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6538 Hwy 801SEnvironmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 / (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001822 ~ Billed To: Wanda Reeves Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5756-16-4100 Subdivision Info: Location/Address: Highway 801 S-27028 Property Size: see map **NOTE* i i 2904 Isgmpremment/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 TypeAl- #People ! #Bedrooms .2 #Baths Dishwasher: /Z Garbage Disposal: ❑ Washing Machine: ICS Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: NewM'Repair ❑ System Specifications: Tank Size/000 GAL. Pump Tank GAL. Trench Width —1 /01 Rock Depth _/,� Linear Ft. %1= Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED E FINISHED GRADE. ****NOTICE: Contact a representative of the Dav system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day r FILTER RISER(S) IF 6 " BELOW Health Department for final inspection of this tion. Telephone # is (336)751-8760.**** /--/W Environmental Health Specialist's Signature: Date: (p '27el DCHD 05/99 (Revised) Account #: 990001822 Billed To: Wanda Reeves Reference Name: Proposed Facility: Residence ATC Number: 2904 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section, P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5756-16-4100 Subdivision Info: Location/Address: Highway 801 S-27028 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: lee Date: g!5� .27 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) Date: 7 `/0—Pj 1. 2. I P"1 2 r �E� H u TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department JUN 2 2 2001 Environmenta/Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIROl OMENTAL HEALTH (336) 751-8760 n A111[ nnn..r. ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed/( a"r � Mailing Address &53 City/State/ZIP Le)c Name on Permit/ATC if Different than Above Mailing Address 3. Application For: Site Evaluation 4. System to Service: /\❑ House EfMobile Home 5. If Residence: # People Contact Person Home Phone n Business Phone �/ �(U t%' City/State/Zip yImprovement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms # Bathrooms 6_ O Dishwasher ❑ Garbage Disposal VWashing Machine ❑ Basement/Plumbing H Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats *ounty/Clty Estimated Water Usage (gallons per day) 7. Type o£ water supply: ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes )k�No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # �5�—�� `�� `, v Property Address: Road Name _v J City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: �e d r� .S � �� (' PQ Sy Cd'✓ %t l Lv( t/ ate' J S �-- 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 an 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 suitability. DATE 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 Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. a Invoice No. a3�� ople ulloolm m N-1 s 0499 DAVIE COUNTY HEALTH DEPARTMENT y Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001822 Tax PIN/EH #: 5756-16-4100 Billed To: Wanda Reeves Subdivision Info: Reference Name: Location/Address: Highway 8016-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 05� 27-w Water Supply: Evaluation By: On -Site Well Community_ Auger Boring l -1 — Pit Public VJ 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 r' ? ''•'? Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 66 a 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 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 - gal/day/ft2 DCHD 05/99 (Revised) Parcel #: L60000000903 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search 0 h View Property Record for this Parcel View Man for this Parcel , View Tax Bill Information Parcel #: L60000000903 Account #: 8302957 Owner Information Tax Codes 19,43 ETCHIE DESTINY R & REINHARDT KAYLA ETTAMAE 6,50 ADVLTAX -COUNTY T 30,82 42 HOBSON DRIVE 56,75 FIREADVLTAX - FIRE TAX 56 75 OCKSVILLE NC 27028 01 Information Township EressProperty (Units/Type): 3.120 AC JERUSALEM :6538 S NC HWY 801 Deed Information Local Zonin ate: 12/2013 Book: 00945 Page: 1039 Plat Book: Page: Legal Description PIN 13 AC HWY 801 5756164100 Property Values uildin 19,43 BXF: 6,50 nd: 30,82 arket• 56,75 ssessed: 56 75 eferred• 01 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00945 1039 12 2013 WD Unqualified Improved 0 2 00155 0056 07 1990 WD Qualified Vacant 14,000 View Prooerty Record for this Parcel View Man for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 A.7IF 01-0rj11-11!C 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=1458976 8/31/2016