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2975 Hwy 64E ] .Y� �:.i .. .� `�.. n _ �na . 1 � . �"`K..v. •...;z'.;. ��. ;' � :�...-..�,.... . .� • �.,f' � ,� �-'J:r:_ .,.y}w _ . �. �: . :�� . . � ` . ._ ,..:: .. r ... . �...,. . . ' . ., . _. . �, - . . . .: ,..,. r�;,,-_.,� .,. -: .J -.,.i .;.;. ., j`. �� ;�:�� J , ;_.�:,:. DAVIE COUNTY HEALTH DEPARTMENT ._ ��o . �:� � � " - - -�IMI�ROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION � 1�.�� ,�\ ; . � '=-�•,*T10TE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c . � Sewage Treatme t and Dis osal Rules (10 NCAC 10A .1934-.1968) PQI't111t Nll1f'1b@� � .,Name �.c��1�.r� \\� �S�. '��,'R�'�� Date �'�" � �� ,�1.+ 'N� �'��•�� ion \\ '� � � � �z.�1 �Z\c��..��5 J ��. . ��,. rl� C;��= r �� ^�,� ,� \ .� -� -� -.,.._ ,� . ,�. ' �. � ,z, `�„�_ ._T� c-ti�,,�'��. \�-- r�._��1{ �� t n`�, .�� c� 'v`,,C� � -� �� Su division Name Lot No. Sec. or Block No. � Lot Size �� `�� House Mobile Home _ Business V Speculation No. Bedrooms No. Baths � No.,in Family � ��-*�ti�9- Garbage Disposal YES �❑ NO p Specifications or System: � . Auto Dish Washer YES ❑ NO p Q�jt � � d _$ �awk_ � '"� =��u Auto Wash Machine YES ❑ NO �❑ , , �` j� '�;`1S�� s r >(�, ��! '� ��{ ��:�� L' �.�f Type Water Supply , __ �nC►ZJ�',� _ � ._ . *This permit Void if sewage system described below,is not installed within a8 months from date of issue. , ,�� .. a� � w CQ . �r.� �p, r , �i� ��.LF�t,��.%a� ' \• � P :t., ' I 4�. � � , :,,,, 1 - ._ ;---�-,-.......--�-_,.,;,�.I;��r1 . . _. . . .� � 1" - � '°�`� . �. .. _ , � _. . _..----- ...__ ____... _. ( _�41. � ��_...�,;_______=�� ' ---�- _ � � \ �`, ..._._�l-�..� ✓, O' . a, . � ' +, . � '� � �."s; � '� � • � � ` ^' � � � � / ' t�- � �a'� � , � . : L. � . , ��x� . . - � f � . ,�. . ' . . . . .iM;. � .. . . . . . .. .. . , . . �� . . 1 � I r � --- ----- -. _ ---- ` ' - . . . . - . � . � .. . � ' . ��, . �� . � . � . � . . . . �1� . � . . . � . � . l �"_�„ � .4iarr! . . . '`-] _ p P y� L\ ��,, ,` � ,��_� �t E�� ; Im rovements ermit b �� `�'��'> . ^^-' ��-�• *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. or�'day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: - System Installed by �� *�-� •:r, r• , -, . F � . � . . . . . . � to: �' . . � . . ' . . � . � . ... _ ;. .i . . ., ' �S S �o W t� � � �.. _____ .; .� , Certificatewof Completion � • �\�� '� Date -1 ' "� �, . , "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 regu(ation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. +� , {::, o��.�� (PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ` �LL �' � Davie County Health Department T � w�� O r � �� j/ Environmental Health Section �C� ^ P. O. Box 665 ` Mocksville, N.C. 27028 � �. � CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone��¢/�7 1. Permit Requested By Business Phone �-T=,�.�.� 2. Address 3. Property Owner if Different than Above �oa Pool�a 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 Mobile Home Business� Industry Other b) Number of people 4- 6. a�If house or mobile home, state size of home and number of rooms. � , � �3 House Dimensions � Bed Rooms Bath Rooms Den w/Closet 4 3 . � � I b) If Business, Industry or Other, State: Number of persons served What type business, etc. TQuc��ac- �o. Estimate amount of waste daily (24 hours)�D -l.� F�urNes 7. Number and type of water-using fixtures: commodes � 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 9 /� ca c K�S b) Land area designated to�building site FRo.'T 2 Ac,�ps c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? Na What type? This is to certify that the information is correct to the best of my knowledge. q -a► _�g Q�� cJ.