176 Katey LnDAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
MocksviHe, NC 27028
(336)751-8760
Account #: 990003528
Billed To: Stephen Stromko
Reference Name:
ATC Number: 4290
Tax PIN/EH #: 5823-25-1418-02
Subdivision Info:
Location/Address: USHighway601N-27028
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 a ge Treatment d Disposal Systems). THIS
AUTHORIZATION FOR WASTE W ST N ALI OR ERIOD OF FIVE YEARS.
Environmental Health Specialist's Signatur ate: % Jen&-
**NOTE** The issu
has been
A
CERTIFICATE OF COMPLETION
of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
cle 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Wzmggulibe taken as a guarantee that the system will function satisfactorily for any
Iooe���Jk
Septic System Installed By:
Environmental Health Specialist's Signature:
lflol)s
r�
mo�-J)
&-) 1) V Atj Lte-�,
DCHD 05/99 (Revised) I % "& � - � vt� gZjK?
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
` P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 II
IMPROVEMENT/OPERATION PERMIT
Account #: 990003528 Tax PIN/EH #: 5823-25-1418-02
Billed To: Stephen Stromko Subdivision Info:
Reference Name: Location/Address: USHighway 601 N-27028
Proposed Facility: Residence Property Size: 26.81 Acres
**NOTE.Wls�Impro4emeEnt/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 IN'T'ENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
2 1
Residential Specification: Building Type OLS #People .3 #Bedrooms #Baths
Dishwasher: I11"" Garbage Disposal: ❑ Washing Machine: GR"' Basement w/Plumbing: IK Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size 6�AC41S Type Water Supply WELL Design Wastewater Flow (GPD) i� Site: New 0' Repair ❑
System Specifications: Tank Size loco GAL. Pump Tank GAL. Trench Width &I Rock Depth N A Linear Ft..490
90 �
Other: 4-Dcm(L7i 1o,) &gE�sccc-yTtz:) 252o Gamxcko -cf>�6ron--
Required Site Modifications/Conditions: )Als%Au t�J CCW10a,' ' - 1 owcm ubu- ��, �" "4,<
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.****
Pc"A
nn b
\V sM�v
sT V I�� eft
tF ASb&StAg
Ll
►-�ot�S v ,
Environmental Health Specialist's Signature: 'f I Jew U
i
DCHD 05/99 (Revised)
APPLUTION FOR 212E EVAL%ATlONJIfgPACVMW MAT AN
04V!e coaaty Hatut Depatt"nt
t'.lrr&vrraeeurEerdMNlt1Y iiB�eBbrn
.o. 8a: d1//110.1feayital Street
tt001<arl3ial SIG 27010
(376)751-8760
. •eeIJ1fPO=AV1r1te %via APILICA=att camr an ftowl1D VMM ALi Ma 11Yumn
t - IMM"M Ze VXO=M. Rater to the ZVOINXTIOD 29=u= tar t "truatlea■.
D�
d
9 2005
RO
DAyFFiV�����
✓l. dams Ls be sul.&her1 c11 twornf<o
s11me,ees..o d
/it4W ti' '{/ aZ7 ,,? ,.•.c...r.o. Q/o-95/;�-1.1 �%3
itr�awtenuC_u.rytC'r IVL �d ��-t+' ✓w.s.... nw. 910 -b39.1'9 &9 /
Loi. NW asvaceitinc %gAuamo• zusmove �"l ?_ eN— i_L/at71/Or-Pezrjjt o `L�
4atitat7 Adieu. a Cid/Bteta/tl, a. dl, IkA
6'e0. A Wl3Cattoa Tram Xlite 11rm1uaC10A Cl Z.rprovaamsld, reB►it/hSC
.ia• 7ys.a is Ia rltaaX"MUBG .0 xobila oraIDe G swineoa --D.:"umtrr t5 other
..-�• aYr .r.t= e"MA"oAs� auwwete..3 G so.ewts.•al am"$ D ca....a.t-a•
� a
..,..[. tt RULdRooal 1 feapla t 004TON S e SathroMe
1"pl.LvO.ar QWsl.p ntatueslae6ssII tl.okl0. �Ntan.al/il++lwe i10u.moae/Y. )lumping
•f��) l r Q S^
r
I. UPassam/Moutp ar
/Ota.., .lfr tyg.,�,_�„".
