2131 Hwy 601S�5 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issueb in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewag Systems - Permit Number
Name �r� J ?% 1 ,; i Date /'/!�-� N2 6176
Location%
Subdivision Name Lot No. Sec. or Block No.
Lot Size �' House Mobile Home Businesses Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES D. NO Specifications for System:
Auto Dish Washer YES ❑ NO ��•- `` ._f
Auto Wash Machine YES ❑ 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.
r
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 o a.
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 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.
c
�. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
i Davie County'Health Department
Environmental Health Section i 6
P. 0. Box 665 REe CE'�
RC1
Mockoville, NC 27028
' 1. Application/ Permit Requested By SAil)?MOP A 77-
Mailing Address k 1 90 x �3 2 /) Co -�Ui �-Lc=, �'�' �`-2
E c'
Home Phon4o t -,)'L L— )- ✓ 2 Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: C) General Evaluation AS/Tank Installation
5. System to Serve: House u Mobile Home Business
Industry u Other Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
0 Washing Machine J Dishwasher 0 Garbage Dispusai
7. If business, industry, other: Specify type qE�
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: Q Public Private Q Community
9. Property Dimensions C71x1"l��
10. Sewage Disposal Contractor L T� S
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 trio
best of my 'knowledge, and I understand I am responsible for all
charges incurred from this applicati n.
zo-
Date Signature
3mikts SOu7-1 o�p M0CWJ I-Aw
v
Directions to Property:.
S ! D E;
DCHD (10-89)
NAME
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
ADDRESS /_
PROPOSED FACIILTY , dig! �i -n/021
DATE EVALUATED %o z� o
1
G/�'
PROPERTY SIZE ` w9r
LOCATION OF SITE aelf
Water Supply:
On -Site Well
Community
Public d�
Evaluation By:
Auger Boring
Pit
Cut
FACTORS
1
2
3
4
Landscape position
L_
J
Slope %
`/
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Vr
Texture group
Consistence
`
Structure
.c'
i1
_S2.1e
Mineralogy.!r�
/-`
!.•
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
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SITE CLASSIFICATION: !/ A
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
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
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Parcel #: L5070A0024 A
Davie County, NC - Basic Estate Search
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Parcel #:L5070A0024 A Account #:57180000
Owner Information
Tax Codes
LOTT SHERMAN E& PLOTT DOROTHY G
ADVLTAX - COUNTY T
131 US HIGHWAY 601 SOUTH
FIREADVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Market:
Property Information
Township
land (Units/Type): 8.950 AC
JERUSALEM
[Address: 2131 S US HWY 601
Deed Information
Local Zoning
ate: 04/1985 Book: 00128 Page: 0285
Plat Book: Page:
Le al Description
PIN
18.998 AC HWY 601
5746250802
Property Values
Building:
42,28CI
BXF:
36,24
Land:
97,64
Market:
176 16
ssed:
176,16
eferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00128 0285 04 1985 WD Unqualified Vacant 16,500
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=1479088 7/29/2016