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1212 Hwy 801N.• w:: r: :,ys,JX "-arm; ::;U+ _,. ,. ;::; l,...; A:cj' v.e ,�1, cr7 7 :. y -y � `� � `E,s { .. 11; .. , Il, 1 r.. ^� - ^J•- s o . DAVIE COMITY HEALTH DEPARTMENTN Cl— y IMPROVEMENT PERMIT and OPERATION PERMIT �p IMPROVEMENT PERMIT�.',;l 121z / V6 /fwLf IQ/ . **NOTE** This improvement ptrmit.-}OE9-iQTraut6h4z ttie ce?struction or installation of a septic tank system or any wastewater r w r syitee: /-RN R1fi1 RIZATION VOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation cf 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) PROPERTY ADDRESS �dI/► " +� DATE SUBDIVISION NAME v LOT NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS I SEC./BLOCK NUMBER # OCCUPANTS ..•I GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY _ DESIGN WASTEWATER ,(GPD),�-4/n NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TAW SIZE GAL. PUMP TANK GAL. TRENCH'WIDTH V "ROCK DEPTH 1--Y� LINEAR FT _ ("' � OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED.USE CHAFE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. 0 IMPROVEMENT 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:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT AUTHORIZATION NO. 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 136A, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FRICTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 �`;:�au� ,? + ,� t.:.r•t'.:' . s S„, . v',x z .s« . is ry . _: c . - ,. w+= tie DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT, and OPERATION PERMITp;r�. IMiIROVEMENT PERMIT -.1i01 J- - / G ✓t z 0 **NOTE** This improvement permit";t110ES`NpT'authorizejtte construction or installation of a septic tank system or any wastewater systew'AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION oust be obtained from this Department prior to the construction/installation of -a system or the issuance`of a building permit. Y, (In compliance with Article 11 of G.S. Chapter 138A, Wastewater Systems, Section .1980 Sewage Treatment and Disposal Systems) NAME PROPERTY ADDRESS �dI/� " �v+ �I DATE c4 SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS . GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIIE TYPE WATER SUPPLY ,•.4/LZj DESIGN WASTEWATER FLOW, IGPD) NEW SITE REPAIR SIS SYSTEM SPECIFICATIONS: TANK SIIE GAL. PUMP TANK GAL. TRENCH WIDTH r�ROCK DEPTH � LINEAR FTe-91)0/.�/ �► OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FILL INSPECTION OF THIS SYSTEM BETWEEN r 8:38-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OFF INSTALLATION. TELEPHONE # IS (704) 634-8760. Ms .AUTHORIZATION NO:OPERATION PERMIT BY ��G(� 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 5 k.`. GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCiTI2 19/95--.`- . ' y ✓ Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 7 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION \� ` (Issued in compliance pj1 \\41" 5 Cls G.S. Chapter 130A, W ewa ys ms) \ i ***This Authorization For Wastewater System Construction must be issued by the Davie County Environment#1 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.*** AUTHORIZATION NU1+9ER NAME DATE 6(� /� f� N2 04-36 NAME ON IMPROVEMENT PERMIT (If different than above) / 4 f w SITE LOCATION1-4 COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE**t THIS AUTHORIZATION FOR WAS ATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5);YEARS. ENVIRONMENTAL' HEALTH SPECIALIST DATE DCHD 10/.95 x .x, i' _i. �. �.� j 1 ve s `S 4 d'et t _. Y f ..T _v r r L✓V .. , [,'', NAME_ ADDRE! DIRECTIONS TO S DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) �/� PHONE NUMBER � , le BDIVISION NAME LOT # DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY //09;<-f NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY 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 Plione: (336) - 753 - 6780 Davie County Health Dep Environmental Health S P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 E C E Q V E n MAY - 3 2010 ENVIRONMENTAL HE DAVIE COUNTY ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Far: (336) - 753-1680 Name: cacl 00ae.(s ('PAVA" O ti / I Q C.- Phone Number 334�, $) 7 - L/) S) (Home) Mailing Address:(Work) AIC : Detailed Directions To vre-"S on r n� Property Address: r2 f 14y. Fo 1 iVot• k 4Wy4 e C_ /' /UC Z-2,0 G Please Fill In The Following Information About The EXISTING Facility: 6"ki � e - ',' i y Name System Installed Under: Type Of Facility:1/111M.0 C. Date System Installed (Month/Date/Year): Number Of Bedrooms:Number Of People: a Is The Facility Currently Vacant? Yes TSO If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Information About The NEW Facility: %� W;�1 b�f)�a b�d�0o,A;—) Type rs ;� �'� � C;04 /r. /�F%�r �� t �f' yp Facility: Ilk �11VS� �� .a NumberOfBedrooms: Numbero People a Requested By: "'''' Date Requested: 3o. 20/6 (Signature) For Environmental Health Office Use Only pprove Disa proved Comments: w i z Environmental Health Specialist Date: �� *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash 6hec Money Order # 16 Z5 Amount:$ (i UU Date:—!Da. U l ti Paid By: _Z1:,�, ej 1C l'Yi c"r'`iI-'OK51r�-4- LA C t:�. id Received By: & ld S Account #: ZZ /Z Invoice #:y0sr Parcel #: C600000101 Davie County, NC - Basic Estate Search • Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Map for this Parcel View Tax Bili Information Parcel#: C600000101 Account #:16633380 Owner Information BXF• Tax Codes Land: OMPTON DOROTHY M Market: ADVLTAX - COUNTY T �FIREADVLTAX Assessed: 1212 NC HIGHWAY 801 NORTH ID-eferred: - FIRE TAX DVANCE NC 27006 Property Information Township nd (Units/Type): 12.660 AC FARMINGTON [Address: 1212 N NC HWY 801 Deed Information Local tonin ate: 05/2003 Book: 00486 Page: 0539 lat Book: Pa e: Legal Description PIN 14.750 AC HWY 801 5862099481 Property Values Building: 64 36 BXF• 11C Land: 164,03 Market: 228,50C Assessed: 228,50C ID-eferred: cl Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00205 0301 08 1998 WD Unqualified Improved 0 >_ 00393 0232 11 2001 WD Unqualified Improved 0 3 00486 0539 05 2003 WD Qualified Improved 181,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information 1" Return to Basic Search Page 1 of 1 U-1 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=1458119 9/20/2016