1806 Hwy 801N--1-
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Porraw6'a'`'� DAVIE COUNTY HEALTH DEPARTMENT I ` , ��
Name: I a° C Environmental Health Section PROPERTY INFORMfCI'10
/; �P.O. Box 848
�64'}
Directions to property: �� Mocksville, NC 27028 Subdivision Name:
a Phone #: 336-751-8760
Section: Lot:
! f{ AUTHORIZATION FOR
N e l jd 67-i 4 / (� 1�1 �. WASTEWATER Tax Office PIN:#5'9 5 3- - G
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002038 �r t le .4 Road Name: to (0'` `y F� a 1 Zip:a.`76
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
_ ¢ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
...> y /`,� G1 "00 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 4 # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
1
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
i ' i
LOT SIZE 1 G TYPE WATER'SUPPLYP DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE;) yGAL. PUMP TANK hA—GAL. TRENCH WIDTH 3 ROCK DEPTH LINEAR FT.
OTHER ,c ai C1 C e- c/ 4 -P u
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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11 y, FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1
OPERATION PERMIT
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AUTHORIZATION NO. �y OPERATION PERMrI' BY:
SYSTEM INSTALLED BY: k4 Kee. M �n r, L11 Ca,["_
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DATE: O r D
**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 WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 6= (Revi�ea) �73
Pe;ititte$ ' ` DAVIE COUNTY HEALTH DEPARTMENT`,,22
Warne. " rw l t i PROPERTY INFORM A'°I'I�1�
Name., d �l 1 ., fi . Environmental Health Section
P.O. Box 848
. A bisection -to property:Ac `'' t r ;f�(= Mocksville, NC 27028 Subdivision Name:
C
Phone #: 336-751-8760
Section: Lot:
6 AUTHORIZATION FOR
WASTEWATER �yj �r
lee Tax Office PIN:# �
F.
JSYSTEM CONSTRUCTION ( ' n
{ Ile
AUTHORIZATION NO: 0 % 8 3 8 !y Road Name: �` 'y AV Zip: f `
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by.the Davie County Environmental Health Section prior
to issuance of any 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 11 of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
e,u `> y
RESIDENTIAL SPECIFICATION: BUILDING TYPE H # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE 1 TYPE WATER SUPPLY W 'P DESIGN WASTEWATER FLOW (GPD) Q 1 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE t�GAL. PUMP TANK GAL. TRENCH WIDTH 6 , ROCK DEPTH LINEAR FT. 1001, ,
OTHER w *" c t r ! ty'1 ✓N G+ t/ +� -Fa L•� -r~[�/
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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11 ` FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. Y
OPERATION PERMIT
.0 C.
SYSTEM INSTALLED BY: K ^c t oz. [ F1 G"I
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AUTHORIZATION NO. � 9 3X OPERATION PERMIT BY:
300 C
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DATE: G
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
DCHD 02102 (Revised) J ��
APPLICANT INFORMATION
R. ply w -e- k c.A- 9 r- •
1'�, I a-C(z 6
Water Supply:
Evaluation By:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
On -Site Well %f Community
Auger Boring Pit Ll
PROPERTY INFORMATION
16601
R"_1 Va t
,,vim V -Sift I Le 1 AU C
5`6 5- -3 31 ;',1L#") -
Public
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
V
l�
Slope %
HORIZON I DEPTH
— 2
Texture group
Consistence
!`1 )
Structure
Mineralogy
HORIZON II DEPTH
—G
1—
Texture groupG
Consistence
y�
Structure
Mineralogy
.A
HORIZON III DEPTH
- -t,<
404L
Texture groupC
Consistence
�.
Structure
Mineralogyd�
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
• 1
SITE CLASSIFICATION: ��- EVALUATION BY -_J01 LK10 3 cJh !
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: PC.A D )xJ�Q-�
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
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
lYate�
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 05105 (Revised)
..N4 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
/APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) �i c
gigI (�i`'1 J� - PHONE NUMBER
ADDRESS 1�0 NC ff WV t QI - Al SUBDIVISION NAME
LOT #
DATE SYSTEM INSTALLED b 4 NAME SYSTEM INSTALLED UNDER S: P - WOOdGIJ d
TYPE FACILITY A�46US NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 00(1'n&• SPECIFY PROBLEM OCCURRING DLIYY)&01
/
DATE REQUESTED " ZZ'a�i v INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. if93
DAVIE COUNTY HEALTH DEPARTMENT
40
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION t 1'6 o/,
*NOTE:: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name .� e W w �. +�,� Date i �i ' ��� N2 �J
L°_- V) �� s� �� 7 k P M \) � �-1 10 ,
Subdivision Name
Lot No.
i
r Block No.
Lot Size House Mobile Home _ Business_ - Speculation
No. Bedrooms 'f No. Baths , No. -in Family °t
y '•4.. yN tt
Garbage Disposal',," YES [j NO p ; -`
4.. T Specifications for System:
Auto Dish Washer'.. YE5 -2- `NO,wfl
Auto Wash Machine YES p- NO ❑ ,..
1WType Water Supply ti. -- 5� QN.r•s �'O ° )l ( t,
y
*Th is-permit-Voidif sewage -system described below is not installed within 36 months from date of issue.
DL
F.
