4237 Hwy 601S•a
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 \ N �-Q\ WN ��_ c) N Date - + �� + ' N25286
. 9
`�`n\ \ ``/
* v ,a
Subdivision Name Lot No. - Sec. or Block No.
Lot Size , - House Mobile Home _ Business Speculation
No. Bedrooms .No. Baths' No. in Family
Garbage Disposal YES C1 `NO {
Specifications for System:
Auto Dish Washer" YES p"' NO ❑ / c -G �.�. `mak' xz� G�
Auto Wash Machine YES [r NO p
Type Water Supply
*Tqi� permit Void if sewage system described below is not installed within 36 months from date of issue.
x ♦ /
n---�-0
Improvements permit by.c�
*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: 4 System Installed by a
94
Certificate of Completion Date
"The signing of this, certificate°shall indicate that. he system described above has been installed in compliance with
the standards'set ,fogh in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily fo�any given period of time.
r
�• APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department �ti1iE ID ppR
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
d1. Permit Requ sted y �S Business Phone
2. Addres1 .60 Cey
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional_ O /
ther Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Z Mobile Home— Business
Industry Other
b) Number of people I _; �_r ° `11_� off'- B_�-
6. a) If house or mobile home, state size of hom and number of rooms.
House Dimensions 14 6 6 Sa 7
Bed Rooms 3 '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 garbage disposal
washing machine '✓
showers
dishwasher ✓ sinks
7
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions �O Qeres
b) Land area designated to building site 4a 0 5, ?
c) Sewage Disposal Contractor _P&. 7rto"1�
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? n 0
What type?
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
!Q/s - ' �Q� `�'Q� o� lam � i ?ti-�a✓ice. Ca7,c�. d 7A-
1eb ya
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i
7>� G�u�,e�.� ,-va� u#Tion/.
DCHD (6-82)
` DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R 0. Box 665
Mocksville, N.C. 27028
(� SOIL/SITE EVALUATION C
Name — A `c l \, 'M S Date
Address �� S'`�'� Lot Size b
FOC T()RR ARFA 1 l AR AREA 3 ARFA 4
1) Topography/ Landscape Position
S
PS
S
PS
U
U
U
U
?) Soil Texture (12-36 in.) Sandy,S
Zi
PS
S
PS
Loamy, Clayey, (note 2:1 Clay)
U
U
U
U
1) Soil Structure (12-36 in.)S
–4s
–'a:4
PS
S
PS
Clayey Soils
- -
U
U
U
U
L) Soil Depth (inches)�
____<:
S
PS
S
PS
U
U
U
U
i) Soil Drainage: Internal
S
PS
S
PS
U
U
U
U
External
S
S
S
PS
U
PS
U
i) Restrictive Horizons
Available Space
SN
PS
PS
S
PS
S
PS
U
U
U
U
I) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
q Site Classification
U—UNSUITABLE S—SU PS Provisionally Suitable
Recommendations/ Comments:
Described by Title --- - – Date \A-
SITE DIAGRAM
DCHD (6-82)
Dame County Nealtli Dyarhnent
and .Mame NealtFi A en
9 cy
210 HOSPITAL STREET / P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634.5985
April 14, 1988
Mr. Lincoln Carson
Rt. 4, Box 254
Mocksville, NC 27028
Re: -Site Evaluation
601S.
Dear Mr. Carson:
On April 13, 1988, as you requested a representative from this office
visited your site and found the soil provisionally suitable for the
installation of a ground absorption sewage system; however, the building
site cannot be in the flood plain.
If you have any questions, please feel free to contact this office.
Sincerely,
C'N� *�W ''ox ts.
Charles E. Little, R.S.
Environmental Health
CL/wd
Enclosure
Parcel #: 0600000034
Davie County, NC - Basic Estate Search
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Vibw Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: 0600000034 Account #:66530000
Owner Information
Building:
Tax Codes
BXF:
LEDGE LOUDETTA B HEIRS
Land:
ADVLTAX - COUNTY T
Market:
O JUDY HOSKINS
ssessed•
FIREADVLTAX - FIRE TAX
[Deferred:
KERNERSVILLE NC 27284
Property Information
Township
[Land (Units/Type): 10.640 AC
JERUSALEM
ddress: 4234 S US HWY 601
Deed Information
Local Zoning
Date: 10/1980 Book: 00112 Page: 0127
lat Book: age:
Legal Description
[— PIN
10.89 AC HWY 601 LOT 5
5754213744
Propertv Values
Building:
56,7401
BXF:
01
Land:
81 61
Market:
138 35
ssessed•
138,35
[Deferred:
Sales Information
�No. Book Page Month Year Instrument Qual/UnQual Improved Price
00112 0127 10 1980 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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1.5.9
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1467022 7/14/2016