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1688 Hwy 64W AUTHORIZA TION No DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's „Q / ?j P.O.Box 848 Name: Mocksville,NC 27028 Subdivision Name: Phone#:704-634-8760 'mo C�@� Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - SYSTEM CONSTRUCTION Road Name:• '.. - ' Zip: **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Form/Authorization Numbershould be presented to the Davie County Building Inspections Office when applying for Building Permits. (In com fiance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) °! G�'✓ "` *NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION i /y IS VALID FOR A PERIOD OF FIVE.YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED A' DAVIE COUNTY HEALTH DEPARTMENT . PROPERTY INFORMATION, ", IMPROVEMENT AND OPERATION PERMITS - Permttfw s' 7" •"Name ;+' i i Subdivision Name: A a0 A a/ 7-YI 0 C,&— -Dlrectlons'to property: ^K,e °- '°C% Section: Lot: r' f. IMPROVEMENT } PERMIT Tax Office PIN:# - - Road Name: Zip: cX a s **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or.the issuance of a building permit. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ,., ; �' ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE f + C° i'� PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No s�� COMMERCIAL SPECIFICATION: FACILITY TYPEs #PEOPLE�_ #PEOPLE/SHIFT _ #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY t/ DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. . OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: V IMPROVEMENT PERMIT LAYOUT 7 D t� **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYS BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760.' OPERATION PERMIT UJ l STEM INSTALLED BY: dj �JAI (1 l� 1r AUTHORIZATION NO. / OPERATION PERMIT BY: L"'"' DATE ; r^ **THE ISSUANCE OF THIS OPERATION PERMIT SHALL'INDICATE THAT THE SYSTE�l DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKENAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ;.DC1iD OS196(Revised) .. ✓1 7+. .. , 'F. R x :� 1.f .:.'. pry 0 DAVIE COUNTY HEALTH DEPARTMENT n = �= IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perms toe S ,a Name: Subdivision Name: Direction�'to property: j - �'f' Section: Lot: r� f IMPROVEMENT PERMIT Tax Office PIN:# Road Name: f a **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An . AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) - ,'•� .' i r .•=� ,�~S ,'.+` fr *` ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE�11� #PEOPLE c2 #PEOPLE/'SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY ' O DESIGN WASTEWATER FLOW(GPD) NEW SITE R l REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. j OTHER t I REQUIRED SITE MODIFICATIONS/CONDITIONS: i IMPROVEMENT PERMIT LAYOUT 77f f _.i "CONTACT A REPRESENTATIV 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.0 THE DAY OF INSTAI, ATION.TELEPHONE#IS(704)634-8760. OPERATION PERMIT + r r + t i1 d1 STEM INSTALLED BY: 1 , F 5j r � (o it',: lob S7drv' fr _ //(7'AUTHORIZATION NO. (l OPERATION PERMIT BY. DATEr "THE ISSUANCE OF THIS OPERATION PERMIT SHALL'INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S.CHAPTER 130A.SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. OS/96(Revised) . _. _ ,.... -. •- -.}... .._mss,. . .., .. rr� r s ; ,f�.f:.:,jY�y;i4"1'y .Y.e4. ��"r4 »•-ai"' /,•..''�1 '+S.!' Ja ,%1 .s w+ . ` r-�1' i1; .. r ;+.:,i7 j .... '��� �" P"�I"b Hf itYyf . �r. 1''t. 'Y` ,4 .�'Ya k., 4 1 ,� .Y ti.fe • - AUTIiORI7ATION NO: D 5 9 4' DAVIE COUNTY HEALTH DEPARTMENT ` Jr Environmental Health Section PROPERTY INFORMATION Permittees, P.O.Box 848 Name: 416-r PJ"S' Mocksville,NC 27028 Subdivision Name: Phone#:704-634-8760 Directions to'property: ,�,�,�j/ Section: Lot: AUTHORIZATION FOR WASTEWATER ' SYSTEM CONSTRUCTION Tax Office PIN:# - - Road Name: (O*W• Zip: 74 **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Fonn/Authorization Number should be presented,to the Davie County Building Inspections Office when applying for Building Permits. " (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. . ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED N t � k t DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION P6Adttae Name: t''EX 1P�'..'z Subdivision Name: F } Directions to property: `,� ' i= Section: Lot: s . i IMPROVEMENT 't PERMIT Tax Office PIN:# - � z, Road Name: Zip: d O " **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. - (Incompliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section.190dSewage Ti eatmepf and Dispgsal Systems) ***NOTICE***THIS PERMIT IS SUBJECTNO REVOCATION IF SITE Wit" ""' „rte , PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR'MbST SEE THIS PERMITBEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE_/ .#PEOPLE/SHIFT_� #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITEy SYSTEM SPECIFICATIONS: TANK SIZE GAL. P//UMP TANK----GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.= OTHER -C:FZ REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 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 THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. OPERATION PERMIT O&F SYSTEM INSTALLED BY: Pb t� AUTHORIZATION NO. 0154y OPERATION PERMIT BY: /! DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) { 1 1 _ � '.t �z } tY. t r 1 {1•+Lr•`.rY f .. ".l.'d rk. a .- V .•. - L v.: r Ar -- , ..-_ , S { rDAVIE COUNTY HEALTH DEPARTMENT a,. 1P M IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION a Pe4aie's' ' r Name: 1F'� Subdivision Name: Ai Directions toproperty: !