1958 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT
r. IMPROVEMENTS PERMIT AND - CERTIFICATE OF COMPLETION
1
*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;, 41�Cf',=. f,, ;,f" Date
Location r�! /C' c�;r� ` :,' r .�ji l,, . ,I ..1�
Subdivision Name Lot No. Sec. or Block No.
Lot Size /Yetl House Mobile Home _ Business Speculation
No. Bedrooms No. Baths? No. in Family rJ
Garbage Disposal YES ❑ NO Specifications or Sygtem:
Auto Dish Washer YES ❑ , NO."p
'
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.
p
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.
Certificate of Completion /�"Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth M 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.
v.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
- / Home Phone
�V Permit Requested By � Business Phone
�' 2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Sec. - Lot No.
5. System used to serve what type facility: House Mobile Home, Business
// Industry Other
b) Number of people /V/ A
6. a) If house or mobile home, state size of home and number of rooms. 7
House Dimensi
Bed Roomsy�� 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 urinals
lavatory showers
dishwasher _ sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions yge_
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 cerVy tthhat the information is correct to the best of my knowledge.
e�; Y
Date 4Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR OMPLIANCE WITH ALL STATE AND LOCAL LAWS
Directions to property:
Allow 5 days for processing
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT 4
Davie County Health Department
y Qj' Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 103L 2'0.7(4
1. Permit Requested By R . 4 �s��-� Business Phone
2. Address qo8 N,ttjm s,% . g4-- Y�-acl-
3. Property Owner if Different than Above P w� m�Nt
Address
4. Permit To: a) Install Alter— Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot N(
5. System used to serve what type facility: House Mobile Home Business
IndustryOther-�JAv- Y�«� ~` -Oat"
b) Number of people Z o - 7-s-
6.
S6. 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 7 -
lavatory z
Al Do, y/c 411116
Mock.svillc, NG
Raymond M-Gamrnck
Col»mandcv
ko Ncl Z6 •j2o.—
,lr-:,"
aw e"'� . �..cs.F - ( \ 6!
urinals garbage garbage disposal X
showers X washing machine X
dishwasher X sinks 1
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes ✓ No
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor
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 correct to the best of my knowledge.
il-2y.4 rf 0-64g y
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
Gob
= .'7 .1 . �v -
I
SRl .&sine ) I!!,:- L'_`0 / -5-
DCHD (6-82)
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
' SOIL/SITE EVALUATION
FACTORS ARFA 1 AREA 2
2
3
Datehc�C��s
Lot Size
AREA 3 ARFA 4
) Topography/ Landscape Position S S S
1-1�17PS PS
�j U U U U
) Soil Texture (12-36 in.) Sandy, S S S S /
Loamy, Clayey, (note 2:1 Clay) S PS PS PS
`–� U U U
) Soil Structure (12-36 in.) S S S
Clayey Soils PS PS PS
U U U
4) Soil Depth (inches) S S S
pS PS PS PS
U U U
5) Soil Drainage: Internal S S S
PS PS PS PS
U U U
External S S S
PS PS PS
U U U
i) Restrictive Horizons
Available Space S S S
4�s PS PS PS
U U U U
I) Other (Specify) S S S S
PS PS PS PS
U U U "-_,_U
i)', Site Classification
U—UNSUITABLE
Recommendations/ Comments: a -V
Described by
SITE DIAGRAM
Title
ITABLE PS—Provisionally Su' ble�'�
DCHD (6-82)
A
U—UNSUITABLE
Recommendations/ Comments: a -V
Described by
SITE DIAGRAM
Title
ITABLE PS—Provisionally Su' ble�'�
DCHD (6-82)
A
Parcel #: L5010B0004
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: L5010B0004
Account #:20122500
Owner Information
Tax Codes
13,96
AVIE COUNTY DISABLED VETERANS & CHAPTER 75
01
ADVLTAX - COUNTY TAX
17,42
O ROBERT PANCOAST
31 38
FIREADVLTAX - FIRE TAX
31 38
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 1.000 LT
JERUSALEM
ddress: 1958 S US HWY 601
Deed Information
Local Zoning
ate: 11/1985 Book: 00128 Page: 0832
Plat Book: 0001 Page: 005
Le al Description
PIN
LOTS 59-64 DANIELS PARK
5746078838
Property Values
uiidin :
13,96
BXF•
01
nd:
17,42
Market:
31 38
ssessed•
31 38
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
1 00124 0466 10 1984 WD Unqualified Improved 17,000
2 00128 0832 it 1985 WD Unqualified Improved 14,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1470752 7/14/2016