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4029 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NATE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c -; Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) 1A Permit Number Name �- , , , n � Date 4629 Location 140 Subdivision Name Lot No. _ Sec. or Block No. Lot Size ' -�� House �r,� Mobile Home _ Business __ Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO E0 Specifications for System: Auto Dish Washer YES r7jr NO ❑ ) - Auto Wash Machine YES ❑ NO ❑ Type Water Supply _— *This permit Void if sewage system described below is not installed within 36 months from date of issue. r L 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: 704-634-5985. Final Installation Diagram: ed by r Certificate of Completion ��r✓ 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. / at APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section RECEE QED jAN 14 J987 P. 0. Box 665 i Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. a#* -O O i, 1. Permit Re nested By 2. Address 3. Property Owner if Different than Above fir- Home Phone4_Lj71�_qv24_"" Business Phone '4. Permit To`. a) Install Alter Repair b) Privy Conventional her Type Ground Absorption c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House obile Home ' Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions ��ll Bed Rooms Bath Rooms—cam— Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals garbage disposal lavatory showers washing machine dishwasher / sinks 8. a) Type water supply: Publics Private Community b) Has the water supply system been approved? Yes1 GNo 9. a) Property Dimensions b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. AJL��Date Owner Sign ure OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS . Allow 5 days for processing Directions to property: DCHD (6-82) Q DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 _ SOIL/SITE EVALUATION Name �� Date Address Lot Size 5� Fnr`TnRc ARFA 1 ARFA 9 AREA 3 AREA 4 Topography/ Landscape Position S S © S PS U S PS U U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) PS S PS S PS U U q Soil Structure (12-36 in.) Clayey S S Soils<f U '... US US Soil Depth (inches) S � S S PS U S PS U U �) Soil Drainage: Internal S S S PS U U S PS U External S tpP S PS U S PS U i) Restrictive Horizons d X 2 a Available Space SS S PS S PS U U U 1) Other (Specify) S PS S PS S PS S PS U U U 1) Site Classification _10-1 1 U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: 4t Described by _ SITE DIAGRAM DCHD (6-82) Title ��� Date �HM�tP �IIli1���1 �PtiY#� �P}1t�X�tltPZtt anb Borne PPMIth �genrg P. O. BOX 665 utlssi�ille, arty garalina 27028 OFFICE OF THE DIRECTOR January 21, 1987 Mr. Benjamin Johnson Rt. 4, Box 258 B Mocksville, N.C. 27028 Re: Soil/Site Evaluation, 5 Acres 601 South, Davie County. Mr. Johnson: 'As per your request, this office evaluated a 5 acre tract of land located on 601 south on January 20, 1987. On that date the property was classified as provisionally suitable for the installation of an on-site sewage disposal system. Before the Improvements Permit can be issued the proposed dwelling must be marked in order to design the sewage system. If you have any questions concerning this matter please contact this office. Sincerely, �+^" Robert B. Hall, Jr., R.S. Environmental Health Dept. TELEPHONE 17041 834.4985 Parcel #: 060000003501 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 #: 060000003501 Account #:40074000 Owner Information uildin : I Tax Codes BXF• OHNSON BENJAMIN & JOHNSON JEANETTE F 1MOCKSVILLE nd• ADVLTAX - COUNTY T Market: 029 US HIGHWAY 601 SOUTH ssessed: READVLTAX - FIRE TAX eferred: NC 27028 Property Information Township Land (Units/Type): 5.000 AC JERUSALEM [Address: 4029 S US HWY 601 Deed Information Local tonin Pate: 01/1987 Book: 00135 Page: 0205 Plat Book: Page: Legal Description PIN 5.22 AC HWY 601 LOT 10A 5754341333 Property Values uildin : 97,300 BXF• 3,830 nd• 46,820 Market: 147,950 ssessed: 147,95 eferred: Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved Price 1 00123 0006 05 1984 WD Qualified Vacant 8,500 2 00135 0205 01 1987 WD Qualified Vacant 11,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 v1l.t� 000ria-/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/itsnet[View.aspx9prid=1470291 8/2/2016