�� a opts 1 Bios.
(/ /,
�
If tow"*# a qw..a o'Yrl,als 1 Iiaf.e taal.eA ,,,�,,,��✓`
lP
Is 10CaQtlM11i • Bata R2timatod Hates Vaasa hail*" pee Wt
-'7- sr,e of .ata* .jnlr• ❑ Cee Sty/city )(Welt D t:o�,rtaitr
". 11e'7eammetatyap aeditiawe sit aPetieaeadehe[Bettytriosystem isintoodedalcryd13YN 0 N
1ryt., ahB
e+f1AlI'02TieM "'cuss-tsmuirCO PLmint ugui-orhouRfl'u4t1O)imawxReQunTLO }
2! ar,�tnwaruT.rSrMP iEStJSA//7TSDMA.dtdat.IAATMtaAPlLitAT10N. t
t.�'tropertrbGeleRv.ak �•ri+.►�-�"-� t a"WhITCptRltt:rtt)>vtitJre«MotLrrgW ta7A0�CATY:
r..+tetOtficaPlMt it _ o�J fd .ts "ol x0rTh Si Zal
,,r?re►tatpAddraM: Eeedi+tsate aDi N NwY �l inTer�_,tri`o. �
emtvp MQCK5e.G 1,,tr►i I,-- on
!a s SebdivWep vide iatbimttton, 45 WIG",*NU O n 11,
St d=. tutor: — 1ot•. w>tntc hetae eormen neZU4c
?ah tr to twill" dist at tararraodea provided Is tomd to the bin Ogg knowic4p. t vm Jerltatid dui sB7 vw,dt(.)
iter.& Hamner an wpjoet ro,trWaios aerevotsiloa. Uffiitdteptlne,n gltead}QtltosA+tat+. or N me narm Ws
Iabatittad i® M appUntion h MUM K ttlahged. I, etre, wFi,rteenl llrot I pia eenrsn"O far All cup"' &c -"dA.
oAteo(pp/krrNn L iereby, dire Aoa,sBt (0 tRe Ase?l.ral,d AApred,atBuvc at the Devic CalwtY ittdttl Depnrtaw►t
maw upon above duabcd pnrrtylotsttd In DovkCamtr and owmodby
(a eoaddu ou tops area as attNury to ici rm bm dee #fts2 itr.
bo IACfo,-
rr.DATR-SrCdt, - . 'jc� a&"
37II9i1ALrAMAlf8Ei16[DitORDitAWMC4V0URMZ8PLAM4heludtstiotttt&tb7ivwlej: Es4tia=,atyropeled
p upertf 4w ad dNlfuleari vinwWth o.tbs0o, Aad teytkiteadow).
tiltaR.vLtt Ci�rge
COIN Modcl uon wee:
Ms:
'ax
AttabntNo�
Bevb" DCHV (OW
I/0'd To: 2-1 S00Z 8 -EW 082IZVS6i6:xPA S100H3S 03 WHIM
DAVIE COUNTY HEALTI-I DEPARTMENT
Environmental Health Section
Account #: 990003528
PIN/EH #: 5823-25-1418.02Sil/Site EvaluatToll
LiC%IgAiOSMIAromko
Subdivision Info: PROPERTY INFORMATION
R �encu Location/Address: Highway 801-27028
Propostrfl Facility: Residence Property Size: see map Date Evaluated:
Water Supply: On -Site Wcl, Community Public
Evaluation By: Auger Boring Pit Cut
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: _ OTHER(S) PRESENT:
REMARKS: , 1''�►9C t'R'F^x'�t ?�- t
LEGEND.
