6260 Hwy 801S,
4' DAVIE COUNTY HEALTH DEPARTMENT'
4 _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NO* Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
-Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.196%11 Petmlt Number
-'Name `-- Q cA:1 Ax Date J `� , �, N2 t
5579
Loacation VRA- U 1�`) r�� U ��. �� ,l�
Subdivision Name. WV (1616, Lot No. Sec. or Block No.
Lot Size .,House Mobile Home _ `'� Business Speculation
No. Bedrooms- No. Baths No. in Family =)
Garbage Disposal YES ❑a NO Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES NO ❑
Type Water Supply --
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1.
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►�-'^^�-- 5� �+
1'.heS Z
Fd
Certificate of Completion Qs, ( (e " p Date 1)-q- 19 q
*The signing of this certificate shall indicate that the system describe 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.
s APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department REC�tp MAY 0
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone ��
1. Permit Reque ted By ey i t Business Phone �
2. Address
3. Property O227
an ZAve
Address
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
IndustryOther
b) Number of people 3
6. ay If house or mobile home, state size of home nd number of rooms.
House Dimensions 4i2\ Q le- w; Q_
Bed Rooms 4:21, 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
lavatory
urinals
showers
dishwasher sinks
8. a) Type water supply: Public Private - Community
b) Has the water supply system been approved? Yesk"-No
9. a) Property Dimensions ��"
b) Land area designated to building site Q�' ��--
garbage disposal
washing machine -
c) Sewage Disposal Contractor M
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? =CEJ
What type?
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
. Directions to p
DCHD (8-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
\ SOIL/SITE EVALUATION
Name `(� V ��` Date S I
Address P Lot Size 2
,
FAr.Tr)RS
A F� ARCA� AR6 3 AREA 4
1) Topography/ Landscape Position
P
U
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
�PS�
CP�S�
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
A
U
U
U
U
�) Soil Depth (inches)
P
U
U
U
i) Soil Drainage: Internal
Sc�
S
_PS
U
External
PS
PS
!PS
P
�) Restrictive Horizons
Available Space
S
PS
U
S
U
{) Other (Specify)
S
PS
S
PS
S
PS
S
PS
i) Site Classification
U—UNSUITABLE S--71 iT KB—LE PS(—Provisionally Suitable
Recommendations/ Comments: ��. N -off
�y , -
Described by - Title Date
SITE DIAGRAM
DCHD (6-82)
\-r1N1\\
Parcel #: L60000002103
Davie County, NC - Basic Estate Search
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Parcel #:L60000002103
Account #:45696000
Owner Information
Tax Codes
Building:
NK JOHN RICHARD SR& LINK CATHERINE MARY ANN
E280
ADVLTAX - COUNTY T
01
NC HIGHWAY 801 SOUTH
READVLTAX - FIRE TAX
Market:
OCKSVILLE NC 27028
ssessed•
Property Information
Township
nd (Units/Type): 0.680 AC
JERUSALEM
ddress: 6260 S NC HWY 801
Unqualified
Deed Information
Local tonin
ate: 03/2010 Book: 00820 Page: 0453
00717 1072
lat Book: age:
2007 QC
Le al Description
PIN
1.937 AC HWY 801
5756442237
Property Values
Book Pape Month Year Instrument
Building:
48,2401
BXF•
01
Land:
13,1701
Market:
61,4101
ssessed•
61 41
eferred•
00717 1069
Sales Information
No.
Book Pape Month Year Instrument
Qual/UnQual
Improved
Price
1
00194 0045
04
1997 WD
Unqualified
Vacant
0
2
00717 1069
06
2007 QC
Unqualified
Improved
0
3
00717 1072
06
2007 QC
Unqualified
Improved
0
4
00820 0453
03
2010 TD
Unqualified
Improved
48,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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P.t�1
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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
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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=1480247 8/31/2016