3348 Hwy 601SATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
t
1
7
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634.5985. V%Zo
Final Installation Diagram: Syst m Installed by
15
p
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.
DAVIE COUNTY HEALTH DEPARTMENT
_ 1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Number
Sanitary Sewage Systems Permit .
Name r' �� , .:, �, > '': ' --- Date ^? - �'' N2
7912
LA
L
�. ��--
Subdivision Name Lot No.' Sec. or Block No.
Lot Size -�3 0 House _ Mobile Home ---_ Business —_ Industry—
r
_,.
No. Bedrooms —.No. Baths _-2-- No. in Family - — Public Assembly Other
No.
Garbage Disposal YES p' NOD
Specifications for System:
Auto Dish Washer YES ,, NO
Auto Wash Ma^hine YES NO
i +
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
t
1
7
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634.5985. V%Zo
Final Installation Diagram: Syst m Installed by
15
p
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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department IRE C E Q N' E
Environmental Health Section
P. O. Box 665 MAN - 3 1995
Mocksville, NC 27028
Application/Permit Requested B v � /� / U f/S�y 0'�i." •
--------------- - - - - - "' - - - _ _ _ _
1. A
pP Q y
Mailing Address `9 d W19 Home Phone /�! 0
A/v C 2C Business Phone
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve:
❑ Business
❑ General Evaluation Septic Tank Installation Permit
0 House ❑ Mobile Home ❑ Place of Public Assembly
❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms 3
No. of Bathrooms :2 -
❑ Other
Dwelling
Dwelling Dimensions
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: Nf Public ❑ Private
8. Property Dimensions 150,c, 3 F57 lv 6 Sewage Disposal Contractor
❑ Unknown
Section Lot #
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
If yes, what type? -
❑ Basement/Plumbing
❑ Basement/No Plumbing
Washing Machine
Dishwasher
Garbage Disposal
M.
❑ Community
*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:G
C
SO �/ � v ► O/1 �O/� QC /, 4 �S-f r %�O�tN �O'( cJ ov �-"
/1 O'er' G 0%G A ow Awlyls
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. oe
-5 - 95o" 4v—Z—do-
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 1. I OWN the property. ❑ 2. I 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 (1193)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
\ Soil/Site Evaluation
NAME . � c� e ��o % DATE EVALUATED
ADDRESS f2SQIN`_' PROPERTY SIZE
-PROPOSED FACIILTY A6'z''SQ LOCATION OF SITE DSS
Water Supply: On -Site Well _ Community Public V
v
Evaluation By:C hy. Auger Boring Pit Cut
FACTORS
1
1 2
3
4
Landscape position
S
S
5
.--5
Sloe Z
QS-
0-%0
0--
- a
HORIZON I DEPTH
"
%
cbt•
►•
Texture group
'C' L
QJ_
Consistence
Structure
C
Co r2
Eo
Mineralogy
L '.
L
HORIZON II DEPTH
l'
130"
b"
3o
Texture group
C
Consistence
S
Structure
IVA V_
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure,
Mineralogy
HORIZON IV DEPTH
Texturegroup
Consistence
Structure
Mineralogy
SOIL WETNESS
S
S
SS
RESTRICTIVE HORIZON
--
.--
�— -
SAPROLITE
—
--�
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: N EVALUATED BY:
LONG -TER CCEP ANCE RATE • OTHER(S) PRESENT: a
REMARKS: c.
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- V+.. -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/ftz
DCHD(01-901
on
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Appraisal Card
NWRCF RIDENNOYR]EAEETM Return/Appeal N: PreW Nf-{B{N-N[
348 5 US HWY 601 FLAT: 00
05/140 UKIQ ID 24337
1324000 0418419 ID N7 5]55039155
COUNTY TAX (100), FME TAX (100) CARD NO. 9 of 1
aIYear 2013 TEa Year 2036 LOT38DXWOOD ACRIE; 1.390 AC SRC-Inaretim
Ne8 02 On De ] 007 05002 WEST RRUSALEM TW -05 Q- FR -10 EX- AT- LAST ACTION 2032093
CONSTRUCTION O[TALL MARKET VALUE DEPRECIATION
CORRELATION OF VALUE
[6.
BASE
st.na. 0.1
ub Fbor System - I SE
OD
Ar4s
K
RATE
RM EYE
AYB
EDENCE TO MARKET
1
2390
119
83.30
201788199
1995 %GOOD2.D
EPE. WILDING VALUE -GRD 16517
8. 03
?WWAn
alU • 2 T: SIn9N Family ReKMntNI Sln91e Family R.111
Br YPE
EPIL /X V O 3,91
LAND VALUE -CARD 20,
aollnp Structure - 03 STYLE: 1-1.0 Story
TFTAL MARKET VALUE - CARD 189,1
n9 Cow - 03
AL APPRAUIED VALUE -GRD 169,1
MHDP WaN
I eaConaCambuQbn-S 20.
OTAL APPRAISED VALUE -PARCEL 189,1
M. FNor Cow- 08
PRESENT SSE VALUE - PARC0.
O.NAL
nterlor Cour-31
AL VALUE DEFERRED - PARCEL
AI TAXABLE VALUE -PARCEL 189,1
tlnp Find -03
1LDING VALUE 173,9
.U.g Type • 10
eat 1.
VALUE ],go
Caml.. q Type - 03
D VALUE 4:
NT USE VALU!
VeetllroMrN1NN-
throoms
E:EMED VALUE
AL VALU
MFV
- FU2 -CLL-O
N-Bethroans
OTAL POINT VALUE 05. +--1{--+
"Las DATA
EWS}....If--_.}. _....... SB.......... 1
F.
I PGD ISAs Z
FA .0 I Z Z
I I I
ECORD ATE D[B NDICAT!
OTAL AD]USTNENT FACTOR 1.1 1 1 1
6
1021 3 O1 WD G V
AL QUALITY INDEX 11 S f 1
I I I
30
1WD
1 U V 9
I I 7
1 Z
4 r
+-5-+----7{----+11-+
NFATEO AREA 2.082
{Por {
NOTES
ROM PHELPS THOMAS
_4
sUMRG UNR ORIi 4'4 ANN DEP % ovi Be
R
1 TOFAGE 1 2 2 I5. 005 00 7 328
GD 650 M 2M0 0 N PAVING I 3.5 _ 995 99 1 Z
PAVING 15 1,2 S. 995 99 5 1 36
] . 1 Story
[RAC! 2'
51nN
MAU 3,M8 01.78
UILDINODIN ENSIONSBAS-W3657WSOFGD-W26535E26N35 SIWIM14ESF -56E26N6W26 E36N9EIZN31 .
NFOR
ER
ONEST[IRS
D ROTES
LTOTALD
TOT
BES
0 BBT VS!
0
COD!
LOLL
OMiNG
TACE
TAG
DE►7E /
!
WD
am
GOND V AC LC TCDAD
PACT
IINR
C
LAND BY TOTAL AD>11fTED LAND OVERIIIDF LAND
YNlTS TVP ADIST UMR VE VAL NOTE
N NOMESIT 0201
150
0
106204
1.1400 01410+00 a00
PW
6,100.00
1. AC 2.A 14,475 2006
OT NARKETLANDDAT
1.3 20
WAL M NT UE DATA
Page 1 of 1
Owner: RIDENNOUR C F Parcel: N6-000-00-090
http://maps.daviecountync.govlitsnetlAppraisalCard.aspx?idP=1470288&Action=Auto 7/29/2016