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6800 Hwy 801S (2)t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003189 Tax PIN/EH #: 5746-74-8652 Billed To: Rowland Development Corp. Subdivision Info: Reference Name: Location/Address: 6800 Highway 801 S-27028 Proposed Facility Residence Property Size: 5.19 acres ATC Number: 3768 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 CON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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. h 7'0 Septic System Installed By: Zy6S-��1 —4W- Environmental Health Specialist's Signature: 100, bS(&V__ Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH'DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003189 Billed To: Rowland Development Corp. Reference Name: Proposed Facility Residence Tax PIN/EH #: 5746-74-8652 Subdivision Info: Location/Address: Property Size: YAOA N - j -s /[_o 6800 Highway 801 S-27028 5.19 acres ATC Number: 3768 **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 _Z�/ #People o#Bedrooms ��� #Baths 5 Dishwasher Garbage Disposal -.21"' 2 Washing Machine: ❑ Basement w/Plumbing:j2r Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD)1- Site: New Repair ❑ System Specifications: Tank Size,/007GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width rjRock Depth _�L' Linear Ft 122 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmef tal Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMI A L� Davie County Health Department ! Y.fD b�. 1 Environmental Heath Section �l �• L 3 2004 P.O. Box 848/210 Hospital Street � L Mocksville, NCz 27028 _ (336) 751-8760 0402pj�ENTALHEALTH DAVIE CDDK! (Y ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL HE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed /�Q�r'>/� �f �/�.L��O QYi/f �N./ ��P Contact Person �,�/(�I(�S Ko w�/�Ccyt r Mailing Address 2i 7U � a �rV �T Home Phone �� X 5- 7` �Z T" Z City/State/ZIP �Ct/(S (1/�t' N� � �/ Business Phone 70/ ZUZ 1174, 2. Name on Permit/ATC if Different than Above 04MI4.12Z, Mailing Address &,?66 l-1wo :261 .S City/State/Zip 3. Application For: �❑ Site Evaluation ❑Improvement Permit/ATC. th 4. System to Service: 6 -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: Lid' Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People -2 # Bedrooms # Bathrooms Otishwasher ❑Garbage Disposal ashing Machine MBasement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF ' FOODSERVICE: # �Seats Estimated Water Usage (gallons per day) 8. Type of water supply:CLy' ounty/City ❑ Well ❑ Community i. 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: o' lul"Os- WRITE DIRECTIONS (from Mocksvi e) to ROPERTY: Tax Office PIN: # -7 71 S Z Ute/ / Property Address: Road Name avo //W, l D' r City/Zip NlO�&&C 270Z0 %/11 ?Di19e, If in a Subdivision provide information, as follows: 101 l,fmazl-s e� /de Jam/ Name: Section: Block: Lot: Date home corners flagged: D Z O 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 Coupty Health Department to enter upon above described property located in Davie County and owned by --rile- a u4,Qd, to conduct all testi g procedures as necessary to determine the site suitab' DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Incl all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Sign given c - Revised DCHD (05/03 Date(s): Client Notification Date: EHS: Account No. Invoice No. i Mi 11"Aid. iii 3`xPae� ` (2 0 021 CONCORD yp tno.ns.,.,� iaaad ..�.,; 79 5915 0 P� �yMi t�P f j"uIb' �'� 104 ,(Otl t� u t' Nx�r ��ea Oji Y1 AE ($.12A) 3705 : 4723 5754 V` 8732 77? SR 1839 OAKDP .` (260) i -ao LE CIE ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990003189. Billed To: Rowland Development Corp. Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5746-74-8652 Subdivision Info: Location/Address: 6800 Highway 801 S-27028 5.19 acres Date Evaluated: Water Supply: On -Site Well Community Public �r Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH w r� Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group ell(� 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 i SITE CLASSIFICATION: V EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHE S) PRESENT: REMARKS: LEG ND 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) i ■ ■ ■ ■ ■ ■E■■■ ■■■E■ ■■■E■ ■E■E■ ■■■E■ ■ME■■ ■■■■■ MENS■ ■■El■ ■■■E■ ■■E■■ SOMME ■■■■■■M■■■■■■■■■■■■■■SSSS■■■■s■■■■■■■■■■■■■■■■■■.... ■■■■■■■■l■■■■■■■■■■■■SSSS■■■l■■■■e■■■■■■■■s■■■te■■�■ ■■■■■■■■■e■■■■E■■■■l■■e■■■■Mee■■■l■eM■■■■■■■■eee■e■■ ■See■■e■■■Mtt■■■■lMM■ ■■le■■■■l■■e■■M■t■ttt■■e■M■E■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■e■ecce■■■■■■l■■■■■■l■t■■■t■■t■■■■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■SSSS■■■■■■■■■■■■■■■■e■■■■■■■■■■ ■eel■■es■■tet■■■■■■■■�ee■■■■■■■c►.■■■■■■■■■EE■■■■■■■ ■■■■■■■■■■■■■■E■■■■■cele/dee■■■■■■■G■■■■■■ele■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ell■■■■■■■■[I■■■■■■■■■■■SSIt■■■■■■■■■t■ ■■■eel■■ltll■■E■■■■■■■e■■■eeeele■■■■■■■■t■■■■■■■■eE■ ■■■■■■M■■tEE■■■■■■■E■■ESE■■■Eee■■■■etl■e■t■■■■■■■■■■ ■■e■■■■■lttt■■■■■Et■■ ■■lel■t■■■■■t■■■■e■■■■■e■e■■■ ■■■let■■■■■■■ltr■■■■■■■■■■■■a�■ee■lE■■■■e■M■■■llM■■■e■ MENEM iMEMEMEMENNEN MENNENMEMNONMONSONMENEM ■■■■■■■■■■■■■■■■■ INN ME■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■SSSS■■It■■■■■�■■■■■al■■■■■■■■■■ ■■■■■■■■■■SSSS■■t■�!���������:r■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■e■■■■■■■ ■■■■■■■■E■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ON ME ■■ ME ME Parcel #: L50000007801 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search 0 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: L50000007801 Account #:68866500 Owner Information Tax Codes MPBELL ANGELA SNIDER & CAMPBELL ERIC L EC8100 T ADVLTAX - COUNTY NC HIGHWAY 801 SOUTH READVLTAX - FIRE TAXCKSVILLE NC 27028 Property Information Township nd (Units/Type): 5.190 AC JERUSALEM ddress: 6800 S NC HWY 801 Deed Information - Local tonin Pate: 02/2000 Book: 00326 Page: 0783 Plat Book: Page: Le al Description PIN 19 AC OFF HWY 801 68948000 5746 -74 -8652 - Property Values Building: 261,180 BXF• 0 Land: 32,370 Market: 293,550 Messed: 293,550 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00326 0783 02 2000 WD Unqualified Vacant 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information r< Return to Basic Search Page 1 of 1 o-N.r� 1-°v ti's . 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=1475597 8/31/2016