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1679 Hwy 64W DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE--OF COMPLETION., *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a 1 ! Sanitary Sewage Systems Permit Number NameCL '-°sn. ��ou. �Q.s�c. c Date ^ N27679 i Location 9 y •5, `r1w�j lJ� �C." t3k\\�, L Subdivision Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business,-- Industry No. Bedrooms 3 No. Baths 2 No. in Family — Public~A'ssembly Other Garbage Disposal YES ❑ NO [� Specifications for System: Auto Dish Washer YES p� NO ❑ J 00 0 V Auto Wash Ma.hine YES �.NO El �_ +' Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to,revocation if site'plaris or the intended use change. ._ !: ! br{ A D Q C c e o C v 1 i cam. Improvements permit *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by 'I I r�.. A. ° F f r • ' o 0 0 C rtifi ate of Completion Date U �� *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. I.. OL APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville;-NC 27028 _.. ........... _ .. ... ._ ._. 1. Application/Permit Requested By \A3 -- Mailing Address —1 cl y • 5- �t W e s� Home Phone LA Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation 1 Septic Tank Installation Permit 4. System to Serve: ❑ House (�"Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ashing Machine No. of Bathrooms Dishwasher Dwelling Dimensions ky ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: nApublic ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: CS 0 0 This is to certify that the information provided is correct to the best of my knowledge,and I understand I am ree 7nsible for all charges incurred from this application. 'e& e J-;, OA., (f/ !tom DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: I OWN the property. ❑ 2. I DO NOT OWN the property. If you checked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption se age treatment and disposal system. ` ✓'I n� DATE i�J SIGNATURE DCHD(1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section \ Soil/Site Evaluation q NAME w �'� ��� DATE EVALUATED Ch - - +9 ADDRESS S A cc•� PROPERTY SIZE PROPOSED FACIILTY \s\' LOCATION OF SITE LG Water Supply: On-Site Well Community Public Evaluation By:4�1�7-L Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position < 57 5 1-5, Sloe % o © -So 8 -£ HORIZON I DEPTH fall '' Texture group L Consistence 41 Structure Mineralogy HORIZON II DEPTH LA 1-\N Texture group 4Z G Consistence Z Structure %'15- Mineralogy 14 `FMineralo 1',1 , HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON r- — SAPROLITE — CLASSIFICATION LONG-TERM ACCEPTANCE RATE 4 ,L4 I , SITE CLASSIFICATION: ��S EVALUATED BY: (ate LONG-TERM ACCEPTANCE RAE\ _4 OTHER(S) PRESENT: REMARKS: c� N. LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty ;lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 ■■■..■■.■■.■.■■..■■■■■..■■■.■■■■■■■.■..■.■■■■.■..■.■■.■■■■NOM■■■.■ ■■■■■■■■■■■■■.■■■.■■■■■■■.■■i■■■■li■■.■t1■L�Illi'��11.■c���i%i7lGi.■.■.■■■.■.■.■ ■■■■.■■■■■■■■■M..NN■NN■SN■.■ON.NS■■...■■i�1111■■>•lu�■\`■■■■■■■■■.■■.■■ ■■■■■■.■■.■■.■■■.■■■■.■.■■■.■■....■■.■■■el`/Ile. .■e.e.e.1�■.■■■..■■■ ■.■.■■.■■■■■/■■■■■.....■■■..■■■■■■■■.■.■. ■11■■ NOON■■e■ NOON■. ■■ ■■..■■■■■■■■MMO■■■■■..■■.■■■■■■■■.M■..■■O1�■11■■..■Mee■■.......■�.■ ■...■.■■■■■■■■■■■■■■■...■■■■■■■■..■■■.■■■I■111■■■■.■■■■■.■■.■■.■■■■■ ■■■MOMS■■■/..■..■■■■...■■■.A■....■ ■.■.[i�%Ifll�11■.L..■■■.■.■.■.■■.■.■ ■.■■■■■■.■■■■■.■■■■■■e.■1.■11■■■e.► =■.■.■���e�l.tr�■.■e.■■■■■■■.■■.■.■■ ■■■■■■■■■■..■■■■■■....■.■■■10■■■■n► .■■■■e-.�!�■■■..■■.■....■■.■_■■■ ■.■......■■■■■.■■e.S■.■■.■■111.■.;i MMEN■EAM■ii Parcel#:I3OOOOOO22 Page 1 of 1 oP rz Davie County, NC - Basic Estate Search A Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:I300000022 Account#: 82529780 Owner Information Tax Codes LEMENT MARTHA JEAN I IC ADVLTAX-COUNTY T 1679 US HWY 64 WEST FIREADVLTAX-FIRE TAX OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 0.880 AC CALAHALN ddress: 1679 W US HWY 64 Deed Information Local Zoning ate: 09/2007 Book: 2007E Page: 0243 Plat Book: Page: Le al Description PIN 10.875 AC US HWY 64 LIFE ESTATE 5728196131 Property Values Building: 51,62CI BXF: 15,94C Land: 92 00 Market: 159,56C Assessed: 159,56C eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQuai Improved Price 00076 0322 09 1966 WD Unqualified Improved 0 00589 0041 01 2005 WD Unqualified Improved 0 2007E 0243 09 2007 WL Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 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.daviecountyne.gov/itsnetfView.aspx?prid=1473975 7/6/2016