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6578 Hwy 801S�X 0 . - DAVIE COUNTY HEALTH DEPARTMENT ✓. IMPROVEMENTS PERMIT AND CERTIFICATE"'OF COMPLETION J *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a L� Sanitary Sewage Systems Permit Number $.� Name �Z� Date 4; ND 7 2 rfi Location _ �k yj f" P... / i ✓�f r, \ Subdivision'Name Lot No. Sec. or Block No. Lot -Size ,I—OA a House Mobile Home Business -- Industry No. Bedrooms No. Baths — No. in Family__ Public Assembly Other Garbage Disposal YES NO ❑ Specifications for Syst m: Auto Dish Washer YES NO ❑ /!%�c� Auto Wash Ma^hive YES NO ❑ r� 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., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by D -i Caw 01 vi� ;a B 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. I APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PI / Davie County Health Department Environmental Health Section P. O. Box 665 _............. Mocksville, NC 27028 1. Application/Permit Requested By RFC#Q'P10 JUC4 Mailing Address. �� ( Ena _ ��sa ED Home Phone C=� �p� 2 / zEi 5 T , C 91012 Business Phone � � � ^ 7 �c !Z(e 5 74 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business a General Evaluation House ❑ Industry 5. If house, mobile home: Subdivision Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other No. of People L No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: R"Publicc% ❑ Private /� 8. Property Dimensions 'Q c R f_ Jr Sewage Disposal Contractor FrYes 9. Do you anticipate If yes, what type? of the facility this sytem is intended to serve? ❑ Unknown Section Lot # ET"BasemenUPlumbing ❑ Basement/No Plumbing 0 Washing Machine PfDishwasher F"barbage Disposal ❑ No ❑ Community '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: r lzOlt / 6 ocil , v« L, f�D( fT/j� /� 7,-" G6> NDRT/f ) �,5 7— (�/!LL c �0�1 6 9©, /< f P/QOX ,,, ON OP-1V4�(A)AY &5'g;tb)r-' L,I&Rro P1 /9 ti o �Fv N! N' 6 61' cN • 1 TF_ �� 7 D O w /V V'Ew"�U, IF SUR Ass, CRL.L 4ti Y 7%1 r This is to certify that the information provided is correct to incurred from this application. DATE of my knowledge, and I u derstand I r SIGNATURE all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this formMUST be c leted by the owner or a person authorized by the owner: I hereby give consent to the authorized representative o -t Davie Couealt epartri to en above described property located in Davie County and owned by to conduct all testing procedures as necessary to determ' said site's suitability for a ground absoRptionewage treatment and disposal system. DATE SIGNAT E DCHD'(1193) 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME �i"i DATE EVALUATED 42 �2& —gam ADDRESS PROPERTY SIZE 1lgG' PROPOSED FACIILTY LOCATION OF SITE / Water Supply: On -Site Well Community Public [� Evaluation By: Auger Boring j/ Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z — HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH T r r t Texture group Consistence Structure Mineralogy/ ! HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R -Ridge S -Shoulder . L -Linear slope FS -Foot slope 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 CONSISTENCE 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 Mineralogy 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(01-901 ■■■■■.