTION IS VALIDFORA PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: '� ,' Date: o� ` 5� "�3 ?061K -5 - CERTIFICATE OF COMPLETION **NOTE** The issuance of this Cenul too Completion shall indicate the system described on Improvement/Operation Permit has been installed in cc pi ce th Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Sy s," but shall NO AY be taken as a guarpntee at the system will function satisfactorily for any given period of 'me. j ;`I Q/'f Septic System Installed By: Environmental Health Specialist's Signature: 2.�;� Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section (' P. O. Boz 848/210 Hospital Street l "� Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002384 Tax PIN/EH #: 5852-79-3029 Billed To: J.M. Builders, Inc.Subdivision Info: Reference Name: 'kOBkopr �a f . Location/Address: Highway 801-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3361 **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: Garbage Disposal Washing Machin Basement w/Plumbin�Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: EI Lot Size ld tp C Type Water Supply tr �� Design Wastewater Flow (GPD) Site: New Repair 13 System Specifications: Tank Size GAL. Pump Tank �AL. Trench Width Rock Depth Z� "'Linear Ft. _9 Required Site IMPROVEMENT/OPERATION PERMIT LAYOUT FINISHED GRADE. ****NOTICE: _ Contact a o system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m IVED EFFL JE T FILTER RISERS) IF 6 " BELOW the Davie C an Health Department for final inspection of this 1he day of in tall ion. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: Coto y '7)— — S— �3 Y APPLICATIO V FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Env1ro1Zmenta/Hea1th SOW= I ( l .O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 7. Type of water supply: unty/Ci.ty LI Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Do(� ' Property Dimensions: X 2 6o Tax Office PIN: # 2 7 t' —'O oS2 Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Section: Block: Lot: Date Property Flagged: �'�- ©2 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 suitility DATE — 2 ^�� SIGNATURE w THIS AREA MAY BE USED FOR DRAWING YOU TE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, ` setb and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS• Account No. Invoice No.� i 1. Name to be Billed V . 1 t V L'LlAa&, Contact Person V Mailing Address ``I��� �p• V � �' r v\ I� 7 Home Phone ���1 ^ -5 to City/State/ZIP I Q AS -b A 1 1()�' ' Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation (improvement Permit/ATC /❑ 4. System to Service: M House 0 Mobile Home Business ❑ Industry ❑ Other 5. If Residence: # People_ # Bedrooms # Bathrooms hYliishwasher L✓6arbage Disposal LP�Waishing Machine LWBasement/Plumbing 1.1 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks #'Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: unty/Ci.ty LI Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Do(� ' Property Dimensions: X 2 6o Tax Office PIN: # 2 7 t' —'O oS2 Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Section: Block: Lot: Date Property Flagged: �'�- ©2 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 suitility DATE — 2 ^�� SIGNATURE w THIS AREA MAY BE USED FOR DRAWING YOU TE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, ` setb and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS• Account No. Invoice No.� i 711>3 33 311--063 n . N 029 o z ,1+1KT FO 7 o c - ,-,fl L r N rRof-fiqT 1'' = lob� rn.r-PC(--6o.o1 Uj DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002384 Tax PIN/EH #: 5852-79-3029 Billed To: J.M. Builders, Inc. Subdivision Info: Reference Name: Location/Address: Highway 801-27006 Proposed Facility:. Residence Property Size: see 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 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope, FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slopeT - 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) s'. D APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERM711* Davie County Health Department EnviionmentaiHeaith Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for ins 1. Name to be Billed J/ ( 1 k U D (/- (- Mailing Address 3 ---�-5 1�eod Co City/State/ZIP n s rQ At? � 2. Name on Permit/ATC if Different than Above Mailing Address t/qN 2 8 ?o �OA0, OZ Contact Person e / (►1 �qj h Home Phone 33 (o - 971- 2 79 - Business Phone 33& - 994 J 90 D City/State/Zip 3. Application For: VSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People - of # Bedrooms # Bathrooms 3 Dishwasher Garbage Disposal washing Machine VBasement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: )eCounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo