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2895 Hwy 601SO DAVIE COUNTY HEALTH DEPARTMENT - IMPROVEMENTS PERMIY AND CERTIFICATE OF COMPLETION l�J�l9 '*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems Permit Numbero �• Name v �'S7ii� 3 ,�%•..Date N� 73 Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business _— Industry c2 i. No. Bedrooms �--.No. Baths ! x �� No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO 0 Specifications for Syste Auto Dish Washer YESNO ❑ Auto Wash Ma thine YES LTJ 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. Improvements permit by — l �_ /1 *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by �4 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ` Davie County Health Department R •C ; U V � [D Environmental Health Section P. O. Box 665 rtJ0V2'2- 1993 Mocksville, NC 27028 --------------- 1. Application/Permit Requested By. atq P""(;7 Mailing Address P7-'� QoX 232 Home Phone <Z- Business Phone 24-:71- -2 v D 2. Name on Permit if Different than Above Od 1A 3. Application for: ❑ General Evaluation eptic Tank Installation Permit . 4. System to Serve: ❑ House ®-mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People entMo Plumbing No. of Bedrooms 3 ��Washir g Machine No. of Bathrooms sher Dwelling Dimensions '2 ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks 3 No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private ❑ Community 8. Property Dimensions Z , `/SZ 6 c'f c s Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ 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. Directions to Property: �1 , -Soo ��e�9sA,,7 �ijC.f' 04'/✓L This is to certify that the information provided is correct to the best of my knowledge, I understand I Incurred from this application. �i �� DATE SIGNATURE responsible for all charges CONSEN FOR SITE EVALUATION -TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. . If you checked Box #2, the rest of this form MUS 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 Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitabil!'W fora ground abso tion sewage treatment and disposal system. -23 - S � " '-e� DATE STGNATURE DCHD (1193) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / Soil/Site Evaluation NAME e ! !' e l ( DATE EVALUATED ADDRESS PROPERTY SIZE /s fel' PROPOSED FACIILTY LOCATION OF SITE egg S Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 Landscape position Sloe % — r HORIZON I DEPTH (� �• �� Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r Structure S S e 6 Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE [ CLASSIFICATION 73 LONG-TERM ACCEPTANCE RATE [� SITE CLASSIFICATION: �-r LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: A17 �� 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 CCCCCCCCCCCCCCCCCCi.CCCCCCCCCCCCCCCCCCCCC�::CiCCCCCCCCCCCCCCCCCNCC ■■!.■■l........■■l.............. ■...l.... ....■l...■!lee.■..C■■■ ■■.■■.■.■■...■■■..■■.H..■■rie....■!He■!■.■■■.■..e..■=!le...■■.■■■ ENO ■.■.■.■■.......■.■■c........le■■e■rit■...■..t.■....■. ■■.�a UMMMMWL ■..■...........■■...■.....■■■ ...r■t■�■..■■t■.■■■tt.C■■■■■tlinowam■ �iiiiiC�iiiiii�iiiiiiCCiC�■ii�CCi .CCCCCCCCC�iC=CCC.�iiiiiiiC� ■■■.■■■■■t..tt■■■.■...■■■■■■t■■t■■.■■■EtN■■■■■■■ ■■ ■.!■■.■11■.■■■■ ........■■..t■.■tt■■..t■■■tt.■■t■■tt■■n■FAil .■■.■■■ M■■■■■C■11■■..■■ ■■■.■■■ ■�..■■■■.i�■■■■■■ �IrC..0 `� C■CCCCCC=MCCCCCI ■■t■■■t■■■■■■■tt■■■■tt■■.■■l!!�C=v•■■•■. 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CCCCCCCCCCCCCCiiiiiiiiiiiisiiiiu.CCCCCCCCCiiiiiiCMCCCCCC■ommomm i Parcel #: M500000038 Davie 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 #: M500000038 Account #: 18057500 Owner Information Buildin : Tax Codes BXF: ORRELL PAUL DAVID Land: ADVLTAX - COUNTY TA Market: 887 US HIGHWAY 601 SOUTH ssessed: FIREADVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 PropertV Information Township nd (Units/Type): 0.920 AC JERUSALEM ddress: 2895 S US HWY 601 Deed Information Local tonin Date: 06/1969 Book: 00081 Page: 0274 Plat Book: 0004 Page: 048 Le al Description PIN LOTS 12-14 BOXWOOD ACRES 5745789102 Propertv Values Buildin : 87,78 BXF: 1,92 Land: 18,30 Market: 108 00 ssessed: 108,00 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00081 0274 06 1969 WD 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 -° 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/itsneWiew.aspx?prid=1459945 7/14/2016