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Pemuttee's ! DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Name: `--•
t P.O. Box 848
Directions to property: Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
�ltilTc7 Section: t Lot:
AUTHORIZATION FOR j
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -�- - -
`AUTHORIZATION NO: 002500 A Road Name:
**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 Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance,wiI Article l 1 of G.S. Chapter' I30A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONM T _gXffH SPte(AI�T DAZE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE O # BEllROOMS_ # BATHS #OCCUPANTS �' GARBAGE DISPOSAL: Yes or No
COMMERCCI�AL SPECIFICATION: FACILITY TYPE ,11 # PEOPLE # PEOPLE/SHIFT-,I % # SEATS INDUSTRIAL` WASTE: Yes
or No
LOT SIZE S TYPE WATER SUPPLY �AV� DESIGN WASTEWATER FLOW (GPD)N.,P0 NEW SITE REPAIR SITE ' r
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH - ' ROCK DEPTH N LINEAR FT
OTHER f 1AST-0 BOT (0^1 Ft)oy r AY_t5 -C
REQUIRED SITE MODIFICATIONS/CONDITIONS: I~ � ( L; OT r" Map L, -Joe
S D1 A 14-kL k y f
IMPROVEMENT PERMIT LAYOUT
LS
_'I NCS
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
CJ
r
I1 =Z- tom% 'T1,JK
AUTHORIZATION NO. OPERATION PERMIT DATE: 4511 25
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S M DESCRIBE ABOVE HAS BEEN INSTALLED IN COMPLIANCE'!
WITH ARTICLE I1 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' RIPD OF TIME.
DCHD 02/02 (Revised)
9
**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 Number should be presented to the Davie County Building Inspections
Office when applying for Building,Pennits.
(In compliance wit� Article..l 1 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.
ENVIRONM ,_;_.AL1iE-ALTH SPECIALIST.) DA E ISSUED
n
RESIDENTIAL SPECIFICATION: BUILDING TYPE C # BEDROOMS —5—# BATHS <— # OCCUPANTS GARBAGEDISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE t # PEOPLE # PEOPLE/SHIFT
� # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE SOgLD1 'TYPE WATER SUPPLY Cr+y l�? DESIGN WASTEWATER FLOW (GPD) a--'�•~L"'t/ NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH r ROCK DEPTH I A LINEAR FT.
OTHERcurio
REQUIRED SITE MODIFICATIONS/CONDITIONS: E'�� �' Of`r "CV Ll u
IMPROVEMENT PERMIT LAYOUT
�
N&
NG
;.. T /
IL
IF -
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT SYSTEM INSTALLED BY:
l - T4`L I,J T, ---.JK
x
AUTHORIZATION NO. OPERATION PERMIT B(
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE ST DSC
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISP
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERI
DCHD 02102 (ReviW) a
7
MPermittee's
DAVIE COUNTY HEALTH DEPARTMENT.
t
c)U\
a
"" 14tr 1
Environmental Health Section
PROPERTY INFORMATION .,
P.O: Box 848
Directions td property;
Mocksville, NC 27028
Subdivision Name:
i 'r /` eY
G✓J7r �.
t
Phone #: 336-751-8760
_;
,,
Section: Lot:
AUTHORIZATION FOR
WASTEWATER
Tax Office PIN:#
tx ,'
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002500 A
Road Name.Ip
**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 Number should be presented to the Davie County Building Inspections
Office when applying for Building,Pennits.
(In compliance wit� Article..l 1 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.
ENVIRONM ,_;_.AL1iE-ALTH SPECIALIST.) DA E ISSUED
n
RESIDENTIAL SPECIFICATION: BUILDING TYPE C # BEDROOMS —5—# BATHS <— # OCCUPANTS GARBAGEDISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE t # PEOPLE # PEOPLE/SHIFT
� # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE SOgLD1 'TYPE WATER SUPPLY Cr+y l�? DESIGN WASTEWATER FLOW (GPD) a--'�•~L"'t/ NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH r ROCK DEPTH I A LINEAR FT.
OTHERcurio
REQUIRED SITE MODIFICATIONS/CONDITIONS: E'�� �' Of`r "CV Ll u
IMPROVEMENT PERMIT LAYOUT
�
N&
NG
;.. T /
IL
IF -
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT SYSTEM INSTALLED BY:
l - T4`L I,J T, ---.JK
x
AUTHORIZATION NO. OPERATION PERMIT B(
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE ST DSC
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISP
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERI
DCHD 02102 (ReviW) a
7
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760 /Fax: (336)751-8786
February 2, 2006
Mrs. Lola Lumley
2223 US Highway 64W
Mocksville, NC 27028
Re: Failing Septic System
Dear Mrs. Lumley:
A complaint investigation at the above address revealed surfacing sewage from
the onsite wastewater system serving the residence. This failing system is a violation of
Rule .1937(a) of Title 15A Subchapter 18A of the NC Administrative Code, which states
in part, "Any person owning or controlling a residence... shall discharge all wastewater
directly to an approved wastewater system permitted for that specific use. " Additionally,
Rule .1938(b) states, "The person owning or controlling the system shall be responsible
for assuring compliance with the laws, rules, and permit conditions regarding system
location, installation, operation, maintenance, monitoring, reporting, and repair."
This letter is to inform you that you have thirty days from today's date to make
the necessary repairs. I have enclosed a copy of the Improvement Permit/Authorization
to Construct that details the specifications for the repair.
Please contact me with any questions. If finances for the repair are a problem,
Davie County Department of Social Services may be able to assist. You may contact
them at 751-8800. Thank you in advance for your cooperation. �---�
Jeff G. Beauchamp, R.S.
Environmental Health Section
Parcel #: H300000020
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: H300000020
Account #:8304082
Owner Information
Buildin :
Tax Codes
BXF•
MLEY WILLIAM KEITH
Land:
ADVLTAX - COUNTY T
Market:
18 REDWOOD DRIVE
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 1.000 LT
CALAHALN
ddress: 2223 W US HWY 64
Deed Information
Local Zoning
Date: 08/2014 Book: 2014E Page: 0803
lat Book: Page:
Legal Description
PIN
671AC HWY 64
5719648154
Property Values
Buildin :
8197
BXF•
Land:
25,00
Market:
106 97
ssessed:
106 97
Deferred:
Sales Information
No. Book Paye Month Year Instrument Qual/UnQual Improved Price
L 00418 0461 04 2002 WD Unqualified Improved 0
>_ 2014E 0803 08 2014 DC Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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Davie County Web Site
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/itsnettView.aspx?prid=1475289 7/12/2016