If yes, what type? k**IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBAUTTED by the client with THIS APPLICATION. `01 Property Dimensions:. WRITE DIRECTIONS (from Mocksvillc) to PROPERTY: Tax Office PIN: # 0. L-02� - I l0 V �- `'� V 0 0 Property Address: Road Name I V O 1 T n 0 1 City/Zip �o C LA- S v I l Z �'id� �-� re'1�,Y �/�nt? Y) A-V-, AJ, If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: 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 Vounty Healtl epart� nt to enter upon above described property located in Davie County and owned by to conduct all testing pr wedures as necessary to determine the site suitability. DATE S SIGNATURE 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 Revised DCHD (07/99) Datc(s): Client Notification Date: EHS• Account No. �� 3 Invoice No. Z� 3 (3.08 A) 4943 t - a5+o ay h>. , (17.04A) 7809 8952n>') I•• •`� s 2888 8982 a I .1866 - a 00 , 06000053 i 4852 Reel pn) 0051 p21) 0000005301.4664p 7670 C6000OW7202 Pte) 7.4SA C60005 f it 273 C600000058 a 0600000056 ( 060000006601 efic I I 5.27A M . 1160 . :C600ogOp6o � I . 6A p 6049 C6000 '7510 (( 13.32 A 2580 4idiu.) 04327A) ` 16 e: /1 s - (3.21 A) 1 1046 .. ::;:. + �• ry ( f902A) . 41.Al . ISO ml I 21A) T54r♦ $92 3 I S429 475 J •3082 Z0 39Vd AI-IV3N NOI9NINN3d EBE6LSZ9££ ZD:SO Z90Z/8Z/i0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account P 990002138 Billed To: Dr. Robert Fox Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By: PROPERTY INFORMATION Tax PiN/EH #7 5852-79-3511.01 Subdivision Info: LocatiordAddress: Highway 801 N-27028 see map Date Evaluated: On -Site Well Community, Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position T Slope % 217/ HORIZON I DEPTH e// Texture group rG Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r` Structure Mineralogy , - e 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: /:K LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY:`A4� OTHER(S) PRESENT: 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 ois 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 I MineraloQv 1:1, 2:1, Mixed Notes I 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 chrome 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) l 4943 6952 T.., (,tap _ 2888 4 8982 1809 ( .1863 a X852 • C600000053 1' .NI lUi � ... ... � — � _. ... _. �. ... •t1YCPf POaO" _.. � foe til 60000005301: 060040004p 054 (1.5 I. 5670 060000001202 7.4SA 060005 2513 C600000058, C 1 yl o. 0600000056 / C60000006601 'L ; 1160 1 • .. 0600000060 f t S � 6A J q 6a4l 7610 321 A •, 2]ao 11 1 1a.35A.) 0 2 �S„ . . .97A) i S4e1 04. ' 1 1 •, (3.21 A) 1046 7 t 0856 .9 - 0 1 .78a, 8892 so ' "— ...... .. ...... ,... _...'.. ., ...._ .. ,. •• is SE32 t5a4 I Sa29 - 1475 ! • i 3:a2' ZO 39vd 1,1-1'J3d NOi9HINN3d EBE6TSL5EE zv:GO Z00L/8�/I 1 f Y Y DAVIE'COUNTYHEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 February 7, 2002 Dr. Robert Fox 325 Steed Court Winston-Salem, NC 27104 Dear Dr. Fox: On February 6, 2002 this office evaluated 3 sites aon a 13 afire tract of land that fronts NC Highway 801 and Myers Road in Davie County. Site 1 that fronts Highway 801 is classified provisionally suitable for the installation of a septic system. Site 2 is classified unsuitable for a septic system, however, this classification could change dependant on where the property lines are established. Site 3, that fronts Myers Road is classified provisionally suitable for a septic system. Before any permits are issued the exact house location must be staked off. If you have further questions please feel free to call our ofice at AC336-751-8760. Sincerely, k4tt Robert B. Hall, Jr., RS Environmental Health Specialist RBH: df Parcel #: C60000006001 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search iQ View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: C60000006001 Account #: 8300437 Owner Information Tax Codes Buildin OLSHOUSER MARK H & HOLSHOUSER DONNA M ADVLTAX - COUNTY T 1,68 1510 NC HIGHWAY 801 NORTH READVLTAX - FIRE TAX Market: ADVANCE, NC 27006 ssessed• Property Information eferred: Township nd (Units/Type): 6.000 AC FARMINGTON ddress: 1510 N NC HWY 801 Deed Information Local Zonin Date: 06/2011 Book: 00862 Page: 0681 Plat Book: Page: Le al Description PIN 16.000 AC HWY 801 5852793029 Property Values Buildin 293,05 000111 BXF: 1,68 nd• 90,27 Market: 385 00 ssessed• 385 00 eferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00409 0197 02 2002 WD Unqualified Vacant 121,000 2 00862 0681 06 2011 WD Qualified Improved 420,000_' View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 vN-V O t 1 -1 4: 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=1467246 9/15/2016