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376 Village Rd� Davie Countv. NC Tax Parcel Rennrt Tuesdav. October 1 l. 2016 Parcel Number: NCPIN Number: Account Number. Listed Owner 1: Mailing Address 1: City: MOCKSVILLE State: WARNING: Ttll51S NU"1' A SUIZV�Y Parcel Information K10000001402A Township: 4797951043 Municipality: 80008000 Census Tract: WILSON CEOLA Voting Precinct: 376 VILLAGE ROAD Planning Jurisdiction: Zoning Class: NC Zoning Overlay: Zip Code: 2702&8474 Voluntary Ag. District: Legal Description: 1.000 AC VILLAGE RD Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Totai Assessed Value: �9�—�--��'�' Davie County, �a� �� NC 0.75 Elementary School Zone: 2/1994 Middle School Zone: 001720818 Soii Types: Flood Zone: Watershed Overlay: 0.00 Outbuilding 8� Eutra Freatures Value: 14810.00 Total Market Value: 23810.00 Calahaln 37059-801 SOUTH CALAHALN Davie County DAVIE COUNTY R-A COUNTY LINE COOLEEMEE SOUTH DAVIE PcC2,CeB2 DAVIE COUNTY 23810.�0 No ; ,, : . . . �_ ' a 'FY. e.+ 1 . „ � . �,..�.� ...,�. _ .. _ �� , .� � '.��_� . . .. . . . �� , , . t, . - . . � . , q , �'. ,. • , . . . , �O AUTHORIZATIQN NO: O 6 3%' DA`VIE COUNTY HEALTH DEPARTMENT ' � Environmental Health Section PROPERTY INFORMATION . Permittee's,,.� P.O. Box 848 Name: �! (�O�Q �I�/�✓� ./"���� / f Mocksville, NC 27028 Subdivision Name: � Phone #: 704-634-8760 Directions to property: !/' �:r� .� ,r- ;� Section: Lot: � i AUTHORIZATION FOR WASTEWATER Tax Office PIN:# r� �� l� 3 SYSTEM CONSTRUCTION ��—L-L� - � - �� RoadName:_L�/�'a�.j� �'c�. Zip: � L��� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. ' (Tn compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) � � / : � „ ; ��,,,� � ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION `�'`i; u<.- �ii. '�-�;�"�, �, � _,��' ij,�: y LS VALID FOR A PERIOD OF FTVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �--":'�.� ��} � ����:• ��. .�� � "4-k�� t..;��.. �i���:. . ...���. .���. , e .., . t , , ' .. . .. . .. � . . . ��� . �. - .......-,:. . .,:�. �..,,.. �... �., - • ,,., . . T , ; , . , li'r ,._ _, �, , ; , ,,,,,, . . _ '-, q ,�!-• 4 ... .-... ' +� � ' I�A'�IE COUNTY HEALTH DEPARTMENT -�- �1� �'+ IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION r �QCII11CtP.8' $ • �� / < � Name: �� ��-�� f r-�l�!'� �.!.f':�i!�i9�;r Subdivision Name• Directions to property: � #' IMPROVEMENT PERMIT Section: Lot: Tax Office PIN:# E f'`- r" 6-�` _ t' �,� 'a Road Name:_�f �1 • ; ._ _R;�_�. _ Ziv: _' ''� �` _ '� �'' **NOTE** This Improvement Pernut DOES NOT authorize the construction or installation 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 pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ` l:� ,, �- ***NOTICE*** TIIIS PERNIIT IS SUBJECT TO REVOCAITON IF STl'E !: ; ,.,. � , ,,�', �;' :: PLANS OR TI� INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE _ INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUII..DING TYPE j%J �# BEDROOMS �% # BATHS �# OCCUPANTS _� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILTI'1' TYPE # PEOPLE # PEOPLFISHIFI' # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE 1�� f�� ,�TYPE WATER SUPPLY �'��' �� DESIGN WASTEWATER FLOW (GPD) �Ji �� NEW SITE � REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ��a� GAL. PUMP TANK GAL. TRENCH WIDTH ���"� � ROCK DEPTH � a , LINEAR FI'. � F` `.f � REQUIRED SITE MODIFICATIONS/CONDITIONS: _ IMPROVEMENT PERMIT LAYOUT �-�f��r ��� - (� �C .