1205 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
!J IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `
NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c j
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name IT D. Lf�<_`/<�% ,! k,--'A1--Date
A
Location , i
.1 .
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: U,
Auto Dish Washer YES T NO
Auto Wash Machine YES NO
Type Water Supply
"This permit Void if sew,pe system described below is not installed within 36 months from date of issss e.
i--�,v 'e
nit 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
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.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
RECeV8p OCT p 1
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone 998 —5 3 2 0
1. Permit Re uested By $r 2C- Business Phone 7g'Q�
2. Address r 3'52
n 1nrs V/ C' ,CX 2%oe?e
3. Property Owner if Different than Above Mem V- c kers
Address /C� � � gC1V gjt1CP , /l/G
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
Industry Other
b) Number of people P_
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions )YO -O sa, -i�/,
Bed Rooms r. 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 urinals garbage disposal
lavatory showers washing machine
dishwasher sinks 1
8. a) Type water supply: Public Private Community C n -/-Y too---ve y -
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions I q I& r e S 110,0e,pe ro X,
b) Land area designated to building site
c) Sewage Disposal Contractor %r ra A/:5 0 n r /h' S
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 information is correct to the best of my knowledge.
� bate Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
I7�s
�i Cly
A, DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name, X-64 Date '110116-11k
Addkss Lot Size ZZ -
A
FACTnRS AREA 1 AREA 2 AREA 3 AREA 4
Topography/ Landscape Position
PS
S�
�17
S
PS
S
PS
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
P
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
P(PSS
PS
PS
MU
U
U
Soil Depth (inches)
S
S
S
S
PS
Ids
PS
PS
U
U
Soil Drainage: Internal
S
S
S
S
PS
S
PS
U
U
External
S
S
S
S
PS
b�
PS
U
PS
U
I) Restrictive Horizons
/
P-
Available Space
�;
S
S
S
PS
Q
PS
PS
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
(1S
,
U—UNSUITABLE S—SUITABLE C PS—Provisionally Suitable
Recommendations/ Comments:
Described by Title Date
SITE DIAGRAM
DCHD (6-82)
---()FFICE OF THE DIRECTOR
pahie (gauntU Pealth c'Oeyartment
ana Pame ettltf� genc
P. O. BOX 665
,morkstbille, North (attrolina 27028
October 16, 1986
Mr. J. D. Brock
Route 5, Box 342
Mocksville, NC 27028
Dear Mr. Brock:
As per your request, a representative from this office visited
your site on October 6, 1986, to determine; the soil/site suitability
for the installation of a ground absorption sewage system. Unfortu-
nately, we must classify the site unsuitable for any type convention-
al and/or alternative ground absorption system.
Sincerely,
Robert B. Hall, Jr. R. S.
Environmental Health -
RBHJR:sg
TELEPHONE
17041 634.5985
Parcel #: C60000010004
Davie County, NC - Basic Estate Search
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Parcel #: C60000010004 Account #:10204000
Owner Information
uildin :
Tax Codes
13XF•
ROCK J D& BROCK JUDITH E
Land:
ADVLTAX - COUNTY T
arket:
1205 NC HIGHWAY 801 NORTH
ssessed:
FIREADVLTAX - FIRE TAX
eferred:
DVANCE NC 27006
Property Information
Township
nd (Units/Type): 5.160 AC
FARMINGTON
ddress: 1205 N NC HWY 801
Deed Information
Local tonin
ate: 11/1986 Book: 00134 Page: 0591
Plat Book: Page:
Le al Description
PIN
5.00 AC HWY 801
5862181129
Property Values
uildin :
144,59
13XF•
1,34
Land:
7036
arket:
216 29
ssessed:
17039
eferred:
45 90
Sales Information
INo. Book Page Month Year Instrument Qual/UnQual Improved Price
h 00134 0591 it 1986 WD Qualified Vacant 63,500
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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1.5.9
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