147 Miss Ruby LnDAVIE COUNTY HEALTH DEPARTMENT n4I /� 7 W
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
lq7 /hiss dub
Account M 990000744 Tax PIN/EH M 5746-34-0486
Billed To: William Smith Subdivision Info:
• Reference Name: Mickey S. Smith Location/Address: Hwy. 601 S.-27028
Proposed Facility: Residence Property Size: 1.60 Acre
ATC Number: 2177
**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 LA / 10446 #People #Bedrooms _ #Baths —�
Dishwasher: ❑ Garbage Disposal: ❑
Commercial Specification: Facility Type
Washing Machine: 9 Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
#People #People/Shift #Seats Industrial Waste: ❑
Lot Size 00 Type Water Supply Design Wastewater Flow (GPD) .Q�a Site: New Repair ❑
System Specifications: Tank Size e O GAL. Pump Tank GAL. Trench Width Rock Depth ��`o _ Linear Ft.<_�
Other:
Required Site Modifications/Conditions: / l
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.****
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a
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #:
990000744
Tax PIN/EH #: 5746-34-0486
Billed To:
William Smith
Subdivision Info:
Reference Name:
Mickey S. Smith
Location/Address: Hwy. 601 S.-27028
Proposed Facility:
Residence
Property Size: 1.60 Acre
ATC Number: 2177
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:
CERTIFICATE OF COMPLETION
Date: /0 (1 — 9 7
**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.
CA101
Septic System Installed By: /« '' lz✓ /C _
Health Specialist's Signature : Date: Z
DCHD 05/99 (Revised)
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Envfiortmenfof Health Settfon
P.O. Box 848/210 Hospital Street
Mockaville, NC 27028
(336)751-8760
0 CT;I�0W
AUG 25 1999
ENVIRONMENTAL HEALTH
D Coaiodes
I showers
It TOODSERVICE: # Seats
7. Type or water supply:
! urinals i Rater Coolers Q
Eatimated dater Osage (gallons per day) �
B"County/City 0 Well 0 C ty
s. Do you anticipate additions or expansions of the facility this system is Intended to serve? lames "o
If yes, what type? -
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 11 iL7 X �S� �{ �. WRITE DIRECTIONS (from MoclwAlle) to PROPERTY:
�/
;V Tax Office PIN: N i 1 ��
)--5-1uo-p-)y.oi = b'7 (D- -04 VC)
Property Address: Road Name #WO V- 5: s I Sep I.1 -e J r Q 1S a
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
►y
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--
—c y
G
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C�li11—h P (� ass ,o Leo
c i S 1t /l J �J Cru. f
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
enbmitted in this application is falsifled or changed I, also, understand that I am responsible for all charges Incamd from
this appUcadom I, hereby, glue 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.
mss"- 9 5
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property Imes and dimensions, structures, setbacks, and septic loations).
Site Revisit Charge
Date(s): ,--
Client Notification Date:
I EHS:
Revised DCHD (07/99)
Account No.
Invoice No. YJ15—'r
d. 9% 939
***ZDWCRTANT*** THIS APPLICATION CROM BE M=SMM UNLESS ALL THE REQUIRED
n=10 10N IS P/RO�V IM. Refer to the IM IMATION BULLETIN for instructions.
1.
Mass to be Billed Lei i!/1�/i! , .S/!'Ie ��/1
Contact lesson'
Mailing Address Z' / n/'/�i jl /t��.l
sae. phone
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City/statemp ,� /�' ,( Al, C. o2c�/l%
��
% stain.. atone (T/l
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dace on Pecait/ATC it Different than Above
Hailing Address
City/stag/alp
s.
Application ror: VOite =valuation
0 Improvement Pe=dt/ASC a Both
s.
systan to service: 13 Bonse 6/Mobile Boma
O Business O Industry l] Other
5.
