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1100 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: I sued 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 Location N° 5356 Subdivision Name Lot No. _ Sec. or Block No. Lot Size House Mobile Home _ Business Lei Speculation No. Bedrooms ZMi 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 d __ V *This permit Void if sewage system described below is not installed wit hi 3 months from date of issue. 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: ystem Installed by % L, I Certificate of Completion y 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 i satisfactorily for any given period of time. • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box -665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Re nested By 2. Address T _�;– Ba Home Phone 9 9 2112 r Business Phone 7iS -4 Od 3. Property Owner if Different than Above lia 1,4 ej 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 IndustryOther b) Number of people 6. aj If house or mobile home, state size of home and number of rooms. House Dimension Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Allel � • "� -Sco Estimate amount of waste daily (24 hours) 10 0,41 7. Number and type of water -using fixtures: commodes lavatory uri showers dishwasher sinks 8. a) Type water supply: Public Private Community 7 b) Has the water supply system been approved? Yes No 9. a) Property Dimensions cs . 000' 11 b) Land area designated to building site S–C X /V O garbage disposal washing machine c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? A16 What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: se -e- '�*O_Ae-d C)Qp) DCHD (6-82) �. �,,• RECEIVED APR © 1986 APP (CATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT v Davie County Health Department Environmental Health Section „d p�w� ►" P. O. Box 665 Mocksville, N.C. 27028 /�d CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone �% ` 29 9 1. Permit Requested By jj nN,9 Ei� ©P� &= 7,56 A.' Business Phone SAnle 2. Address cX Is 7 'Ocl uAlvice .0 C_ 3. Property Owner if Different than Above f Address 4. Permit To: a) Installer 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 6. a) If house or mobile home, state size of home and number of rooms. -House-Dimensions - Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served �• What type business, etc. i.JE.1 d ;,'e Estimate amount of waste daily (24 hours) L -C ", ecv 7. Number and type of water -using fixtures: commodes urinals garbage disposal lavatory / showers washing machine dishwasher sinks f 8. a) Type water supply: Public Private— Community b) Has the water supply system been approved? Yes No L' 9. a) Property Dimensions 2 b) Land area designated to building site 1 GG c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type?h-11,„ This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: �+✓' Cool '(a Z yo_=As -F 7`0 Tc E��} pol-- �'�+!=-1 I rZoPt�'�J �5 rvEK-I �� C>Ir.' ��,.rx.►�rEc! �u-� �tTc�.>� � �,�ct�sl� wh6E1E4. 01 1 9 VIPT DCHD (6-82) i Name_A Address FACTORS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION . -- Date --�� ARFA 1 ARFA 9 Lot Size ARFA s ARFA A 1) Topography/ Landscape Position d) 9) S PS(PS S PS P� U "CJ ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) I ` S PS S PS S PS fPS� U U U 3) Soil Structure (12-36 in.) Clayey Soils S PS S PS S PS � (P$J U U U Soil Depth (inches) S PS S PS S PS S U U U i) Soil Drainage: Internal S S S PS U. PS U PS U PS External S PS S PS S PS S U U U i) Restrictive Horizons �S Available Space S PS S PS U S PS U U I) Other (Specify) S PS S PS S PS S PS U U U U Site Classification � U—UN ITABI.E SSU Recommendations/Comments: �e P P//r Described by SITE DIAGRAM DCHD (8-82) PS—Provisionally Suitable { rDavre Counr v Nealii Departmenf and Nome Nealtlf A err -_ a 9 q 210 HOSPITAL STREET / P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-5983 May 20, 1988 Mr. Tom Glasscock Rt. 5, Box 88 Mocksville, NC 27028 Ret Site Evaluation Dear Mr.Glasscock: On May 16, 1988, this office evaluated a 2 acre tract of land near the intersection of Yadkin Valley Road and 801. The soil and fill material on the majority of the lot is unsuitable for a septic tank systems however, on the extreme back right side there is a small area of undisturbed provisionally suitable soil. This area is large enough for a small septic tank system consisting of a 1000 gallon tank and 100 linear feet of line. It is imperative that this area be left undisturbed. Should it be filled in or graded down, the lot classification will change to unsuitable. If you have any questions, please call this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health RH/wd Enclosure Davie County, NC Tax Parcel Report Wednesday, September 21, 2016 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: C70000002401 5862283248 82521257 G & B OIL COMPANY INC PO BOX 811 E LKI N NC 28621-0000 1.928 AC HWY 801 1.94 7/2003 005010943 148730.00 0.00 105630.00 254360.00 254360.00 WARNING: THIS IS NOT A SURVEY Parcel Information Township: Municipality: Census Tract: Voting Precinct: Planning Jurisdiction: Zoning Class: Zoning Overlay: Voluntary Ag. District: Fire Response District: Elementary School Zone: Middle School Zone: Soil Types: Flood Zone: Watershed Overlay: Farmington 37059-802 FARMINGTON Davie County DAVIE COUNTY R-20,H-B,I-2 DAVIE COUNTY OD No FARMINGTON PINEBROOK NORTH DAVIE GnB2,GaD,WATER X WS -I V -P All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the ou-it implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold Davie County, NC harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website.