� r i7 •+/ `� !•J f i N **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 930 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. I OPERATION PERMIT SYSTEM INSTALLED BY: �'V A�� L pp i j�S �,�K � i�- �1—I (r.1 oT a►J S �rC� N1. ►-10�1� F � �x �,7��c3�xlg'� 5 'f- � -7 � L AUTHORIZATION NO. ���� OPERATION PERMIT BY: DATE: �Z �I / **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM D CRIBED 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 WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. . DCHD OS/96 (Revised) ' �,1 �-d' ,�►� r �� . . `, ��', � Y r � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & �jJ —C �-"�" �11 � �'D � _�/ Davie County Health Department � � � � �=/ � � 1� � �,,/ T7"� � Environmental Health Section D ` (i-�`� � �1 ' � . P. O. Box 848 ,�`- ` � �:--.�t: 1 ` �1l) ��, � Mocksville, NC 27028 '� 1997 � � `� (704) 634-8760 U' � '��'�* PORTANT**** THIS APPLICATION CANNOT BE PROCESSED U ALL THE REQUIRED INFORMATION IS PROVIDED. 1 �n�� 1. Name to be Billed 0�� ��"" "� l� Contact Person b �Mailing Address Home Phone � City/State/Zip �%����,�(��� � C � � � �� Business Phone 2. Name on PermidATC if Different than Above �%�1�� ('Y� Mailing Address _ 3. Application For: 4. System to Serve: 5. If Residence: ❑ Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: ❑ Site Evaluation ❑ House � Mobile Home # People � ❑ Gazbage Disposal Specify type _ _ # Showers # Seats City/State/Zip �' Improvement Permit & ATC ❑ Business ❑ Industry 0 Other �" Both # Bedrooms � # Bathrooms _� �Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 7. Type of water supply: ❑ County/City # People # Sinks # Urinals Estimated Water Usage (gallons per day) �' Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes �'No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. � y A� Property Dimensions: i Tax Office PIN: # r - �S � - �� �� � I � 1 ', Property Address: Road Name _� r L�� f � � 1 City/Zip /�DG���� �/ � 1 1 If in Subdivision provide information, as follows: 1 1 Name: � I Section: Lot #: � 1 1 WRITE DIRECTIONS (from Mocksville) TO PROPERTY: ���L/L �P'� f/! - �. S� � ,�'�' , This is to certify that the infortnation provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter aze 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 County Health Department to enter upon above described property located in Davie County ... n n E n and owned by as necessary to deternune the site suitability. �;DATE � �� �' 9 � SIGNATURE Revised DCHD (06-96) conduct all testing procedures `� _ _ _ _ _ __ _ ____ ___ _ _ _ _ __ ___ _ __ _ _ _ _ _ _ -, � � N CV � 3aa _� 224 (531� � � ° �` � �-- � � � 238 Q � � � � t� � o c� D` I� � �. c�1 � ' ' � cv �t�z �-- O� Z �6Z � � - . �0� -- � � lii t� , , � , I � I � .. __ .., . _. � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT SoiUSite Evaluation APPLICANT'S NAME ��<S 6�'L PROPOSED FACILITY /.i`/b`� SUBDIVISION _ � Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit FACTORS Slope %a HORIZON I DEPTH Texture group Consistence