5655 Hwy 801Sl' o
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1. Penrictee's f DAVIE COUNTY.HEALTH DEPARTMENT
NargA: -•,l .-1` .�+c.�%� � � Environmental Health Section PROPERTY INFORMATION
1, 77
P.O. Box 843
Directions to property: -Cl %" �r't ��.f 4/1, . , jcksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
l AUTHORIZATION FOR
�, WASTEWATER
'-� 2469
� _ SYSTEM CONSTRUCTION Tax Office PIN:# - -
AUTHORIZATION NO: 6 9 A Road Name: Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental 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.
(In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISS ED
RESIDENTIAL SPECIFICATION: BUILDING TYPE l # BEDROOMS � # BATHS # OCCUPANTS—,—?GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYP,EE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY U DESIGN WASTEWATER FLOW (GPDJ�- I -p NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. 'TRENCH WIDTH ROCK DEPTH —Zff LINEAR
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
II **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DA,'13
OPERATION PERMIT
SYSTEM
iT.ZO-R FINAL INSPECTION OF THIS SYSTEM
CION. TELEPHONE # IS (336)751-8760.
-y
0Ay a G
AUTHORIZATION N OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
Darn ozmz (Revised) 1P 3 3
i DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME __) 2 �- �- ✓� e _ PHONE NUMBER 29X -e - 9%4
ADDRESS e5-6 _qS )4,-,j y E0 I S SUBDIVISION NAME
DIRECTIONS TO SITE ('0 01 2
of Le_+ -T
LOT #
1SA_ S � �f11Dn
DATE SYSTEM INSTALLED g 2 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY 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. 1193
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
2Permit Number
Name ;�� �t -R-rwh Date l ;2- L
a�foti
Location
Subdivision Name Lot No. - - Sec. or Block No.
Lot Size House ✓� Mobile Home - Business Speculation
No. Bedroomsy
No. Baths 7-' No. in Family .
Garbage Disposal YES ❑ NO ❑ Specifications for System:L�
Auto Dish Washer YES Q NO fl
Auto Wash Machine YES ❑ NO ❑
Type Water Supply f
*This permit Void if sewage system described below is not installed within 36 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:
Q,�
pr"
System Installed by �►��
1
sli1
- Certificate of Completion, ,iti`�;, d: ��'. 1 Date
"The signing of this certificate shall indicate that the system described 4above 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.
_+DAVI E COUNTY HEALTH DEPARTMENT (, w Y �d S
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note:'Assued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
' ?i
Name �,)� `Lp-rh Date 3 1 f cG
1 Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size .1 tfl� House Mobile Home _ Business Speculation
No. Bedrooms —3 No. Baths No. in Family ?'
Garbage Disposal YES ❑ NO ❑ Specifications for System: oo,
Auto Dish Washer YES ❑" NO ❑
Auto Wash Machine YES pr -NO ❑,
Type Water Supply _ f _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
4
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
ay-,
- Certificate of Completion �1 "` �~ 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 td#zr ac a guarantee that the system will function
satisfactorily for any given period of time. -
;. DAME COUNTY HEALTH DEPARTHIENT
ENVIROP3YMUTAL HEALTH SECTION
SOIL/SITE EVALUATIO17
VAIM DATE
LOCATION 1?61
Ir
LOT SIZE
TOPOGRAPHY: S
SOIL TE:,TURE : ,!�- 3
SOIL STRUCTURE: S
DEPTH: O..0 Cv
RESTRICTIVE HORIZONS:
PERCOLATION FATE: Presoak Hark & time I Drop Time Pate lir.. Inch
1.
2.
3.
** CLAS S IFICATI
' Suitable Provisionally Suitable Unsuitable
COIRIEIITS:
SANITARIAI? _/i`1 ,,'','`r�
SITE DIAGF,A.N
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IN
6
Dbvie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #:L70000000502
Account #:44102630
Owner Information
OBXF:
Tax Codes
Land:
LAMBE JEFFERY SEAFORD
Market:
C ADVLTAX - COUNTY TA
Assessed:
5655 NC HIGHWAY 801 SOUTH
Deferred:
FIREADVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 0.920
JERUSALEM
ddress: 5655 S NC HWY 801
Deed Information
Local Zoning
Date: 06/1985 Book: 00127 Page: 0091
Plat Book: Page:
Legal Description
PIN
1 AC HWY 801
5766172596
Property Values
Building:
89146C
OBXF:
5,76C
Land:
17,95
Market:
113,17
Assessed:
113,17
Deferred:
Sales Information
No. Book Page Month Year Instrument Qua[/UnQual Improved Price
1 00127 0091 06 1985 WD Unqualified Improved 16,000
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