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2079 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT y IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION • "NOTE: Issued'in Compliance with G.S. of North Carolina' Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit. Number i Name Date %moi / t'4025 Location L j%, Subdivision Name Lot No. Sec. or Block No Lot Size �l %Ic House Mobile Home Business — - Speculation No. Bedrooms �%`--� No. Baths_ No. in Family Garbage Disposal YES ,0 NO D'f Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO ❑ Type Water Supply _— 'This permit Void if sewage system described below is not installed within 36 months from date of issue. 1 Improvements permit by 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by ✓ "' i Date Certificate of Completion - " , I '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 regulation, but shall in NO way be as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name Date 4925 Location Subdivision Name Lot No. Sec. or Block No. Lot Size i House Mobile Home Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES :E] NO 0 Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES E] NO -❑ Type Water Supply ----I *This permit Void if sewage system described below is not installed within 36 months from date of issue. Ilk Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion Date *The signing of this certificate shall indicate that the system describ6d above has been installed in compliance with the standards set forth in the above regulation, 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 / S Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Req 2. Address — 3. Property Owner if Different than 6pove 6 Address 4. Permit To: a) Install Iter Repair � b) Privy Conventional Other Type Ground Absorption Home Phone Business Phone c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business �� IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms , Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes lavatory _ urinals_ showers dishwasher sinks 8. a) Type water supply: Public f Private Community b) Has the water supply system been approved? Yes 9. a) Property Dimensions b) Land area designated to building site c) Sewage Disposal Contractor garbage disposal washing machine 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is corre t to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COM Allow 5 days Directions to property: DCHD (6-82) E WITH ALL STATE AND LOCAL LAWS Name s Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date 11,11"OpYr Lot Size / 7xL CAP-TnPQ AREA i AREA 9 ARFA 3 AREA A Topography/ Landscape Position S PS S PS S PS U U U U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S <gtf�> S - -<:ff> S PS S PS U U U U I) Soil Structure (12-36 in.) Clayey Soils S CPi5>p5"j S„ S PS S PS U U U G) Soil Depth (inches) PS S PS S PS U U U U )Soil Drainage: Internal � 5, S PS S PS U U U U External � „ P��-' S PS S PS U U U U i) Restrictive Horizons ') Available Space PS S S S PS S PS U U U U 3) Other (Specify) S PS S PS S PS S PS U� U U U I) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Sum Recommendations/Comments: Described by .��/ Title „� Date SITE DIAGRAM i 2 A/ DCHD (6-82) STArl State of North Carolina Department of Natural Resources and Community Development Winston -Salem Regional Office James G. Martin, Governor S. Thomas Rhodes, Secretary August 8, 1985 Mr. Steve Beaver Christy Trucking Rt. 8, Box 112 Mocksville, N.C. 27028 Subject: Waste Oil Collection Tank Dear Mr. Beaver: This letter is in regard to your inquiry by telephone on August 5, 1985. There is no permit required by this Office for your waste oil holding tank. However there is one suggestion for the design of the waste oil system in the service pits. The pit drain could be connected to the waste oil drain pipe so that just before the waste oil holding tank filled up the oil would fill the waste oil drain and and begin to back-up in the pit. This insures that oil spillage does not occur from the holding tank without someone being aware of it. We understand that you will have an oil reprocessor pick up the waste oil. The size of the holding tank should allow for approximately 60 days holding of oil and other liquids that may be spilled into pit. A tank with approximately 500 gallons capacity is suggested. If there are any questions on this item do not hesitate to contact me. Sincerely, M. Steven Mauney 4 Regional Engineer MSM/cm cc: Jim Swicegood Davie County Health Dept.-/ WSRO Central Files 8003 North Point Boulevard, Winston-Salem, N.C. 271063295 • Telephone 919-761-2351 An Equal Opportunity Affirmative Action Employer Parcel #: G300000085 Davie 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 #: G300000085 Account #:82518061 Owner Information Buildin Tax Codes BXF• & C BEAVER FAMILY LLC EMOCKSVILLE Land: ADVLTAX - COUNTY T Market: 079 US HWY 601 N ssessed: FIREADVLTAX - FIRE TAX Deferred: NC 27028 00402 0957 01 2002 WD Unqualified Property Information Township Land (Units/Type): 1.780 AC MOCKSVILLE ddress: 2079 N US HWY 601 Deed Information Local Zoning Date: 01/2002 Book: 00402 Page: 0957 Plat Book: Page: Legal Description PIN RACT 2 US HWY 601 5729599896 Property Values Buildin 8414 BXF• 1 Land: 40,05 Market: 124 19 ssessed: 124,19 Deferred: 3 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00150 0328 08 1989 WD Unqualified Improved 24,000 2 00402 0488 02 2002 WD Unqualified Improved 0 3 00402 0957 01 2002 