2962 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT 'fit/bo, oo 3
IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit- Number
Name. r.;;� �C�-t >.��>>S Date -3 N2
6699'
,6CiI
Location"
" U I � � ,.._ ;• - Imo!:
�1r .� � -',_.. � i. r.>; ^ 7 �; �•^:.;�,e..�
'Cr- ?s.jrlr:+.
Sub ivision Name
Lot No. Sec. or Block
No.
+
Lot Size
House ''�
Mobile Home __ Business
Speculation
No. Bedrooms
No. Baths
r
- No. in Family 1- _
Garbage Disposal
YES ❑ NO [T
Specifications for System:
Auto Dish Washer
YES ❑ NO p
Auto Wash Ma,hine'
YES ®' NO ❑
c.
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
*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 704-63475985.
Final Installation Diagram: System Installed by Mat'1�
4�1
,rte
Certificate P
of Completion C�� 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.
l APPLICATION FOR SITE EVALUATIONAMPROVEMENTS PERMIT
S L Davie County Health Department ,
Environmental Health Section
P. O. Box 665
�1 h ^1 e Qn 1J Mocksville, NC 27028
1. Application/Permit Requested By cl�a �v -S
Mailing Address 0 33
Home Phone •Z 3 3 3 Business Phone -�
2. Name on Permit if Different than Above
1
3. Application/Permit for: ❑ General Evaluation P. Septic Tank Installation
4. System to Serve: jl House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms -3 ® Washing Machine
No. of Bathrooms - ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business,`industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No..of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: El Public K Private Q -Community
8. Property Dimensions d 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:
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.
DATE i SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 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 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 suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (12-90)
t" DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
TT Soil/Site Evaluation
NAME �1� \ DATE EVALUATED - ,3 - D
ADDRESS S 9` PROPERTY SIZE
PROPOSED FACIILTY D ° 5 LOCATION OF SITE
Water Supply: On -Site Well Community Public
Evaluation Bye (e•L Auger Boring Pit Cut
FACTORS
1
1 2
3
4
Landscape position
Sloe 7.
CS
HORIZON I DEPTH
'
L. `'
6"
u
Texture group
S L
S C L
Consistence
_
Structure
G
C
Mineralogy
I I
HORIZON II DEPTH
1
2 'D.
a l'
Texture groupC
L
GL
C L
Consistence
Structure
t2
C
R.
Q:1 R
Mineralogy`�1
l •
1 ',�
' )
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
—
--�
SAPROLITE
—
—
---
CLASSIFICATION
S
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: � EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: L4 OTHER(S) PRESENT:
REMARKS: ";?'
END
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
Moist
VFR-Very friable FR -Friable FI-Firrn 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
Mineralmy
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
DCHD(01-901
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Parcel #: M50000005201
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#: M50000005201
Account #:25192750
Owner Information
90,880
Tax Codes
FELLOWS NORRIS LONDON& FELLOWS BETTY MCINNIS
Land:
ADVLTAX - COUNTY TA
962 US HIGHWAY 601 SOUTH
102,320
READVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Deferred:
Property Information
Township
Land (Units/Type): 1.000 AC
JERUSALEM
Address: 2962 S US HWY 601
Deed Information
-Local Zoning
ate: 07/2006 Book: 00671 Page: 1065
Plat Book: Page:
Lecial Description
PIN
1.00 AC OFF HWY 601 LIFE ESTATE
5745862812
Property Values
Building:
90,880
BXF:
0
Land:
11,440
Market:
102,320
Assessed:
102320
Deferred:
=fn
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00163 0767 05 1992 WD Unqualified Vacant 0
z 00671 1065 07 2006 WD Unqualified Improved 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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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
hq://maps.daviecountync.gov/itsnet/View.aspx?prid=1459875 7/19/2016