2475 Hwy 601SY t,,,::r:'�k4 a z+.Wi t•' .i :,:'i f .syY r .,. t. •o 'y,i'"` +...3'..'a sL+S.r.,,i. w �'1"_)._:'\hro)... .'i-4. r. c-..rf... � .- . � r •_ - v ':4- ' ._ - ,
Vt
DAVIE COUNTYTH
HERL DEPARTMENT00
IMPROVEMENT PERMIT and OPERATION PERMIT ,
IMPROVEMENT PERMIT
**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION, must be obtained from this Department pri�fO ojo
• construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1t of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
.
NAME �.� s 5�' �J.e J�-° PROPERTY ADDRESS—1 ' `> �� '� 0 aG
�7 DATE �' I t
LOCATION 3s �• ,� 11.�.C� 1\
SUBDIVISION NAME LOT NUMBER nn SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE ��5"` # BEDROOMS # BATHS # MIMTS GARBAGE DISPOSAL: Yo O/No
COMMERCIAL -SPECIFICATION FACILITY TYPE # PEOPLE", #r PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Ye's%No�
LOT SIZE TYPE WATER SUPPLY �1� .DESIGN WASTEWATER FLOW (GPD) LID NEW SITE REPAIR SITE
T {
SYSTEM SPECIFICATIONS. TANK SIIE lOOo GAL. PUMPTANK "w,GRI. "TRENCH WIDTH ROCK DEPTH I �" LINEAR FT., )00
OTHER r
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS'SUBJECT TO REVOCATION ,IF SITE PLANS'OR{THE INTENDED USE CHANGE. YOUR,WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. f
y
00, .x
00: 1
IMPROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
- ;' I •..• 'IIS �'9 �•� � �j(�
AUTHORIZATION' NO. O LAW:) OPE PERMIT. BY Qa DATE 3
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 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 10/95
IRA J;N
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PI tg @ IE 0 v
Davie County Health Department
Environmental Health Section MAY 2 8 199
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By 4 e�`!-i' Ae
Mailing Address ;2 9- i r /= ie/ _L3d M4C-. /esdi%%. Home Phone 43N = Sep -S/
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve:
❑ Business
❑ House
❑ Industry
5. If house, mobile home: Subdivision
No. of People y
No. of Bedrooms 3
No. of Bathrooms 2
Dwelling Dimensions
General Evaluation
Business Phone
U(Septic Tank Installation Permit f,9)"O'D
C��Mobile Home
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water sage Figures .
7. Type of water supply: ❑ Public Private
8. Property Dimensions Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
Directions to Property:
f ol�S + j �,� ��`771orn��'Cro�rells
3�p CRR 5 cA1
CCIL-
101077
❑ Place of Public Assembly
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
2 -Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ No
PROPERTY INFO TON
❑ Community
Tax Office PIN: #5"'Jy�-y3-3/rJs
PROPERTY ADDRESS, as follows:
Road Name: 60 -5.04e2/
city:
SUBMIT A PLAT WITH THIS APPLICATION.
fin/ /"I % evisions effective October 1, 1995.
n en /
u1h6t--e ou
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
,!5- -.2 9- - 2 6 - �/� A alZtee
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: CV1. I OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Departrpent to enter upon above described
property located in Davie County and owned by (OE-¢ - r v %q Copp-eP L. i 6 by R r r e//
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
S- 2 91— 9G
DATE SIGNATURE
DCHD (1/93)
`� \\ 12k 9.55 779
- 37
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9.1 295 200 10 7 \ / o
SEE M- 5 �\
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K- 4
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NORTH DAV I E
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28, 1976
M- 4
1 M- 5
1 M- 6
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �s 6 ��S'�\ DATE EVALUATED _Q
ADDRESS 4Cn9 _ PROPERTY SIZE
PROPOSED FACIILTY • `moo Cn R LOCATION OF SITE
Water Supply: On -Site Well _ Community Public
Evaluation BYJ � Auger Boring Pit Cut
FACTORS
1
2 3 4
Landscape position
Slope %
- o
O -
HORIZON I DEPTH
Lk6IOLA
Texture grou
L
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture groupCL
L
Consistence
�c
Structure
Mineralogy'
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
--
r
SAPROLITE
�---
CLASSIFICATION
IVs
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATED BY:
LANG -TERM ACCEPTANCE RTk
' OTHER(S) PRESENT:
REMARKS: Q f
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 :lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vt.. y 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
.3C --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
tx:HD (01-901
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~County
Davie Health' Department
ENVIRONMENTAL HEALTH SECTION
/ ', o
P.O. Box 665
Mocksville, N.C. 27028
x
AUTHDRIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
do, a o
lof
(Issued in compliance with Article 11
�~ G.S. Chapter 130A, Wastewater Systems)
***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.***
"�
AUTHORIZATION N LIVBER
NAME/ c� rs�.1� DATE ! {
d ° 0400. ;
NAME ON IMPROVEMENT PE//RMIT (If different than above)
U I S v � ` Fityi.7'j�rz IaL ACL
SITE LOCATION (>a O ,—
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
**WICE*** THIS`AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FDRA PERIOD OF FIVE (5):YEARS.
„
b —D'S q
ENVIRONMENTAL HEALTH SPECIALIST
DATE
DCHD 10/95:
x
n
. .. •.:? ..: r i":_ a i lYi .y_. .. , s� a e. .. R..-.. . wf lttf r a r _' R ..i'•
S>�� rli, ,Y .. ii e� ... ti -
Parcel#: L500000035
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
•
Parcel #:L500000035 Account #: 18004000
Owner Information
RRELL JERRY R& CORRELL LIBBY R
l9mso�-FAIRFIELD ROAD
NC 27028
Tax Codes
ADVLTAX - COUNTY TA
FIREADVLTAX - FIRE TAXCKSVILLE
Pro a Information
Township
VLand (Units/Type): 1.130
JERUSALEM
dress: 2475 S US HWY 601
arket•
Deed Information
Local tonin
Date: 02/1994 Book: 00172 Page: 0572
[Deferred:
plat Book: Page:
Legal Description
PIN
1.44 AC HWY 601
5746433195
Property Values
uildin :
10,37 01
BXF•
nd:
8,53
arket•
18,90
ssessed:
18,90
[Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00125 0751 02 1985 WD Unqualified Vacant 0
2 00172 0572 02 1994 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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ONZ
wriol-S
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/itsnet/View.aspx?prid=1492440 7/14/2016