If Residence: f People .3
f Bedrooms _ f Bathrooms
0 Dishwasher 0 Garbage Disposal 041ashing Maobins 0 9ussunt/21uebing 0 Dassaant/Ho plaebing
G.
if ausiness/Industry/Otbar: specify type
i people i sinks
D Coaiodes
I showers
It TOODSERVICE: # Seats
7. Type or water supply:
! urinals i Rater Coolers Q
Eatimated dater Osage (gallons per day) �
B"County/City 0 Well 0 C ty
s. Do you anticipate additions or expansions of the facility this system is Intended to serve? lames "o
If yes, what type? -
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 11 iL7 X �S� �{ �. WRITE DIRECTIONS (from MoclwAlle) to PROPERTY:
�/
;V Tax Office PIN: N i 1 ��
)--5-1uo-p-)y.oi = b'7 (D- -04 VC)
Property Address: Road Name #WO V- 5: s I Sep I.1 -e J r Q 1S a
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
►y
�o
--
—c y
G
> o�
C�li11—h P (� ass ,o Leo
c i S 1t /l J �J Cru. f
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
enbmitted in this application is falsifled or changed I, also, understand that I am responsible for all charges Incamd from
this appUcadom I, hereby, glue 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.
mss"- 9 5
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property Imes and dimensions, structures, setbacks, and septic loations).
Site Revisit Charge
Date(s): ,--
Client Notification Date:
I EHS:
Revised DCHD (07/99)
Account No.
Invoice No. YJ15—'r
d. 9% 939
P7777"
ChA
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61
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gay
(2.77A1
8511
This map is for PERC TEST
and BUILDING PERMIT purposes
only. The Davie County
Tax Administrator's Office
assumes no liability for any
(2.21A) �� information contained on this map
8460
P
COUNTY -ID: L510OBOO1401
PcC2
(3.82A) August 25,1999 9:49 AM
9281
neo 1.11A Parcel Identification Number
3108 5746-34-0486
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #:
990000744
Billed To:
William Smith
Reference Name:
Mickey S. Smith
Proposed Facility:
Residence
Water Supply: On -Site Well
PROPERTY INFORMATION
Tax PIN/EH #: 5746-34-0486
Subdivision Info:
Location/Address: Hwy. 601 S.-27028
Property Size: 1.60 Acre Date Evaluated:
Community
Evaluation By: Auger Boring t1� Pit
Public L�
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
,L
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
0 -
Consistence
i
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:
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)
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DAVIH COUNTY HEALTH DHPAH.T ERT
ENVIRONMENTAL HEALTH SECTION
P. 0. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #: (336)751-8760
September 13, 1999
Mr. William R. Smith
1147 Barringer Road
Salisbury, NC 28147
Re: Site Evaluation/N.C. Hwy. 601 S.
Tax Office PIN: #5746-34-0486
Dear Mr. Smith:
As requested, a representative from this office visited the aforementioned site on
September 10, 1999. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
provisionally suitable for the installation of an on-site sewage system.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/mp
Enclosure(s)
Parcel #: L5100B001401
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #:L5100B001401
Account #:82519413
Owner Information
Tax Codes
4,500
RANFILL TIMOTHY WAYNE& CRANFILL DONNA W
13,760
ADVLTAX - COUNTY TA
18,260
88 BEAUCHAMP ROAD
18 260
FIREADVLTAX - FIRE TAX
7f0
ADVANCE, NC 27006
Property Information
Township
Land (Units/Type): 1.610 AC
JERUSALEM
ddress: 147 MISS RUBY LN
Deed Information
Local Zoning
Date: 12/2005 Book: 00641 Page: 0248
Plat Book: 0001 Page: 059
Legal Description
PIN
1.66 AC OFF HWY 601 P O LOTS 8-9
5746340486
Property Values
Building:
BXF:
4,500
Land:
13,760
Market:
18,260
Assessed:
18 260
Deferred:
7f0
Sates Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00115 0504 02 1987 WD Unqualified Vacant 1
Z 00116 0876 10 1994 WD Unqualified Vacant 0
3 00641 0248 12 2005 QC Unqualified Improved 0
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/itsnetIView.aspx?prid=1462444 7/29/2016