4310 Hwy 801S (2)DAVIE COUNTY HEALTH ._DEPARTMENT
-IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:7ssiied in Compliance With Article If of G.S. Chapter 130a
Sanitary Sewage Systems j Permit Number
Name .�, �, acs n 0h Q �, \ a� N 5 o t Date ` NO
R�'�.� 6593
.'Location �► �``•� �-_°
IJ N
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 0-- Specifications for System:
Auto Dish Washer YES ❑ NO p
Auto Wash Ma.hine YES Er NO ❑
Type Water ,Supply _
*This permit Void if sewage system described below is not installed within 5 years from date of issue. .
This permit is subject to revocation if site plans or the intended use change.
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: System Installed by
DI
Certificate of Completion _.�-Z__ 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.
7
1. Application/Perm
Mailing Address
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department , �S = 91 A�
Environmental Health Section f
P. O. Box 665
Mocksville, NC 27028
Home Phone �-- 9 I ��- ,2 j Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation
4. System to Serve: ❑ House X Mobile Home
❑ Business ❑ Industry ❑ Other
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
No. of Bathrooms Z
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served .3
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks =
No. of Urinals O
Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown
Section Lot #
No. of Water Coolers n
Water Usage Figures
❑ Basement/Plumbing
❑ Basement/No Plumbing
Pr Washing Machine
❑ Dishwasher
❑ Garbage Disposal
7. Type of water supply: Public ❑ Private ❑ Community
8. Property Dimensions aa ",a Sewage Disposal Contractor R .,b
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes fR' No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 1: I OWN the property. ❑ 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this for MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
1 --� \ Soil/Site Evaluation
V"(\"NAME 4�`t� �° `'s �� ah,1`r`S o DATE EVALUATED I - 20 - 71 '
ADDRESS S P V e PROPERTY SIZE S Q. -
PROPOSED FACIILTY \'A\• V LOCATION OF SITE 'Ra I S
Water Supply:
On -Site Well
Community
Public t�
Evaluation By:rU—
Auger Boring
Pit
Cut
5
Slope
FACTORS
1 1
2
3
4
Landscape position
-S
5
Slope
$ G
S) 50
50
HORIZON I DEPTH
611
'
Texture group
5(1—
S
S Q
Consistence
2
'�
Structure
C
Mineralogy
HORIZON II DEPTH
41 :"4
Texture group
Consistence
i-
rt
,:r-
Structure
VA5}�
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
,SS
SSS
RESTRICTIVE HORIZON--
SAPROLITE
CLASSIFICATION
,S
LONG-TERM ACCEPTANCE RATE
>a
i
y
SITE CLASSIFICATION: \ �_.> EVALUATED BY: 0-
LONG-TERM ACCEPTANCE RATE: ,
OTHER(S) PRESENT:
REMARKS: _ _VLQ� be�-+� — , -I
LEGEND
Landscave Position
R -Ridge S -Shoulder L -Linear slope FS-Footslope N -Nose slope
CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope
Texture
S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt
SICL-Silty clay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
Moist
VFR-Very friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm
Wet
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic
Structure
SC -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineraloity
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon- Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water' or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD(QI-901
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Parcel #: J70000010303
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel _View Tax Bill Information
Parcel #: J70000010303
Account #:40344500
Owner Information
BXF:
Tax Codes
nd:
HNSON LAMON L& JOHNSON SHIRLEY L
[310
Market:
ADVLTAX - COUNTY TA
ssessed•
NC HIGHWAY 801 SOUTH
Deferred:
READVLTAX - FIRE TAXVANCE
Unqualified
NC 27006
0
>_
Property Information
0065
Township
Land (Units/rype): 4.990 AC
Unqualified
FULTON
ddress: 4310 S NC HWY 801
3
00856
Deed Information
04
Local Zoning
Date: 10/2015 Book: 01003 Page: 0607
Improved
11,000
Plat Book: Page:
01003
0607
Le al Description
2015 WD
PIN
5.03 AC HWY 801
55,000
5777251645
Property Values
Bu" 1'
11,83
00
BXF:
2,520
nd:
31,63
Market:
45,980
ssessed•
45 98
Deferred:
0
Sales Information
No.
Book
Pape
Month
Year Instrument
Qual/UnQual
Improved
Price
L
00114.0339
07
1981 WD
Unqualified
Improved
0
>_
00851
0065
02
2011 TD
Unqualified
Improved
13,000
3
00856
0878
04
2011 WD
Unqualified
Improved
11,000
t
01003
0607
10
2015 WD
Qualified
Vacant
55,000
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
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