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 o s�1F 0 ria 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/itsneWiew.aspx?prid=1477066 8/10/2016 Oz -- DAVIE COUNTY HEALTH DEPARTMENT name: E ���:�-1a Environmental Health Section PROPERTY INFORMATION /t I, ^� P.O.' Box 848' �d, Directions to property: iC� �c=-l..a:"3 Mocksville, NC 27028 Subdivi" cion Name: Phone #: 336-751-8760 - `{' It- I "SLS Section: Lot: AUTHORIZATION: FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION NO: + A Road Name: '7� lJ� I�> Zill, q **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance withAYt#ele 11 f G.S. Chapter 130A, Wastewater Systems Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION r' r IS VALID FOR A PERIOD OF FIVE YEARS. ' ''EN RO EfN, A EH.S EC IS DAT ISSN ED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE A40# PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOTSIZE PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 4� NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ©C0 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. 1 OTHER 2520 REQUIRED SITE MODIFICATIONS/CONDITIONS: �iaL� %�!'� 11-151A K4►[: i *,*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 (336)751-8760. OPERATION PERMIT 1 L SYSTEM INSTALLED BY. �S AUTHORIZATION NO.1PERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT M DESCRIBED AB HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 0202 (Revised) t Rug 18 04 04:19p davie county envhealth 33G 751'8786 p.2 a ... _... ZZ CEO WE -D 1A AUG 2 0 2004 *** Is IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 'Z�Srlo 7& � 11te�.N�W -ro APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED :0. Refer to the INFORMATION BULLETIN for instructions. ,3„ Name to be Billedk Jjr I U('_tC_i1) f Inc -1 Contact Person M � ty) (()j('��7�Ieye n Mailing Address Z-bgq Us 9,4.--�—� Home Phone City/State/ZIP -MWke, t 1 le _ IVC —t't7 b2 -C% j Busineess/ Phone 2. Nama on Permit/ATC if Different than Above_ Solme Mailing Address City/State/zip '-3. Application For: Siti:i Evaluation ❑ Improvement Permit/ATC 13 Both 4 System to Service: ❑ Houze ❑ Mobile home Business ❑ Industry ❑ Other .S- Type system requested: )a Conventional ❑ conventional modified ❑ innovative '6. If Residence: # People # Bedrooms # Bathrooms — ❑Dishwasher ❑Garbage Diuposal Mashing Machine Basament/Plumbing ❑Basement/No Plumbing 'T',ruclu n�99 - 7. If Business/Industry /other. verify type iAX0 h(7TI S t trio # People �_ # Sinks # Commodes it showers # Urinals �� # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of,water supply: prCOunty/City ❑ Well ❑ Community 9. Do you anticipate additions or e-x-paansions of the facility this system is intended to serve? A Yes 13 No If yes, what type? 0 haLhl -I i"ur k i 116 _ VL�O1 ld ( ) kL -6 add an Odd iT cn01. I rQ: ***IMPORTA ""* CLIEI` TS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. ather a PLAi rLLSITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. —Property DImensions: r+-�( T.. /� qo5 / \7.qz3;�oz t/ a AVRITE DIRECTIONS (from Mocksville) to PROPERTY: ..Tax Office PIN: # `� � 5 d5b- 1."1 ��0 � l�U �� �� �. � I�13(i d—s `Property Address: Road Name \40 Inlri Rt • 4� City/Zip AhcKs'1ii l le- NC Z flb' z j r and 6—VI5 � l If in a Subdivision provide information, as follows: Name: Tek'�i1g �S o�bo, Mk 14C Section: Block: __ Lot: ate home corners /lagged: 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. 1, also, understand that l am responsible jor all charges ifrcrrrred Jronn this application. I, hereby, give canserit to Lire Authorized Representative of the vie Currt Healtlr De rent to enter upon above described proper'y located in Davie County and owned by JohnN VL0.YP�' to conduct all testing procedures as nc zessary to determine the site suitability. M ,/DATE V v4 SIGNATURE THIS AREA MAY BE USED FOR DItAWING*YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given �fy Revised DCHD (05103 Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. r i-t�*"adu'N�57fyr;"'l",h""q "�ySzY+.'r'7-S.:�yf,JLa'�.FhE'C• .t 3 .{'1, 'ilw��- ��' ,�: a,+, .`Z'� r.- � y a•Qw, i.+' y„"�...r:, .. DAVIE COUNTY HEALTH DEPARTMENT; IMPROVEMENTS PERMIT AND ;CERTIFICATE OF COMPLETION 'i J Ji *NOTE Issued in.Compliance with G.S. of North Carolina 130 Article 13c t ' Sewage.Treatment'and Disposal Rules (10:NCAC 10A .1934-.1968) Permit :Number, Name' � r ,= Date. r i i J Location t i , t Subdivision Name Lot No. Sec.*-or-Block`No- t Lot SizeHouseMobile Home Busiriess ��Speculation '''j i i ,:. :,. -:; <. . . ..:. ... .. .k-''' `iJ yey l" , .i 4a { r: , .• 7r J;�as.r i. ,No. Bedrooms No. Baths_:;. _ No. in Family Garbage Disposal` YES ❑ NO [3 Specifications for System �•' Auto`Dish Washer: YES "❑ NO C] `r ? ` Auto Wash Machine YES"❑ NO ❑ Type Water Supply, ,This permit Void if sewage system described below is not installed within 36 months from date of;issue yJ , i t r1 r`t F I' 43 Improvements permit by "Contact a representative of the Davie County Health Department for final inspection of this system, between., 30 9:30 A.M. or•1:00-1:30 P.M. on day of;completion. Telephone Number.704-634-5985.,., Final Installation Diagram: System Installed by ✓ 'r 1 iI d i - - I f 1 5f � I ' J • I � i • ii IJ , r :a Certificate of Completion Date; "The signing of this certificate shall indicate that'the system described above has been installed;in:compliance with thestandardsset forth in the above regulation, but shall in NO way be taken as a guarantee'that the system will function cnfic aerfnrihi fnr nn 'v