+ 'gd' + Section: Lot: IMPROVEMENT , PERMIT Tax Office PIN:# - s r ` Road Name'-- Zip: J g ► { **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) w_. f ;`, _ • ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No r�i r COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE_� #PEOPLE/SHIFT_� #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY / p DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE ._ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH LINEAR Fr.lan OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAY(OUT� -**CONTACT A REPRESENTATIVE OF THE DAVIE COTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM J BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.O THE DAY OF INSTALLATION.TELEPHONE41S(704)6348760. IT OPERATION PERMIT Rei �Y�� l 'j`✓ y YSTEM 1rTSTALLED B1 � (1 40 .. .� : !/ / t. 135.7_L� AUTHORIZATION NO. � OPERATION PERMIT BY: **THE ISSUANCE OF THIS OPERATION PERMIT`SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN`AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY.GIVEN PERIOD OF TIME. D3�96(Revised) 1 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) V)12fNAMEryr PHONE NUMBER ADDRESS •�je"y SUBDIVISION NAME 422 4,%'14 L LOT# DIRECTIONS TO SITE DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITYSgy'�h NUMBER BEDROOMS 0�?SAVJ5 NUMBER PEOPLE SERVED y TYPE WATER SUPPLY (,n SPECIFY PROBLEM OCCURRING DATE REQUESTED ` INFORMATION TAKEN BY�L� This is to certify that the Information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1/93 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT NAME /Acyl' r` /Jri� PHONE NUMBER • ADDRESS �1.�/ / 7 SUBDIVISION NAME SUBDIVISION LOT# DIRECTIONS TO SITE DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER SPECIFY PROBLEMS OCCURRING 6,.1;44 DATE REQUESTED INFORMATION TAKEN BY fi �� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:Issued in Compliance With Article 11 of G.S.Capter 130a/7 s 211 Sanitary Sewage Systems ero ''- y�DG Permit Number Name Date _�- -�'!� N2' 5934 Locatio Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths _ No. in Family Garbage Disposal YES ❑ NO 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 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. J= Improvements permit by 'Contact a representative of the Davie County Health Department for final 'inspection of this system between 8:30- 9:30 A.W or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by f r. Certificate of Completion -� ?��'�" 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. DAVIE COUNTY HEALTH DEPARTMENT l/ _ - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.C apter 130a, Sanitary Sewage Systems �lo ��l Permit Number Nam Date NO 5934 ; Locatio Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business � S � peculation No. Bedrooms No. Baths — _ No. in Family Garbage Disposal YES ❑ NO Specifications for System: Auto Pish Washer YES ❑ NO y Auto Wash Machine YES E] NO �O�X�rI�-7�� 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 plans or the intended use change. i r i Improvements permit by *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 - V r Certificate of Completion /'r Date AIA 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. Parcel#: I30000002001 Page 1 of 1 Davie County, NC - Basic Estate Search 1-Ob�-s Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search Jew Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:I30000002001 Account#:6539000 Owner Information Tax Codes LROTH OIL COMPANY ADVLTAX-COUNTYTBOX 4089 FIREADVLTAX-FIRE TAXNSTON SALEM NC 27115 EressProperty InformationTownshi : (Units/Type): 0.850 AC CALAHALN 1688 W US HWY 64 Deed Information Local Zoning �Iako�ok:#Page: 5 Book: 00180 Page: 0273 9 al Description PIN 1.85 AC HWY 64 5728198360 Property Values i ildin : 97,69 BXF• 10,76 nd• 129 59 Market: 238 04 ssessed: 238,04 eferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00180 0273 04 1995 WD Qualified Improved 85,000 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.daviecountync.gov/itsnetfView.aspx?prid=1473978 6/30/2016 rr� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Note:,.Issued in Compliance with G.S. of North Carolina Chapter 130-Article 13c. Permit Number .' , Name r ''- '.r} ` Date ' r,.: Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home — Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: �- Auto Dish Washer YES ❑ NO ❑ ',_• ; Auto Wash Machine YES ❑ NO -❑ ' t /�' Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. 1. r r� '-„i' .rte..-,..�...�.._...-.-.-......... i Improvements permit by *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 L V Certificate of Completion Date T q- I-L *The signing of this certificate shall indicate that the system describe 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 h IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name f```l�,i':i o�C _ Date is Location 's �A---I vPJ Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths �j No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: j2 r/i i z- Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO fl go '� r, G 5" U w) Type Water Supply _— *This permit Void if sewage system described below is not installed within 36 months from date'of issue. AND Fitc. 1 17 Li Improvements permit by � �� ' *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 mM`t iylxt o V Certificate of Completions Date 7- ) 7 *The signing of this certificate shall indicate that the system describe4 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.