��,,- �a�t£�� Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: J � � �4 �- � �o�:,� - ,Co1� �m �� ,dcCle, � 6¢ � .�- e�.►�a�,r A� , ' �, a� Kud�, � ` , � 7� �.. ,� �;�,,�� ,�� , ��, 7� ,y �� , � � oC.dt' .v� vi� :�c. �0-C� �- o- �- -�'v"�"',�c'rc.�' �4�-' ,�.f 1 �.. �_ 1 . . ��• �� . f��`�� , � DCHD(6-82) . � . f ;,,, . ;� � . •,�� DAVIE COUNTY HEALTH DEPARTMENT ' ENVIRONMENTAL HEALTH SECTION � - SITE EVALUATION CONSENT FORM � 1. Complete the form below and return to the Davie County Heaith Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form � LOCATION OF PROPERTY: �,.��- DATE RECEIVED �N�w�b.��T- (office use only) �Iw Ensr A-r �'o�K ,�eSiD�Ca��,��e.x�. yes no 1. I am the owner of thE above described property. yes no 2. I am not the owner of the above described property, however, I certify that I have consent from Rea Popl�,J , owner to obtain a owner's name site evaluation by the Davie County Healtn Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. I hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. -a1- � Gc�Cc�,ca.eca•�r•.- DATE SIGNATURE 4. I hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: —Owner only Owners designated representative ✓Anyone requesting results � — Only those listed below -a�- �-LJ,��.� �� DATE SIGNATURE DCHD(11/84� i F � � • •.. I �.,.:. . . . . . DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section. � - P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name �� 2.�� \5 � C �'�V �� Date �'b�+ �:��b 1 Address � �`�� Lot Size � * '� � FACTORS ARE 1 AREJ4..2J AREA3.> ARE 4 1) Topography/Landscape Positio� � S � PS LPS� � l7'� U U 2) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) PS PS P � � �� U � � 3) Soil Structure (12-36 in.) Clayey Soils P � PS � � U � U 4) Soil Depth (inches) � PS � � . U U U U 5) Soil Drainage: Internal . S S � PS � S U Extemal _� � � � . � U U U 6) Restrictive Horizons � �-� . --� , 7) Available Space S � S g PS PS � U ' U U 8) Other (Specify) S S S S pg PS PS PS U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionaliy Suitable Recommendations/Comments: � 2 ��\ � �"� - � - oJ Described by � - ��- Title � � Date �-��--�� SITE DIAGRAM . �... �� ► �` . _ ►� � � '`� � , -� -�Sf a �� , �.�:1 UCHO�6-82) -� Pazcel#: J700000079 Page 1 of 1 . oP�r� Davie County, NC - Basic Estate Search �ov�,� ., Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search Q View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:J700000079 Account#:80403060 Owner Information Tax Codes ISECARVER ROBERT C&WISECARVER WANDA C ADVLTAX-COUNTY T 975 US HIGHWAY 64 EAST FIREADVLTAX-FIRE TAX OCKSVILLE NC 27028 Pro e Information Townshi nd(Units/Type): 8.940 AC FULTON ddress: 2975 E US HWY 64 Deed Intormation Locai Zonin ate: O1/1990 Book: 00152 Page: 0461 lat Book: Pa e: Le al Descri tion PIN .11 AC HWY 64 5767996376 Pro e Values uildin : 23818 BXF• nd: 167 63 Market: 405 81 ssessed• 405 81 Deferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Prlce 1 00152 0461 01 1990 WD ualifled Vacant 27 000 View Prooerlv Record for this Parcel View Ma�for this Parcel Vfew Tax Bill Information «Return to Basic Search All informatio�on this site is prepared for the inventory of real property found within Davie County. All data is compited from recorded deeds, plats, and other public records and ddta. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verlfication 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, (n 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. 1.5A http://maps.daviecountync.gov/itsnetlView.aspx?prid=1473164 6/22/2016