Structure HORIZON II DEPTH Texture group Consistence Structure HORIZON III DEPTH Texture group Consistence HORIZON IV Texture group Consistence SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 1 SITE CLASSIFICATION: � LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (OI-90) 2 DATE EVALUATED `��% PROPERTY SIZE /Z t� ROAD NAME %�%���� Public Cut 3 4 5 6 7 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 tructure SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogv 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of iill - In inches Restrictive horizon - T'hickness 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 Classifcation - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gallday/ft2 ■�■■■�■�■�■�■■■�■�■■�■■�■■■�■■ ■■■■■■■�■■■■���������■����■��■ ■■■■■■�■■■�■■������■��������■ ■�■��■���■�■���■�����■ ■■■■■■ ■�■��■■�■■�■■■■■�■■■�■■■�■���■ ■����■���■��■�■���■■■■■��■■�■■ ■■■■■■■■■�■■■��■■�■�■����■■�■■ ■■��■��■��■��■����■������■���■ ■�����■■���■■■■■�■■■■■�■■■■■■■ ■■■■■���■�■������������■�����■ ■■�■���■■■■��■���■�■�■ ■��■�■ ■■■■��■■■�■■■■��■■�■�■� ■��■�■ ■■����■■��■�■■■■■�■■���■■�■■■■ ■■�■■�■�■■�■■���■��■�■■�■■■��■ ■�■�■ ■�■■■ ■�■�■ ■■■�■ ■■■�■ ■�■�■ ■�■■■ ■�■■■ ■�■�■ ■■■■■ ■■■�■ ■�■��■■■■■■■■■■■■��■�■■�������■ ■�■�■��■■�■■■■■■■■■��■��■■�■�■■ ■■■�■■■■■■■■�■■��■■�■■■�■��■■■■ ■���■��■■���������■�■■■■■■■■■■■ ■■�■■��■�����■■��■■0■���■��■��■ ■■����■������■■���■�■����■�■��■ ■■�■��■■��■��■��■■�■��■���■�■■ ■■�■���������■ ■■���������■��■ ■■�■��■■��■�■■��■■e■■■■■�■■■■■■ ■■�■■�■■■�■■■■■■■■■�■���������■ ■■����■■��■�■■��■■�■■■■■■■■■■■■ ■■����■�������������■■■�■■����■ ■■■��■■��■��■��■■��■�■���■■�■�■ ■�■■■■■�■■�....====�::���i�����■ iiiiii�l�iiiiiii '�iiiiiii�iiiiiii� ■�■�■■■i�■■■■�■■■��■�■■���i�����■ ■�■�■��i�■■�■��■���■��■���i�■■■■■ ■������i�■�■■�■■��■■�■■�■�i■��■■■ ■■�■■�■i�■�■■■�■��������■�i■■■■■■ ■��■■�■u■�■■■■■�■■■■■■���������■ ■■�����i������■���■■■■■■■���■��■ ■�■�■�■■�■■■■��■■�■■■■■�■�������s....======��■��■ ■■■■■�■■■■■■■�■■■�■■�■��■��■����iiiii■■�■■■■■■■■■ ■�■■■■■���■�■�■■��■�■■■■�■■�■�■���■ ■��■���■■�■■■■■��■■�■�■■■�■■■■■��■■ ■■t��■�����������■��■��■■�■■■■■�■■■ ■■■■■■■■■■�■■■■��■■�■��■��■■��■�■■■ ■�������■�����■�■■■�■�■■�■■��■��■�■ ■��■�������■�■�t���������■■�■■��■�■ ■�■■■�■■■■■■■■�■■��r:�■■��■�����■ ■ ■■■■■■■■■�■■■�������n����■��■■�■ ■ ■�■�■�■���■����■���■ri■■�■���■�■���■ ■���■���■�■■■■�■■�■■�■■■���������■■ ■■■�■�����■��������■��■■■■■■■■■■�■■ ■■�■■■�■�■��■��■��■�■��■���■�■■■�■■ ■■�����s������■��■��■��■���■��■�■■■ ■■���■■�■■��■■■��■■�■�■■�s■■�■��■■■ ■��■�■■■■■�■■■■��■��■■■■��■■�■�■ ■ ■■■��■��■■����■��■���■■■■■■■■■���i■ ■��■■■■■■■■■■■■■■��������■��■■�■■■■ ■■�■���■■��■��■�■■■■■�■��■■��■�■■�■ ■■■■■■■����■�■�����■�■■■■■■�■■■���■ ■���■■■■■■■■�■�■■��������■�����■�■■ ■■■�■■���������■���■■■■�■■■■■�■■�■■ ■�■��t■■��■����■��■■�■�■■���■�����■ ■�����■■■■■�■��■��■�■�����■�■�■■ ■ ■�����������■�■■��■�■��■���■■■■��■ ■■�■■■■■�■�■■�■■�■■�■��■���■■■■■■■■ ■■�����■■■�■■�■■��■�■��■���■■■■��■■ ■■�������■��■�■��■��■■�■��■■����■■■ ■��■�■��■■��■�■■�■��■�■■■�■■�■�■■■■ ■��■■■■■■���■�■��■��■�■■■■■��■��■�■ ■■■ ■ ■■���■■��■■■ ■■�■���■■■�■ ■■■■■■�����■ ■■���■■■■��■ ■■■■■�����■■ ■■�■�■■��■�■ ■�������■�■■ ■■■�■■■■■�■■ ■�■�������■■ ■������■�■�■ ■■���■■■�■�■ ■■���■■�■■�■ ■����■�����■ ■��■ i