1116 Hwy 801N16
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued 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 � tri r 4 / ,Date 1Z_ ? 1W— N2 5417
Subdivision Name
Lot No.
Sec. or Block No,
i
Lot Size _lL' House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES p NO [( Specifications for System -
Auto
stem•Auto Dish Washer YES NO ❑�=�y��ti/,y. - /�'U'%�'
Auto Wash Machine YES NO
Type Water Supply
This permit Void
--if sewage system described
I
installed within 36 months from date of issue.
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:
f
System Installed by Z1L�
{
s>i
id
Certificate of Completion Date Z/jz
"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.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone i�y62
1. Permit Requested By <
2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional her Type
Ground Absorption
usiness Phone
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business'e"__�
IndustryOther
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.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes 6 urinals
lavatory '14
dishwasher
showers /Z-'//1
sinks
8. a) Type water supply: Public v Private Community,
garbage disposal
washing machine Z
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions C;2
b) Land area designated to building site
c) Sewage Disposal Contractor.�✓/ �1����
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the informa:MPELIANCE
the bet of my knowledge.
Date 0 er Signature
OWNER IS SOLELY RESPONSIBLE FORWIT ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION '
Name , 1A1I'loy ;1)Date _ ��►
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 ARFA d
1) Topography/ Landscape Position
�)
5)
4)
8)
P
S_
U
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
PS
S
(may
'CC
&U,
!) Soil Structure (12-36 in.)
Clayey Soils
C -LJ
S�
CS�
y�
U
U
Soil Depth (inches)
99
h
c�
U
U
U
Soil Drainage: internal
Ap
�
U
S�
(–S)
U
S
U
External
P
4)
S
S
U
U
U
Restrictive Horizons.
') Available Space
S.S
U
S
VU
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
i) Site Classification
U—UNSUITABLE > S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by
to•oei
DACdIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
i
P.O. Box 848/210 Hospital Street
Courier 409-40-06
Mocksville, NC 27028
Phone#: (336) 751-8760
Fax#: (336) 751-8786
October 30, 2007
Stacey Lavery
497 Griffith Road
Advance, NC 27006
Dear Mrs. Lavery,
After careful review of your application for the 12,000 square foot
retail/office/warehouse space, the Environmental Health Section is unable to approve
your request.
• May 15, 2007, an application was submitted and approved for the 7500 square
foot expansion of your current business.
• July 2007, received a call from Building Inspections Department stating that what
had been approved by Environmental Health was not the same as what had been
submitted to them.
• October 2007, Environmental Health received a plat from Stone Land Surveying
Company displaying the parent parcel being divided. The half that was divided
for the new building also contained the septic system for the parent parcel.
• October 23, 2007 a new application was received for a 6,000 square foot
retail/office space and 6,000 square foot of warehouse space. This application was
reviewed and turned down based on the following criteria:
• Insufficient space for the expansion and repair of the septic system 15A
NCAC 18A.1945
o A 6,000 square foot retail space with 3 to 4 employees would require
671 feet of initial septic system and 671 feet of septic system for
repair. The septic system that is currently being used for an adjacent
building is sized specifically for its design use. There isn't sufficient
space to expand and repair an expanded septic system.
• Location of Sanitary Sewage Systems 15A NCAC 18A.1950
o The original building was staked 20 away for the septic system. The
plat submitted October 2007 placed the building on the septic system.
Septic systems can be no closer than 15 feet to a basement. The lower
floor of the building is considered a basement and does not meet the
set back.
Although your application has been denied for the aforementioned reasons, you may
want to consider acquiring additional property in the surrounding area where rights of
way and easements could be obtained for the installation and operation of a septic
system.
On a different note, the division on the parent parcel must be addressed with our office.
The Environmental Health Section has not received the recorded easement that allows the
parent parcel to continue to legally use the septic system. The easement and descriptive
map should be submitted to this office as soon as possible.
If you have any concerns /questions or if I may be of assistance, please don't hesitate to
contact me at (336) 751-8764 or robert.nations@co.davie.nc.us.
Sincerely,
Robert M. Nations, RS
Environmental Health Specialist
4,
nnolV Al LUN
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
cwV jjoOAV 01 `t t- UtL1
WASTEWATER CERTIFICATION F DWELLING
Check One) REPLACEMENT ❑ REMODELINGid RECONNECTION ❑ µ.
Name: S Phone Number: �O (Home)
Mailing Address: (Work)
Oiwv A& 7-_16NVa
/
De a Directio s o Site: , f1J� ld
vMkj'ai 6
Property Address: //i(l M- f WI 00 1�-1
Please Fill In The Following Information About The Existing D el Ing: S
f � a
Name System Installed Under:---- Type Of Dwelling:
Date System Installed(Month/Day/Year)1LIPS t14 0 . Number Of Bedrooms: Number Of People:
Is The Dwelling Currently Vacant?
• Yes No If Yes, For How Long?
Any Known Problems? Yes ❑ Nq Cy/� Y
My
Please Fill In The Following Information About The New Dwelling:
Type Of
Kequested
For Environmental Health Office Use Only
Approved e Disapproved ❑
3Z
Of People -
Requested:
Comments: F -.0 c --,.%A. J_-1_1 ; ova• rvi L.gt r JT �fr� vv►- S •ta j f c 5 4<_tetqi ,
Environmental Health Specialist v Date
*The signing of tlus form by the Environmental Health Staff is in no way intended, nor should be taken as a
guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash ❑ Check "Oney Order ❑ #
Paid By:_
Account #:
By:
# v d1�
Parcel #: C700000020
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search
Tax Bill Search Sales Search 0
View.Prooerty Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: C700000020
Account #:81676000
Owner Information
BXF:
Tax Codes
Land:
IMMERMAN JAMES S JR& ZIMMERMAN LINDA A
Market:
ADVLTAX - COUNTY T
ssessed:
99 GRIFFITH ROAD
[Deferred:
FIREADVLTAX - FIRE TAX
DVANCE NC 27006
Information
Township
��Property
(Units/Type): 0.700 AC
FARMINGTON
16 N NC HWY 801
Deed Information
Local Zoning
Pate: 12/1980 Book: 00112 Page: 0573
Plat Book: 0009 Page: 185
Legal Description
PIN
10.750 AC HWY 801
5862281168
Property Values
Building:
22104
BXF:
12,18(
Land:
43,85(
Market:
277,07(
ssessed:
277,07(
[Deferred:
cl
Page 1 of 1
n°v r4' �
Davie County Web Site
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00112 0573 12 1980 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
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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/itsnet/View.aspx?prid=951256 9/20/2016