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1646 Hwy 801NDA IE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT 1o, of Bedrooms _ Date is permit is granted to �`2 / ��� for the installation of a septic tank._ �.t the residence of zx � Address IR,,?, LZ,-40jIV ie , Building Contractor Address Septic Tank Specifications: Length Width Depth Capacity Gal. Manufacturer's Named -z. AddressC 'No. of lines ,2 width ,3_(in. Total Length oo ft. No. of Sq. Ft. G o 0 Type of filter material �eo Total tons used Minimum Requirements: House Wailer Tank Cap. 800 Sq. ft. line 400 Two-bedroom house 800 0( Three-bedroom house Ing 900 No one shall install a septic tank in Davie County without a permit from the Health Officer or his agent. Date of final approval Signed: r Sanitarian I hereby certify that the above septic tank has been installed according to specifications. ASigned: _ Septic Tank Contractor Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville. I r" .©Ic0 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE::OIF COMPLETION =*NO_TE: Issued in Compliance With Article 11 of G.S. Chapter 130a Rrp Sanitary 'Sewage Systems '' / C%r'�. % ! Al Permit Number Name ., � �- ��" riS �y - 7�I �u %��bate " J�� N2 7599 R" Locationif'_,�5". //� f %-- �r�•�r�� l� /�%5 G�i'�Gi� r'S��" 'J.� r�;�t' Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home —T//Business Industry r1 1. /S�GYP.��GEif ' No. Bedrooms ~� . No. Baths . �-,— No. in Family _ Public Assembly%Other Garbage Disposal YES ❑ NO Specifications for Systema ,. ' a/l/K Auto Dish Washer YES ❑ NO A uto Wash Ma^hine YES. ❑ NO Type Water Supply 'This permit Void if sewage system described belo of in to ed ithin 5 years from date of issue. This Perrgit is subject to revocation if site plans t inte e u change. " *Contact a representative of the Davie County Health Department for final ins 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 7 Final Installation Diagram: System Instal t m between 8:30-9:30 A.M., Certificate of Completion — fn 1 Date 'The signing of this certificate shall indicate that the system described above has beerinstalled in comp,Uance with the standards set forth in the above regulation, but shall in NO way betaken as a guaraQtee that the system W l .function satisfactorily forany given period of time. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �°� A7 n ADDRESS PROPOSED FACIILTY DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well / Community Public v Evaluation By: Auger Boring (/ Pit Cut FACTORS 1 2 3 4 Landscape position 4, L Slope % HORIZON I DEPTH Texture group 57L r Consistence Structure Mineralogy HORIZON II DEPTH �' d271 6'� Texture group C C Consistence f^: 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: l' S(lye -rlD Ac - EVALUATED BY: Ak 6/ LONG-TERM ACCEPTANCE RA REMARKS: 01Qs"SiC to e DCHD(01-901 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 flay 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 ■ ■■M■ ■EM■ ■■■ ■MMMM■ • ,,.// �� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS IE�1 /7 2 Davie County Health Department v E Environmental Health Section P. 0. Box 665 16 v �N' Mocksville, NC 27028 1. Application/Permit Requested By GREEN MEADOWS BAPTTST CHTTRCH Mailing Address RT_ 2 BOX 312, MOCK4VTT,T,F, NC 270?R Home Phone PLEASE CALL:CRATG CARTFR 40-2341 Business Phone 2. Name on Permit if Different than Above 3. Application for: General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home LR'Place of Public Assembly ❑ Business ❑ Industry 5. If house, mobile home: Subdivision ❑ Other of No. of People �1 No. of Bedrooms \_ J No. of Bathrooms �J Dwelling Dimensions 6. If business, industry, place of public assembly, other: No. of People Served _ No. of Commodes Is - ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal Specify type �^t� No. of Sinks 3 No. of Urinals No. of Lavatories 3 No. of Water Coolers I— No. of Showers 0 Water Usage Figures 7. Type of water supply: IR' Public ❑ Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? ❑ No ❑ Community 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: 1-40 east to 180 exit — exit on to 801 and go approx. 3 miles toward Farmington. Church is on right. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurr"m this application. DATE S GNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. DATE 'SIGNATURE DCHD (1/83) Parcel #: C600000021 # Page 1 of 1 oA�t� Davie County, NC - Basic Estate SearchZOv�,9 Davie County Web Site Basic Search Real Estate Search Tax Bili Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: C600000021 Account #:30384000 Owner Information Tax Codes ADVLTAX - COUNTY T READVLTAX - FIRE TAXCKSVILLE RE EN MEADOWS BAPTIST CHURCH NC HIGHWAY 801 NORTH NC 27028 BXF• Information Township EressProperty (Units/Type): 4.920 AC :1646 N NC HWY 801 FARMINGTON 1 47 Deed Information Local Zoning Pate: 01/1900 Book: 00077 Page: 0202 Plat Book: Page: Le al Description PIN 5 AC HWY 801 5852592267 Property Values Building: 1,404d8l BXF• Land: 6Market: 1 47ssessed: 1 47 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00077 0202 01 1900 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/itsnet/View.aspx?prid=1469141 9/21/2016