273 Bean Rd f!
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETIONS o U
;eNOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a j
' Sanitary Sewage Systems \ `Permit Number r
Name `,,ti, z.�� \� ', t\,t< �7 .t-ti,`��+ >;', Date - i J N2 !
{,i
Locati .., e.�.t r.� �� yh 0.3
oZ 73
Su �ivisioneLot No. Sec. or Block No.
Lot Size ' `-' >4 House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO 0' Specifications for System:
Auto Dish Washer YES p, NO ❑
Auto Wash Machine YES p'' NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 I
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. 4
Final Installation Diagram: System Installed by
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a
Certificate of Completion Date �� 3
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulatign, but shall in NO way be taken as a guarantee that the system will function
\ satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Departmentk
� 1 1
` Environmental Health Section �wEO OC
P. 0. Box 665
Mockaville, NC 27028 16
1 . Application/Permit Requested Byy/"1CcL
Mailing Address I �Ql� .2 z '-: t //A
Home Phoned' �� 3 9� Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Abov-,—
4. Application/Permit For: neral Evaluation 0 S/Tank Installation
S. System to Serve: louse u Mobile Home 0 Business
L Industry u Other 0 Unknown
6. If }souse, mobileom Subdivision Sec. Lot#
-5/ e-- q- S�j/e ofd, l g -n1� ye-.+ at, h0WOIL
No. of People `i" Dwelling Dimensions
No. of Bedrooms _ J Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
Washing Machine dishwasher 0 Garbage Dasposai
7. If business, industry, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
8. Type of water supply: 0 Public ffl.-Private Q Community
9. Property Dimensions
10. Sewage Disposal Contractor
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? Yes No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5
years from date issued. Improvements Permits are subject
to revocation, if site plans or the intended use change.
Effective October 1, 1989.
This is to certify that the information provided is correct to trice
best of my knowledge, and I understand I am responsible for all
charges incurred from this application.
/6/1 /f 0 A222�Av
ate Signature
Directions to Property :
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Lxl-� b.e-P fR P .ILIL /6 S'
9,0
Lam a
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT D
ENVIRONMENTAL HEALTH SECTION OCT Z
SITE EVALUATION CONSENT FORM -
1. Complete the form below and return to the Davie County Health Depa
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
' (office use only)
yes 1. 1 am the owner of the above described property.
yes no 2. I am not the owner of the above descibed property, however, I certify that I
have consent from J'^^- e-I' , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
jo // lqo
DATE SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
— Owners designated representative
Anyone requesting results
— Only those listed below
ATE SIGNATURE
DCHD(11/84)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
\\ Soil/Site Evaluation
NAME C) Z),P'X \'VO N DATE EVALUATED
ADDRESS S A C. PROPERTY SIZE
PROPOSED FACIILTY d se LOCATION OF SITE O F? I S
Water Supply: On-Site Well t/ Community Public
Evaluation 1Z_ Auger Boring V Pit Cut
FACTORS 1 2 3 4
Landscape position S -S
Sloe 7. - a` e ` -3e� _ a
HORIZON I DEPTH
Texture group �• C
Consistence
Structure V•
Mineralogy '1l '. 1
HORIZON II DEPTH LL c`N 1 14 6, Z�
Texture group
Consistence V
Structure R
Mineralogy '
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS .SS c5 -
RESTRICTIVE HORIZON
SAPROLITE —
CLASSIFICATION g
LONG-TERM ACCEPTANCE RATE ,1, - a - 1A.0 I -3.K. %1
SITE CLASSIFICATION: - EVALUATED BY: �
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
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(01-901
Parcel#:N600000099 Page 1 of 1
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Parcel#: N600000099 Account#:31942500
Owner Information I Tax Codes
A
. BEAN
RONALD LEONARD&HAMILTON VICKIE BAITY ADVLTAX-COUNTY T
BEAN ROAD FIREADVLTAX-FIRETAX
CKSVILLE NC 27028
Property Information Township
nd(Units/Type): 6.080 AC JERUSALEM
Edress: 273 BEAN RD
Deed Information Local Zoning
ate: 12/1990 Book: 00157 Page: 0235
Plat Book: 0005 Page: 137
Le al Description PIN
LOT 3 BOXWOOD ACRES 5745828082
Property Values
uildin 255,63
BXF• 1,12
Land: 54,54
CCII
arket: 311,29
ssessed: 311,294
eferred• CI
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
00157 0235 12 1990 WD Unqualified Vacant 13,500
00129 0264 12 1985 WD Qualified Vacant 9,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1471318 8/2/2016