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•�,, 'S� DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS 'PERMIT AND CERTIFICATE OF COMPLETION
"NOTE: Issued in Compliance with G'.S.',of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name \� i r- ��\ " �:= Date —�� ( ' r��1 �9,08 7
Location ` *,. , c.
Subdivision Name_ Lot No. Sec. or Block No.
Lot Sizes House Mobile Home _✓' Business Speculation
L
No. Bedrooms No. Baths I ' _ No. in Family
Garbage Disposal YES ❑ NO [J
Specifications for System:
Auto Dish Washer YES ❑ 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.
I}
Improvements permit by
*Contact a representative of the Davie,County Health Department for final inspection of this system between 8:3b-
9:30 A.M. or 1:00-1:30 P.M.r on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed byV)2411\
Certificate 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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT����
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028 O�0S
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. j
Home Phone �9 2 - 0?SA?
Is ne- �
1. Permit Rerues,ted By , Business Phone
2. Address �� sL n y i yn 1 Wo r k_s t� N. !7n Zs'
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Priyy Conventionaly Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.-
5. System used to serve what type facility: House Mobile Homed Business
Industry Other
b) Number of people 'T
6. a) If house or mobile home, state,� size
��of home and.number of rooms.
X
House Dimensions )y �
Bed Rooms Bath Rooms I ��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 2- urinals garbage disposal
lavatory �, showers a `�� � washing machine f
dishwasher "'D At— sinks
8. a) Type water supply: Public ✓ Private Community o' w_e u)
b) Has the water supply system been approved? Yes ✓ No
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 m knowledge.
Date Owner ` nature.
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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1/
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AD COUNTYLTUE RIS & FIUNTING CRFEPRICE $ 43 , 410 , MLSNO.
AR 1/0 1 SC Davic CountyLTSZ e)
ZN R WTR SW TXCN COMPANY '
PVD YFS GRID TXV PROP COMPUTER
RSTR NUMBER
RMKS Acrea e located half way between Statesville
mocksville just minutes north of I-40 . Great homesite
or dividable . C;ood mix of hardwoods and sof w
Land lays well .
SALESMAN'S
CObll'U'fLH
DIRECTIONS1 I-77 to - „ NUN HER
left to F(w „
Go 2 . 9 miles on County =r r r
Creek .P _o ► gn both siden
DIC
AS 0kMWS/ti1.lUkS OF 11115 1'WN7111Y, 111 A�•�lM.N.1 UPAP611111TY AW LIABILITY MN 111:
INIAAWIW ULAN 11:NI.IN. ims, IN 4imtw IS OfILW:U 1U 111: W%T OP OUN 0"UIU] AP91
W:I.II.f INR SILIUITI W:51111111'1'IU S'IAIFILAIlm IT Ill. IIWIwAxi,
SIWAIU S OF 004AS/SI AAS:
Thanks for taking a minute to look over this data sheet .
This property will make excellent executive homesites or
a private retreat . Please feel free to contact me should
you or any client have any questions .
May your year bring continued success !
Sincerely,
Gary T : Knox
(704)892-0196(Bus)
SPECIAL ' INSTRUCTIONS i (704)892-7802(Bus)
(704)892-4013(Res)
(704)377-0146(Pager)
KNOX REALTY
P.O. Box 4- 103 N. Main St., Davidson, NC 28036
MLS GARY KNOX 03
"omeS FOR LlV1IlG
LA KNOX REALTYLS Gary T. LSPH S -4 013
LAPH 392-01-9 SLRN PARKS HL:�::
Vesto/ W Potts
D,B 126, Pg 85
Spike se'
I r
cen.'e-rine S
Or 42" E -
l96
Iron pipe
SO -
S 7. 28' 32 <- � --
Robin A. Vitez
D.B. 164, Pg. 50 3
Tract 2 0
0.9382 Acre N
h
Rr '
0)
spike ser y4
.5 7'
C/ Tolp,/
cen'erin �, 42"
69.1>
5e, "cinr lBl, j7 ren
0/ 42.. W
d,
CL
Iron pipe
N
set co
Tract 1
0.9382 4 cre
—
N 71
.-
O
i
J
V)
r�
MRebar
found
r�
V J '
1
SDike found in
CC centerline
L
-� Orientation line
Y
-� David Wayne Anderson 8 wife,
Donna Pack Anderson
Y D.B. 162,, Pg.)337
(TractD w
tr
� r) O
N8° 08' 43 W
379.64-
6 0
79.6460F/W
David Wayne Anderson 8 wife,
Iron pipe
found Donna Pack Anderson
I .,
a ?z 51, /Z D.B. 162, Pg. 337
enr �I ne --w / (Tract II)
85° 55
N J's' 43
4� L O Cn
Spike sel in �? O
cen'crline
Survey For:
f
r,n pipe .F _ N B5° 56' 27'
�.end rp,�i y i founde — -- --in David Wayne Anderson & Robin A. Vitez
sfonepile
Calahaln Twsp., Davie Co., N. C.
VICIr11t Ma � -�, i Cleveland Hal Joyner
D.B, 173, Pg, 664 Title sources: Tract I - D.B. 164, Pg. 50
Tract 2 - D.B. 182, Pg. 337
�f
Surveyed February 14th, 1996
5!TE
Tax Map References: Map F-2, Parcels 24.01 8 24.02
M
�2 MA 'T' S, INr Poo; stered Land S.rveyor, hereby :e-fife �~Cb"''10,,,�
rT
ha' t� ris p a was irawn by me from anactua! survey made ra`OLr•,,,• ��� . Scale: I" = 60'
"Y 7"' wtn ec s'on ra!!c of .�� ti9
incl sec! and s� n i'u,e his February 29th, 1996. t�Q SEAL 8-3
g g �9 L-3361 � = F
?o ��. Cline & Associates
6` �,SUW,
1-0 ��� 1707 Dallas Lane
S;,,.� Statesville, N.C.
RLS 33F• (704) 871-9197
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION c��
Name Date _ a�
AddressS1� Lot Size '6
FACTORS AR CAN1 AR ) AREA 3 AREA 4
1) Topography/Landscape Position S S
( P� PS PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) PS �P PS PS
U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils PS PS PS
U U
4) Soil Depth (inches) S S
PS PS PS
U U U
5) Soil Drainage: Internal S S
PS PS
U U
External S S
P PS PS
U U U
6) Restrictive Horizons
7) Available Space S S S
PS PS
_'per U U
8) Other (Specify) S S S S
PS PS PS PS
U U U
9) Site Classification i r
U—UNSUITABLE S— PS onaliy Suitable
Recommendations/Comments:
Described by �- Title - Date
SITE DIAGRAM
1
J
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