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3912 Hwy 601N�..rr DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION . • *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems �r.�>*=° .� Permit Number e k'�rr,''91, r�,i_ D Nam%ate_ N- 6493 Loc ion Subdivision Name Lot No. Sec. or Block No. -Lot Size r}�� House Mobile Home _ Business Speculation No. Bedrooms- No. Baths '> No. in Family _— Garbage Disposal YES ❑ NO Q' Specifications for System: Auto Dish Washer YES NO ❑� �� : Vic, Auto Wash Ma^hine YES NO ❑ V cI c Y 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 — __Z *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 u. Certificate of Completion G� U Date , *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 taken as a guarantee that the system will function satisfactorily for any given period of time. y o`r's APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ,. Davie County Health Department 2� rho Environmental Health Section '-CEIVED P. 0. Sox 665 Mockaville, NC 27028 JUL 1 5 iggi 1. Application/Permit Requested By Mailing Address ir, b^ NC -';) Home Phone -2%6 ffe9(1h Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation XS/Tank Installation 5. System to Serve: House Mobile Home 0 Business Industry Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People No. of Bedrooms No. of Bathrooms Washing Machine Dwelling Dimensions Basement/Plumbing Basement/No Plumbing Dishwasher 0 Garbage Dasposai 7. If business, industry, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers S. Type of water supply: .�+ !'` Public 0 Private 0 Community 9. Property Dimensions ()O 1( jro a as o n z6a 10. Sewage Disposal Contractork. m efl- Sar.c 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 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 tree best of my knowledge, and I understand I am responsible for all charges incurred from this application. 1-7:% -, S I �,4,4 f 1altt� Date Signature in / lib/ N ��•%s ,9s' / ,�'•�v�c� SoZ 4� �i - m _(' Directions to Property: DCHD (10-89) C;'110les DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 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 (qd� o�M•r �q Gvi� �n��' SC/�,c (office use only) yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from , 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 propertyand conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. - 9-q/ - DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: Aswner only owners designated representative Anyone requesting results Only those listed below 12-4 A/�/yr--� r/'7- �F/ DATE SIGNATURE DCHD (11 /84) r ' r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME /;d6MNS ADDRESS PROPOSED FACIILTY Water Supply: On -Site Well DATE EVALUATED 'V% PROPERTY SIZE LOCATION OF SITE Community Public l/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L L G L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH r + Texture group Consistence r - Structure Mineralogy /, AV Al 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 •t/ SITE CLASSIFICATION: __4 EVALUATED BY: /Yl if LONG-TERM ACCEPTANCE RATE: a 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 Mineralo[ty 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 ■ON■ ■MM■ Parcel #: D300000069 Dzvie 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 #: D300000069 Account #:82521722 Owner Information Tax Codes HARRIS FREDERICK A& HARRIS LINDA K ADVLTAX - COUNTY T 912 HIGHWAY 601 NORTH IREADVLTAX - FIRE TAX MOCKSVILLE NC 27028 Market: Property Information Township Land (Units/Type): 1.850 AC CLARKSVILLE ddress: 3912 N US HWY 601 2006 WD Deed Information Local Zoning Date: 07/2015 Book: 00994 Page: 0864 00994 0864 lat Book: Page: 2015 WD Unqualified Improved 97,500 Legal Description PIN 2.073 AC HWY 601 5822111928 Property Values Building: 174,27( BXF: 5,53( Land: 26,04C Market: 205 84 ssessed: 205,84( Deferred 01 Sales Information No. Book Page Month Year Instrument Quai/UnQual Improved Price 1 00521 0307 11 2003 WD Unqualified Vacant 0 Z 00645 0679 01 2006 WD Unqualified Improved 0 3 00994 0864 07 2015 WD Unqualified Improved 97,500 4 2011E 0060 01 2011 EF 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�DUR� 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=1175997 8/16/2016