Landscape Position
R - Ridge S - Shoulder L - Lincar 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
CONSISTENCI:
Most
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI Extremely firm
��4•
-wet t Z
✓ SNS - Non sticky SS - Slightly sticky S Sticky VS - Very Sticky �� 2 7
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastid SCJ ;
Structure 713
Single grain M - Massive CR - Crumb - GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prisipatic .3o
Mincraloev
1:1, 2:1, Mixed /
Horizon depth - In inches ( Z4
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsultablc)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
WOM _W
Texture groupConsistence
Q•�®or.®���r®
..
W
im-
0..��ff
_ =� A MHORIZON ®®®
11 DEPTH-
M, IM01
Texture group
Consistence
us] a
&MMMIRM9ME
Texture group 1111WORFM
NUMMONS
Consistence ARNWIMONO
'%4UN��022"*
HORIZON IV DEPTH
Texture
ii��-
Consistence1:
■�i ir��
Structure
SO_IL WETNESS
CLASSIFICATION
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: _ OTHER(S) PRESENT:
REMARKS: , 1''�►9C t'R'F^x'�t ?�- t
LEGEND.
Landscape Position
R - Ridge S - Shoulder L - Lincar 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
CONSISTENCI:
Most
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI Extremely firm
��4•
-wet t Z
✓ SNS - Non sticky SS - Slightly sticky S Sticky VS - Very Sticky �� 2 7
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastid SCJ ;
Structure 713
Single grain M - Massive CR - Crumb - GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prisipatic .3o
Mincraloev
1:1, 2:1, Mixed /
Horizon depth - In inches ( Z4
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsultablc)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
NUNN HIM
■ ■:.........°■■■.■.- �__•....■°MMMME°°■°■■..moon.....MANmono .1�..■
.eC�'e■.snow
■■■.■e.: ■■...■.e.:®°■../■.■...■°■■■...■■
■ ■...■ .a�C./...■■■ ■■...NOON■■.►....e.■■■■■■■■.■.■■
CCC��:C:::C►'�. ::CC:C::aCC::■CCCCCCCiiiiiiCCCCenummom°on
CC■■E■.■■■/■C.■.■■..■.■■.■■:/..■■......■.■\\■.N.■■■■eCC::
.C.. ■.■■t..■■ ■■..... . . ................■.....■.®.■■..
■........ .■..... . ..■............■....■■e■monso
■
■.Ce.■.■■■..C.C.■■■■■.■ ■■■e ■ ■°:.■:.■:.■:.ei.■.. ■■ .°•.I�.t.t.■..■:s.■:t..:■.s..:■.■:■
'°::. . . ■■■■.■■ . ■■.i■■■. ■■■a mul:: •o .� ■..■■ .■t °.■ ..
■■■■ ::::::C ::ia:E■■ emmanon: i:: °'eC■■■■ ■■■■■■■■■.■■e ■ ■■■.■■■■. :: ■■■■■■ ■■■■.■■■.::::::: . ::::: MEN.4:::::: :: ..:..■
r11 IRMO
Mania
. .. ............................ .......... . .■now no
E....
E :E..■ ■►C :
.ee. : ■■ WE NNNo W a s■. �.....■.ee■. ■se :■..
■CEC' ::o::::ox'•nn'nC'°''"°' +j mommmm:::E::: C .::°i"■'
■■ ■: ..:. ■■::t\::::::':: ■./..■■e■■■/■■■■..//.■EE ■■:■■
E ■EC■ Ce1■■�■■mmon .e■ ■ ■eCii:::::::::::::::mom MEN ON
lnl ■ ■/•
Nonni.N�/e�� POP■■.■■■.■..■■.■■■■.
DAI... ....■.//. .■\/a�O ■.///..■■...■....////■..■�■E/E..
