3998 Hwy 601SPerrmttee's ) ' AVIE COUNTY HEALTH DEPARTMENT
Name: Environmental Health Section PROPERTY INFORMATION
Nam
/ 1 1 P.O. Box 848
Directions to prorerty: th�f -' �'z Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002333 A Road Name'..�`L f1Y Zip:
**NOTE** 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.
(In compliance with Article 11 of
G.S. Chapter" S A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
"-6NVENT' rA TH(St?ECIAL'T`. DATEISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE H -wrl-,-t. # BEDROOMS # BATHS Z. # OCCUPANTS - GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
�1 �, � j� 0--*# PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
C
LOT SIZE ' A�'"� TYPE WATER SUPPLY ► "r DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SIT0--*
SYSTEM SPECIFICATIONS: TANK SIZE1 �OGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
OPERATION PERMIT
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AUTHORIZATION NO. OPERATION PERMIT BY:
SYSTEM INSTALLED BY: ,?1.t`✓�.1/�Ylt�/"
1
DATE: Z -Z 7 -a'e r
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM MRSCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
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et' ttee's ' !� / i' lw AVIE COUNTY HEALTH DEPARTMENT
ame:'IfC� Environmental Health Section PROPERTY INFORMATION
t P.O. Box 848
Directions to property: - rJ � '� Mocksville, NC 27028 Subdivision Name:
f Phone #: 336-751-8760
fi`1 131tC�.0{.
Section: Lot:
IORIZATION NO: Q O 2 8 3 3 A
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
Road Name.,,i "1 � } It ' I i, Zi
p ! t = Z
**NOTE** 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.
(In compliance with Article 1 I of G.S. ChapterlIA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
fr. y ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
Dr. ,;'. 7 IS VALID FOR A PERIOD OF FIVE YEARS.
WSPECIALIST'` .+ DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 1 f'# BEDROOMS - # BATHS 4L # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIA1Lt SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFr
LOT SIZE `tir- TYPE WATER SUPPLYt,�l DESIGN WASTEWATER FLOW (GPD)` ^'
SYSTEM SPECIFICATIONS: TANK SIZE' — '-GAL. PUMP TANK GAL. TRENCH WIDTH
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
# SEATS INDUSTRIAL WASTE: Yes or No
NEW SITE REPAIR SITE
ROCK DEPTH LINEAR FT.
OPERATION PERMIT
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AUTHORIZATION NO. z p� OPERATION PERMIT BY:
SYSTEM INSTALLED BY:.ClW4111/�
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DATE: 2 — Z 7 -,f�) 0
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DB8CRIBED 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.
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f DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION Z �, / _ py- -
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) aJ`/� (S -9
-
APPLICATION
ATAIA[i� &dlol PHONE NUMBER ZY Z6 �
ADDRESS i3�i� �l�U� 1001 S. MWA �� �/� SUBDIVISION NAME
�/
/ LOT #
DIRECTIONS TO SITE bbl t;�. ��SS 7 WV d} 6 / C-3/n)/jeS IIID
/ � v /l
DATE SYSTEM INSTALLED n O� NAME SYSTEM INSTALLED UNDERAdU (ihaA110
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING 0m 6461;�-
�Ijlx 44 Ad i- NaD M a) bb P Atl tin L, At 1iaj
DATE REQUESTE INFORMATION TAKEN BYZXLZI L4f
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
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DAVIE COUNTY. HEALTH DEPARTMENT 32b
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I-of'G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name �.n��c> \ � v �� >J Date—3- i i - 1 o N2 5891
4 CA -1
Subdivision=Name Lot No. Sec. or Block No.
Lot Size % (�.rc . House Mobile Home Business Speculation
No. Bedrooms No. Baths __ No ..in Family _
Garbage Disposal YES ❑ NO p'� Specifications for System:
Auto Dish Washer YES ❑ NO [}�
Auto Wash Machine YES E3"- NO ❑ p0 l i
Type Water Supply C o �'v __—
*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.
j�
ri 1
Improvements permit by�t
*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
3
Q
o
a
Certifica of Completion ° Date ` �y v
"The signing of this certificate shall Yndioate h the systemdes ' ed above has been installed in compliance with
the standards set forth in the above regulati ut shall in b y be taken as a guarantee that the system will function
satisfactorily for any given period of time., l`�=
C
DAVIE COUNTY HEALTH DEPARTMENT Blab
{ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - f 0'
*NOTE: Issued�in Compliance With Article IfoTG.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name ``� �t� v r� +�> Date (e� NO 5
LocationIX
.'C
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ r Business Speculation
No. Bedrooms No. Baths No -in Family
Garbage Disposal YES ❑ NO ❑'' S Specifications for . stem:
Auto Dish Washer YES E] NO p' p y
Auto Wash Machine YES pf NO ❑ r i ;U� :• �It
Type Water Supply C C, \/
i
*This permit Void if sewage system described below is not installed within 5years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
Improvements permit by
4 • • �•
*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 Install tion Diagram: System, Installed by
!^
`' N� v S `� R6�� •
Certificate of Completion ° Date ` ���" o
The signing of this certficate Z-114dicate that the system,desrrt ed above has been installed in compliance with
,the standards set forth in the above reg ulati n,�but shall in y betaken as a guarantee that the system will function
satisfactorily for any given period of time
_ INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME' v PHONE NUMBER - J T
. ADDRESS R� �'� • SUBDIVISION NAME
q
SUBDIVISION LOT 0
DIRECTIONS TO SITE • (0 01 C' • -�-,\ X 1't� �.
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED V's - 1? cls INFORMATION TAKEN BY C, ��
Parcel #: 0600000022
Davie County, NC - Basic Estate Search
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Parcel #: 0600000022
Owner Information
HUNN BEAULAH ESTATE
O CONNIE NICHOLS
OCKSVILLE NC 27028
Property Information
Land (Units/Type): 0.980 AC
Address: 3998 S US HWY 601
Account #:15180000
Tax Codes
ADVLTAX - COUNTY T
��READVLTAX - FIRE TAX
Township
JERUSALEM
Deed Information Local Zoning
Date: 04/1958 Book: 00061 Page: 0028
Plat Book: Page:
Legal Description PIN
1 AC HWY 601 5754246859
Property Values
Building:
5155
BXF:
Land:
15 75
Market:
67 30
ssessed:
67 30
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00061 0028 04 1958 WD Unqualified Improved 0
View Proper Record for this Parcel View Map 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 .
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1460305 8/9/2016
IN
VERA MAE
SCH WILLIE A & KIMBERLY/S
F-IC)SC](AMMER WILLIE & JANESTiER
FEA$'TER EDIT
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HOS A�4E-�l& ZEL
6 115.7
HU R GEND N
T141MIAR ETHEL CO N /
CHUNK BEAULAH ESTATE
LARK JOSEPH & LURLINE
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ILLIAMS FRANCIS V / PARKER LYMAN C