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El
Improvements permit by�a> -�-
*Contact a representative of the Davie County,Health Department fblr final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
'The signing of this cd
the standards set forth
satisfactorily for any gi
t� C>
o q
Certificate of Completion - Date \ `�
cate shall indi to that the system described above has been installed in compliance with
the above regula ' n, but shall in'NO way be taken as a guarantee that.the system will function
tperiod of time.
r' APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department ,
• Environmental Health SectionP.
OMocksv�ill a N.0 2ECE
7028 i1VED SEP
2 �
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.�'����
Home Phone
1. Permit Requested By—414/ct✓
2. Address /10 /��n ��. �✓,hs fu �.�,
Business Phon�/9�1�5' /Z )s'
11JL 2 7/D3
3. Property Owner if Different than A ove � �Q✓�
Address .110-r 197e ,a sy
(f
4. Permit To: a) Install `Alter Repair
b) Privy Conventional 01 Other Type
Ground Absorption
c) Sub -Division EI Sec. Lot No.
5. System used to serve what type facility: House L/ Mobile Home Business
IndustryOther
b) Number of people y
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms__ Bath Rooms 2 Den w/Closet /
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes 3 urinals 0
garbage disposal
lavatory 3 showers 2
washing machine_
dishwasher 1 sinks
8. a) Type water supply: Public Private ✓ Community
b) Has the water supply system been approved? Yes No 13ef�j
lea/V""-,"/V""-,4" "
9. a) Property Dimensions— 6,e j ' RAYL 4,
b) Land area designated to building site o
C) Sewage Disposal Contractor A/0'h �e
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
Z_
DateOwner Signature
OWNER IS SOLELY RESPONSIBLE FOR COM IANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing /•
Directions to property: // ��
/!%ac'es v/ � //
/V 144- �asJ�h�
t•7 ��Ch ' " 'GGK/'aL✓..� 6i �JQL� GL ✓d
Jroc exi' /�e'`
a�P4_v yOGt e
QrGJG/ / "j CGr h . t.1 �h tti
a , low/�j �e� �ae , t✓
4,`,„Q,J
�ha"J f PD d�Gs� lc jaDY .
ez, W/.� Ce�� xl�.c, aua.. 6 •.� o/�•�.. a�j1 �o uk/ t�� Sa�.
Davie County Health Department
�,• Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
(office use only)
yes no 1. 1 am the owner•ofthe above described property.
yes no 2. 1 am not the owner o,16the above described property, however, I certify that I
have consent from ddeo 0" 1 , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
le-
DATE
0 SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
Owners designated representative
Anyone requesting results
:,,,Anyone
those listed below
Zr�
DATE SIGNATURE
DCHD (11 /84) „
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name—
Address
ame Address
9:Ar..TnRc
ARF1A 1 1 ARFe
Date 7 1 l
�?
Lot Size 2�-A
AREA i AREA A
I) Topography/ Landscape Position
S
<=S
S
S
PS
PS
PS
U
U
U
U
?) Soil Texture (12-36 in.) Sandy,�
Loamy, Clayey, (note 2:1 Clay)
PS
(,PSs
S
PS
S
PS
1) Soil Structure (12-36 in.)
Clayey Soils
P
I
S
PS
S
PS
U
U
U
�) Soil Depth (inches)
pSPS
S
PS
S
PS
U
U
Soil Drainage: InternalS
S
PS
S
PS
pg(S
U
U
U
External
PS
S _
PS
S
PS
S
PS
U
U
U
i) Restrictive Horizons
Available Space
S
S
PS
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
i) Site Classification
.S
U—UNSUITABLE S--8UfT4BtE--"" PS—P-TrbvimarMfly Suitable
Recommendations/ Comments: O� X `("u -
Described by �� Title J Date
SITE DIAGRAM
VCHD (6-82)
Davie County .�lealt/i De artment
and Ylome Nealt`r n
ye cy
210 HOSPITAL STREET/ P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
Joe Woodward
110 Lillian Ct.
Winston-Salem, NC 27103
September 24, 1987
Re: Site Evaluation
Off of 801 N.
Dear Mr. Woodward:
On September 24, 1987, as you requested a representative from this
office visited your site and found the soil provisionally suitable for the
installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Q5�� �<.
Charles E. Little, R.S.
Environmental Health
Enclosure
CL/wd
Parcel #: C600000008
Davie County, NC - Basic Estate Search
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Parcel #: C600000008
Owner Information
ELCH RALPH A ]R & WELCH LUCY E
1806 NC HIGHWAY 801 NORTH
EOCKSVILLE NC 27028
Property Information
nd (Units/Type): 12.120 AC
[Address: 1806 N NC HWY 801
Account #:77324880
Tax Codes
ADVI X - COUNTY TT
FIREADVLTAX - FIRE TAX
Township
FARMINGTON
Deed Information Local tonin
Pate: 01/2007 Book: 00696 Page: 0924
Plat Book: Page:
Legal Description PIN
12.129 AC HW 801 OFF 5853312262
Property Values
Buill
332,63 01
BXF•
42,65
nd:
82,58
Market:
457 86
ssessed:
457,86
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00144 0546 08 1988 WD Unqualified Improved 200,000
2 00696 0924 01 2007 WD Qualified Improved 527,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1467744 9/22/2016