MO:....■e.../...■...�C...■.■.■......■//./../... . ■..■
.■/. ...■..■..e. ....■............N./.../.C:e■.■
go Mang•••
..°■■.■....:C■■■■■■■ ......■■:::::::::::::::C::::::E C:
110.0111111.4■.■ ■..e .■■ :■C■■.■■.es. C■■e:■■■■■■■.■.e:■■■■.■■■■:eC■■
..��'►.■°��� ■■e.■■■■■ ■■••onommo■...■e■..■.O■■.■■/.■.�
■... •eeC......■. E../.............■■■°°■■■°■■.. E
■s .■■H:1W■■ mine MINE
■:C:°::■■Ci:'C::■■C::.C'mmanommons::C:mmumm:C■'■■:°:::C
.�®■■C:..■■C°1iCi'.•°:C:C®'���'iC:i"■■■..■°■°°■■■■.■■■Ce■■:■■.■
■■ ..... . ...■............■■■°■. ■.■N.■
■■ ■ ■ ■■ ■■►c■si■��.■■./►�C■..........■■....■.:■ NOON
amommomm
BONN■■■■■...... ... . .ae...�................��..�.....
■.C. ■■. v0206C %X REMERN
Milo MR
�a■■i■►�E/e■../..//./..�:s�
��ir,■!u v■■■■■m...N■■....NONE
eNs■■.�■.■.►�w
■ ■O■ N
:l. .■ ■ ■./■\�I%fJ►t/■m■//O.N■on.d'Jr'�.Mason.N\..�aira14 II
. HER
. r■.... ■...■..■.i. .......®mamom■.°■.■.......■..■■ ■■■■e■ ■... .■■Ii. /■..e®...■■■■..ngm.u.■■■..../■■■. ■.N■■n■m■■■/■■■■N■►`1:■E�
.. ■■■ mm ON ■../■.C..�m■e■■■./.en��:e■......./■/.../.■e,■/s
.�e■. ae.. ■■.■....rsC■..■■.■.�er�..../■■■■..m■N■■EN.■��.
.� .°.i■°■°■.. ■.../•.-.�� .■P.n�e.....././.....■■.°°°■°..e■■
E:eE�WERE MP- mommom NNW
�?ENE 'iC.-a'.-eiiii ■■C■./.■........■...°°.■.■°■
■■■ ■®■■■■■■■■■P■.■■■.1� ...■ ::: moommmmmmunn:
:..:C■■■■■■e■.■e■ee...eCe.eC■..e■■e■■■.■.■■■■ ■■■■ ■....■
■ ■■■ ■■.■........■e■..■ ■.■ ■■../..■■■mmm■■■■:■■.::.■Nmm■
■......e.s............ ■.e■et■�r�e..e...■■..Nee..... .■ ■..■
■■oCe■e.Now ee■■■e......Ci.■ r�,.■u��■■..../.../...■■■■■°■°■C■°■■
■ ■■ ■■.......■....../CRUM ■of/r�.....■------■■°■■■.■.■.eeNo
i:::::::::oo°"m'o'on°°°"
Ce....e■ � C ....■■■■e■■■■.■■C■.■ ■
■ m:Cm■:C::o:CC::C::C::It..■::::: ::::::::mmummo:::C::::E:
C:..C■■..■ ■. ..././..�o■■°°■■/.■■.m/m/■■■■■■mO/.m■/..m.O■■
°... .....E..C...■ i■■.....■■■..■■.■■...■.■.■■
NO imm ■C.■CeeC■
■ ■ ■ .NOON■.■■■■■ ■m11 ■.O■MONO.■■m■■■.■■m■mum■m.■ ■■NN■
.■:■ ..O■■■■..ON■mO.■O�iy■■■NOON Nm■■■■■■■■N■■■N■.m■CWOMEN
.� ■ ■■m.■.■■.■■■.■■o../.■.■■Inti.■■Oman■■.■.■■■■■.■■.N.■m/N.■■N■
■ ■ ■
mom..N.■N■■N■■■ ■ IA■■■■..■■O..N.■■.....■.N.NN.......■
i
i�
1
(4.98A) ss
4609 asA)
308
N 'mss 11.440A
2 1588
i%i ,ileo ilei! ri%
I
Q
JQ
ro .i �Igli1 d % ���7or 12.70A�
�I
4228
RIOT
plir
iiPV
"Pi
a i
ryfl� 41 �� tl�C��tip�
�p u
MIN It % �
r� ti"� ', •._ e. ,s n �l, ((IIi 'Ii�%m".lii(I a tl��Es` �, h���k� ,14 YAJI'r'tr
� lr
v
' "'�...
