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2770 Hwy 64E _- T_:t,,. - � ,30. . _ �`- '^l� ' 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�—��...^r�. Date � ' `'t �-�'�� 3��:3 �'�� - � a�:�.. e Location tA�� - �-.. ,�•,,s�_ ��.. Y�� -��-.:,_ e �-��- :� d�,� �� .L. r� _ :� - 1i7�0 U.S �I W�� i, Subdivision Name � Lot No. Sec. or Block No. Lot Size �'7s�,L?�-,' House ��" Mobile Home _ Business Speculation No. Bedrooms -� No. Baths Z No. in Family�_. ; Garbage Disposal YES ❑ NO �- Specifications for System: [c�vo ��1��k �'�:Auto Dish Washer YES �. NO p � ,�•�t,� _ �� x� z•� �o�r • .'��Auto Wash Machine YES p� NO �❑ �,,�, ��1,,i �,�, �� „_ ��.� zz" Type Water Supply �«�: �'� ' __— . _..�_... "This permit Void if sewage system described below is not installed within 36 months from date of issue. - ., � �- .��r, . � . ..T.--.. ��..-r--_,._� � � � 3� � �- ��,�+'„ ,� _� : F ' � 1 .... � � Improvements permit by _`=i •1��`-----�� *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 �� `�'`�' � >C: � o � � � ��a� �� G -,.,� /\� /,,, } l D D f �� i � / Certificate of Completio�� Date �� a3 -� �J #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 ;, Environmental Health Section P. O. Box 665 - Mocksville, N.C. 27028 • SOIL/SITE EVALUATION N'�me �°�n m�o r� Date �" Z�I - g�� Address �' Z- b�� .31� 'n e�4-- �°-a^-�" p�r.�n...� v..�,...-- Lot Size �"7S,x't_ov' t�Jw _ 'Z7S�b FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position . S S S S � �� PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, t,e S t. S S S Loamy, Clayey, (note 2:1 Clay) z�'� � 2`�`� � , PS PS � U U U 3) Soil Structure (12-36 in.) �. S '�,� S S Clayey Soiis 2`�" Zy � PS PS �j U U U 4) Soil Depth (inches) S S S S � �� PS PS � U U U 5) Soil Drainage: Internal S � S S � PS PS � U U U External � � � S S PS PS U U U U 6) Restrictive Horizons w� S s�,�,� 3 Z„ 7) Available Space S S� S S � �� PS PS � U U U 8) Other (Specify) S S S S PS PS PS PS � U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionaliy Suitable Recommendations/Comments: w�� 9 4 �`�^- �''"` R'^�' � � �a�' P1`� �` � S r c�„�p �. ' 3 ��—^�' - Described by 4.rn�- � Title ��• ��-'� �'1*�� Date S -2g-g° SITE DIAGRAM ,`� , �`t' E "� �po�oS�D h�� , , 1�a ,� � —b� \ �,cJ�-�J , � i ' (��'av t+1i Z / / DCHD(6-82) _ � / , . � �r i— r i / . ' ' ' . ��---� -�.s-' ,' APPUCATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie Counry Health Department Environmental Health Section . _ P. O. Box 665 - ' '' � Mocksvilie, N.C. 27028 � , • CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. _� Home Phone 9g�"�� 1. Permit Requested By �O N�( /�/� 0 0 r �, Business Phone 7(� '��0�-l I 2. Address�+ � ��ne e N C. 3. Properry Owner if Different than Above �� Pn n 2., Address �� Nl U L�t 5 V l �� 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 faciliry: House�Mobile Home Business Industry Other b) Number of people � 6. a) If house or mobile home, state.size of home and number of rooms. HouseDimensions �$ � X30 � Bed Rooms�3 Bath Rooms�Den w/Closet b) If Business, Industry or Other, State: Number of persons served i What rype business, eta Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commocles a urinals garbage disposal lavatory �- showers � washing machine � dishwasher � sinks � 8. a) Type water supply: Public Private Community � b) Has the water supply system been approved? Yes No ✓ 9. a) Property Dimensions /75� X aU0 � 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? 1�1 � What type? This is to certify that the information is correct to the best of my knowledge. �S� c,� P'S� ?/j.�a.e ,� � Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS . Allow 5 days for processing Directions to property: �4 1� � �C n o C ree k �.s�- g ��.e�. -�a�m z �h �.s-� �^- � � ' I� ( �'��-� �� l � � (�r I n �T. w�.S�. �} l � S �'r� Vti e C�� a.��-- ` '� � �� g . � 7 , ��ea�.�, �. �� s 9 .�� .s� Y� �-` � '�( ��^'' `Y�ca�..w— . ` � �, , DCHD(6-82) � Parcel#: J70000006501 Page 1 of 1 v�Mt� Davie County, NC - Basic Estate Search � � t�: _ o��c : - Davie County Web Site �- Basic Search Real Estate Search Tax Bill Search Sales Search �Q View Pro�ertv Record for this Parcel View Mao for this Parcel View Tax Bill InfRrmatfon Parcel#:J70000006501 Account#: 51780000 Owner Information Tax Codes OORE TONY K&MOORE TONIA J ADVLTAX-COUNTY TA 770 US HIGHWAY 64 EAST FIREADVLTAX-FIRE TAX MOCKSVILLE NC 27028 Pro e Information Townshi Land(Units/Type): 1.500 AC FULTON ddress: 2770 E US HWY 64 Deed Information Local 2onin ate; 02/1986 Book: 00129 Page: 0753 Plat Book: Pa e: Le al Descri tion PIN 1.52 AC HWY 64 5767688815 Pro e Values uiidin : 122 68 BXF• 25 O1 Land: 32 86 Market: 180 55 ssessed: 180 55 Deferred• Sales Information No. Book Paqe Month Year Instrument Qual/UnQual Improved Price 1 00129 0753 02 1986 WD Un ualifled Vacant 1 View Prooertv Record for this Parcet View Mao for this Parcel View Tax Bill Information « Return to Basic Search All fnformation 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 wlthout limitation the Impl(ed warranties of inerchantability and fitness for a particular use. If you have any questfons about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120. 1.5.9 http://maps.da.viecountync.gov/itsnet/View.aspx?prid=1474829 6/29/2016