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1613 Hwy 64E y. . . . .. ., -�:,a�.�l��...a,,��,r.,,s...�.r.ytKt. , ..,d.w�;.. ... �._:•- r�s..;.,jr,•y,.�r-,�.rp-a,��4 i'v.�.,. .. . . ,. .,c • ..._... ... . -, ..w �.. . . . i . j l �,_ ��/ „�-�} .. . � � � ! �\� :,� CU �� j� ,r;=.;. � �' "_. � � � _,,, ; ., 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) Pel'1111t NU111be1' i ,,.�,1 � ' Name :�j'/ � �J�:'r��'�.� Date �,%7�_ ,3 � ;,i";�� '?�;�� Location ��' ;�� ^ � !� ,�, �;-✓ :,� ,ii�✓�/.%:�' ,�'"%'��. /;�-,�; �;� �l� �,r,/ li G� %C�13 LCS �o� �_ -- �,��1� Subdivision Name Lot No. _ Sec. or Block No. � House Mobile Home _ ' Business Speculation Lot Size,�T�'>�' C "' No. Bedrooms ��y-� No. Baths �� No. in Family�_ Garbage Disposal YES p NO p-' Specifications for System: ; Auto Dish Washer YES � NO ❑ �,�� r��f'� "; ,C`' �y:�/ �;�X. Auto Wash Machine YES � NO �❑ ,_,� � „� ._, �, �� TYPe Water SuPP�Y � �/w --- �C�C_� �1 ( �!' /_� 'This permit Void if sewage system described below is not installed within 36 months from date of issue. � , � i..? % . ; Q; ��`'"_ ��(,�%.�/� G�v.:i /, ` � �' .�_.__�___..._ �� ` _'j//;�'• l�� ` � ,:j �, ,, /'� `, _ ___ ,_ . �_— � . _..�- _ _.__.�,_`� ��- .._...._. y ._.... � � ---_ _ � .__a _ _ - --.____ _ � 1 j _ � Improvements permit by 1%;.�;�'f�� *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. .� s-�-,� - � � Final Installation Diagram: ` System Installed by � /' �1 � � %� _.__�---,.... �Q� � i � .-Li L�i% GU'i,,� . � �Gh`- ___-------� � ' . � . / �;F. . . . . . , . Certificate of Completion �" �� Date.S✓�-�� , �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. r M1 ' �� ..{ la_..��. . ` �f APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT C��G � c - � , Davie County Health Department �� Environmentai Health Section • �`� � P. O. Box 665 Mocksville, N.C. 27028 �, . �� CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone �g 'a?oZ-¢ 1. Permit Re uested By w � Business Phone - 1��S1' �.-�i0/ 2. Address � 3. Property Owner if Different than Above Address 4. Permit To: a) Install�Alter Repair b) Privy Conventional Other Type � Ground Absorption c) Sub-Division Sec Lot No. 5. System used to serve what type facility: House M�ome Business Industry Other b) Number of people � 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions �f X �a � Bed Rooms—��Bath Rooms�—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 � urina�s garbage disposal lavatory -3 showers � washing machine � dishwasher � sinks � 8. a) Type water supply: Public Private Community �/ b) Has the water supply system been approved? Yes�G No 9. a) Property Dimensions��,�� X S U!� � b) Land area designated to building site �J d � x �� c) Sewage Disposal Contractor�r a ct—�� -v` 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. � . D / Date Owner Signat OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days f r pro sing Directions to property: /I �, � . �-- /? � . �' . - ��9` - �� . � ��;�� . � �.�.> w.�.� � yy��,� �- . � . �� , _ z-� � � . � ,� . � — ��'.� ,e,,� ,z� �'�`�- ,� � � � ��`� � � .�� G .�� - ��ti �� .,Q �� 1�s� ' �� ' �� DCHD(6-82) / . . , ;;��> � � ..., • � y' �` � DAVIE COUNTY HEALTH DEPARTMENT �� Environmental Health Section P. O. Box 665 � Mocksville,N.C. 27028 SOIUSITE EVALUATION IVame t��1�� /��/l7 Date Address Lot Size ��r�-S�� FACTORS . AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S � � < s �'�S� S �� 2) Soil Texture (12-36 in.) Sandy, S S � �.� � Loamy, Clayey, (note 2:1 Clay) PS P c �'� C r�'� � � � -� 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS S PC� � � U 4) Soil Depth (inchesj . S S S S PS � ,ti' (� � 't)' 5) Soil Drainage: Internal S S �., PS PS PS � � lJ External � � / (�P �/�� 'tT �`-d' 6) Restrictive Horizons l . . . �/� I:,� G � . � . 1 �� o�� 7) Available Space S S S � � S / U U . 8) Other (Specify) . ps PS PS � U U U U 9) Site Classification �� l/• �. o• � �% � U—UNSUITABLE S—SUITABLE PS—Provisionalfy Suitable Recommendations/Comments Described by � Title �� Date �o SITE DIAGRAM ��/ . � � �Y :� �i' /' i ✓� /�/ �� P � DCHD(6�82) � � , t " f �tt�riE fl�nun#� �ett1#I� �E�ttr#ritE�t# . ttn� �nme �ett1#1� :c��Entg - P. O. BOX 665 � �ucksbille, �orth t�ttrDlintt 270z8 CONNIE L.STAFFORD,BA,MPH TELEPHONE Hee�cn o��aao� July 7, 1987 poa��a-ssas �oa�s3a-see� Martin & VanHoy P. 0. Box 1068 Mocksville, NC 27028 Attn: Ms. Leslie Bradsher Re: Sewage Disposal Installation & Water System/Mildred James � Dear Attorney: The septic system was installed at the aforementioned address on May 22, 1987. At the time of installation, the system met the requirements of the North Carolina sewage disposal laws. This residence is also being served by the county water system. Sincerely, �xG�E�� ` Robert B. Hall, Jr., R.S. Environmental Health RH/wd Pazcel#: J60000001001 Page 1 of 1 v�'�r� Davie County, NC - Basic Estate Search � � .r� , �v c�'� Davie County Web Site •Baslc Search Real Estate Search Tax Bill Search 5ales Search � Vlew Prooertv Record for this Parcel View Mao for this Parcel View Tax Bill Informatlon Parcel#:J60000001001 Account#:39723000 Owner Information Tax Codes AMES MILDRED W ADVLTAX-COUNTY T 1613 HIGHWAY 64 EAST FIREADVLTAX-FIRE TAX MOCKSVILLE NC 27028 Pro e Information Townshi Land(Units/Type): 2.220 AC MOCKSVILLE ddress: 1613 E US HWY 64 Deed Information Local Ionin ate: 03/1986 Book: 00130 Page: 0491 Plat Book: Pa e: Le al Descri tion PIN .32 AC HWY 64 5758203587 Pro e Values uildin : 20130 BXF: 4 18 nd: 22 47 arket: 227 95 - ssessed: 227 95 eferced• Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved PNce 1 00130 0491 03 1986 WD ualifled Vacant 9 000 View ProQertv Record for this Parcei View Ma�for this Parcel View Tax Bill Information « Return to Basic Search� All information on this site is prepared for the(nventory 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 noti�ed that the aforementioned pubfic information sources should be consulted for verification of the information. All information contafned 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 inerchantability 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=1457871 6/29/2016