MdD �
Jill!�. �11 .. •.. ��
At
V d
202 if'71
2 MnB2All
o
i
MnB2 ' _
p �
1�EnB ` a I
a 0 "' O
Md'D
— 20,000A
1.86A) �q 4003 -^
470 1 C
741
,5 $ (2,19A)
SA931-R�' ��..m';A .. .�,� 05A} 5924 ,
7 79 no
(4.48A) 3.003A
7566 — — — — —
/
(13.58A)
/0434 348
9 470
en (2 8
/ 6
5.00A
� (5.04A) – 4E1
4493 9420 % 441:
/ 44J2
s2
QQ
30 21
971
490 254 43 �!
_ (1.89A) ) II 1� 2
4150 7029 `
A
soo 44 2 10
5032 54
IW 151
(17.46A)
2 0932
p7812 (12sA�
M d� °)l q iP Ot 889
1� d OA) .
�f ^ 6796,•r
� w
(1.02A) `b �( (871A)
9790
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760 / Fax: (336)751-8786
April 4, 2005
Stephen Stromko
5080 HWY 24-27
Cameron, NC 28326
Re: Site Evaluation(s)-
26.8 Acreage Tract/HWY 601N
Tax PIN#: 5823251418
Dear Client:
As requested, a representative from this office visited the above sites March 30,
2005 to perform two site evaluations. Based on the information provided on the
Application for Site Evaluation and after the evaluations were completed, both sites(site
#2, site #4) were found to be provisionally suitable for the installation of on-site
wastewater disposal systems.
Before a representative of this office will revisit the site to issue. an Improvement
Permit/Authorization to Construct, the appropriate application must be completed and
submitted to this office.. The location of the facility the system is to serve must be staked
off.
If you have any questions, feel free to "contact this office at 751-8760.
Sincerely,
Jeff G.,Beauchamp;'k.S'
Environmental Health Section
Enc(s)
Parcel #: B300000037
Qavie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:8300000037 Account #:71522970
Owner Information
Buildin :
I I Tax Codes
BXF•
TROMKO STEPHEN& STROMKO TAMARA J
Land:
1 IC ADVLTAX - COUNTY T
Market:
176 KATEY W
ssessed•
READVLTAX - FIRE TAX
Deferred:
OCKSVILLENC 27028
Unqualified
Vacant
Property Information
Township
land (Units/Type): 24.460 AC
06
[ CLARKSVILLE7 --- 71
ddress: 176 KATEY LN
Vacant
0
Deed Information
OWB95
Local Zoning
Pate: 06/2005 Book: 00612 Page: 0004
1995 WB
Unqualified
Plat Book: Page:
0
1•
Legal Description
0004
PIN
4.461AC OFF HWY 601
Qualified
5823251418
125,000
Property Values
Buildin :
319,14 0011
BXF•
4,40
Land:
126,19
Market:
449,73
ssessed•
449,73
Deferred:
2000 WD
Sales Information
No.
Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
L
00344
0466
08
2000 WD
Unqualified
Vacant
0
00612
0007
06
2005 WD
Unqualified
Vacant
0
3
OWB95
E215
01
1995 WB
Unqualified
Vacant
0
1•
00612
0004
06
2005 WD
Qualified
Vacant
125,000
Page 1 of 1
oP�f�
0
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/itsnetfView.aspx?prid=1465966 8/23/2016