■■■■■■■..a■■■■.■./■■.■■e.■ ■..■■■■■■■■■■■■■.■■■■■.�.■■■■■■■ ■■■..■■■■■■.■■■■■■■.■■■■■eee■ •_-.■.■■■■■■■■.e■■■■■■ ■■.■■■■■■■■■■■1� ■■■e■■e■■e■/■■■■■►I■■ .■■■■■e■■■�■■■■■■■..■�■./eH..■..e■e■ee■ ■■e ■■.■■■■■■■■■■■■■■■cam■■■■■.■■■■■■ ■■■■■.■/■ ■■■/■■.■■■■■.■■.■■■■■■ ■■■■■e■.e■Ire■ee■■■■e■■■■■■■■■■■■�ee■■ee■e■■ea.■■■eee■■■■■/■■e■■■■ ■■■.■■■,■■t�.■■e■■■■■■■.■■■■■■...■ ■■■■t.e■ ■w■e� a■■■■■■■■■■■■■■■■■■■ MEMO M ■■■■■.■■■■I■■.■■■■■■■■■■■■■■■■■■■■■■■■■H■ ■■■■■■N H■■■■■.■■■■■■■■ ■■■■■■■■■tl...■■■■■■■■■/e■■.■■..■ee■■■■ ■■■■■■ ■ ■■■■.■■■■■■■■■ C::::::::::C::::::::::'■:0 ::::::Um%l No 0 s:C=::::::J .....[1....►......................�■.■ H■■■.H ■..■■.■■■■■ ■■■■ ■■■■■11..■.�■■■■■■■■■■■/■■■■■■■■■■■■■.■■ _._.....1a ....■......M..■■ ■■■■■1/■■■■I■■■■■.■e.■■■■■■■■■■■■■■■■■■■ ■ ■■ ■ ■HH■■ ■■■■■■ ■ ■■■■■1■■■■■I■■■■■■■■■■■■■■■■■■■■■■■■■.■■...■ ■■■■ ■ 0MEMO H■■■■■■ ■■■.■r.H■■r■■■■■■■■e/■■■■.■■e■■■■� ::::: :MEM:: ■■■■■.■■■■.■■■■■■■■■■.■.■■■■■■■■�■■■■■■■�■■■■�■■■H■■■■■■■■■ ■MM ■■■ ■■■■■,'.■e■■I�■■■■eee■■■■■■/■■■■■■■ ■e■■/■e ■/.■./■■■.■■■■■!e■e■/■■■ ■■■eel.■.■■t1■■..e■■■■■■■■■■■■■■■■■■■■■■.■■ .e■■■H■■.■■■.■■■■■■.■■■ ■■■■■I■■A■�t■■■.■■■■■■■■■■//.■e■■■■eeeN■■ ■H■ ■■■■.■■■■■■■■H■■■■ ■■■■■It■■■■■1■■■■■■■.■■■■■■e■■■■■■■■■■■.■■..■■■■■■■■■■■■■■■H■■■■■■■ ■..■■R1■■■■■■■■■■■■■■ ■■■■■./.■.■ .■■■..■■■.■.■■■■■■■■■■e■■■.■■e■■ ■■■■.\I■...■■■■■//.■■■■■!!■■■.■■■ ■■■■■■■■■■■■■MEN/■■.■■e■■■■■.■■■ ■■■■ ■■■■■■■I/■■■■■■■■■■/■■■■■■■/�e■■■/!■■■/e■■■.■■■■e■■■■■■H■e■e Parcel #: L60000000901 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:L60000000901 Account #: 73827700 Owner Information uildin Tax Codes BXF• DENNIS C & TRITT KAY ff57NC nd: ADVLTAX - COUNTY T arket: HIGHWAY 801 SOUTH ssessed: FIREADVLTAX -FIRE TAXSVILLE Deferred: NC 27028 0 00109 Property Information 10 Township nd (Units/Type): 12.500 AC Vacant JERUSALEM ddress: 6578 S NC HWY 801 0147 04 Deed Information Unqualified Local Zoning Pate: 11/1998 Book: 00207 Page: 0430 00126 0497 Plat Book: Page: 1985 WD Unqualified Le al Description 20,000 PIN 12.504 AC HWY 801 03 5756164610 Unqualified Vacant Property Values uildin 170,02 CCII BXF• 22,09 nd: 6271 arket: 25482 ssessed: 254 82 Deferred: Vacant Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved Price 00092 0594 02 1974 WD Unqualified Vacant 0 00109 0253 10 1979 WD Unqualified Vacant 0 00119 0147 04 1983 WD Unqualified Vacant 0 00126 0497 04 1985 WD Unqualified Vacant 20,000 00136 0501 03 1987 WD Unqualified Vacant 0 00171 0405 11 1993 WD Unqualified Vacant 0 00174 0035 04 1994 WD Unqualified Vacant 15,000 00199 0127 12 1997 WD Unqualified Vacant 15,000 00207 0430 11 1998 WD Unqualified Vacant 9,500 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oPg�„r� �0 U R� 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/itsnet/View.aspx?prid=952700 8/31/2016