6908 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ` �' .1% .''" _5- —�_ Date
Location 4--'
Subdivision Name
Lot No.. Sec. or Block No.
Lot Size House Mobile Home
No. Bedroomsr No. Baths_�� No. in Family.
❑ ❑
Garbage Disposal YES NO
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
4 � Business Speculation /-
Specifications for System: M
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by �✓%l
*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
'- J
Certificate of Completion Date 6
*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 betaken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 6
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone �?2'7 D / LI -4 Y
1. Permit Requested By 0 o Business Phone
2. Address --)00— a/1 fJ r__ _17v Ly
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy ConventionalOther Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Homed Business
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms. y�
House Dimensions. - ��: � �- /.,
Bed Rooms—�2_ Bath Rooms_ Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, eta
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes L�_ urinals
lavatory
showers
dishwasher sinks
8. a) Type water supply: Public -- Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions9-
b) Land area designated to building site
c) Sewage Disposal Contractor
garbage disposal
washing machine
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
L- f - Xf ;2F�- d
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
1
DCHD (6- )
PAUL J
D.B. 102
S! AIE OF: NORTH CAR04 !IA 2AV115 COUNTY
-e.40 ,y
A CAR,�I '' I, SAM P. HALL, CEPT+ Y THAT ° "
, - � � i„ Tc THIS M?;. !',�.:S
OP. -,WN UNDER MY SIi, FRVISKGNI FROM AN
SEAL FIELD SURVEY MADE UNDER MY
L 2030 1 THAT THIS MAP WAS PREPARED IN AOCO? :.NCE
�9 WITH G.S. 47.30 ASA ENDED. WITNESS MY lIAND
. StfR� AND SEAL THIS �s DAY OF 4u6.0 s r
J/ 19-86 HALL'S Lw^D SURMIBO 00.
P.O.
BOE'294
1JJl�L.37S. 0. 27028 PSi 706-482—ti43?
Ri01STERfA LAND SISRVCYOR .�
=N
'J
u"rked
X point
axle
i
MOTE- THIS PLAT IS SUBJECT TO ANY
EASEMENTS, RIGHT -OFF -WAYS, OR AGREE, -'."!-NTS
PRIOR TO THE DATE OF THIS PLAT.
S! AIE OF: NORTH CAR04 !IA 2AV115 COUNTY
-e.40 ,y
A CAR,�I '' I, SAM P. HALL, CEPT+ Y THAT ° "
, - � � i„ Tc THIS M?;. !',�.:S
OP. -,WN UNDER MY SIi, FRVISKGNI FROM AN
SEAL FIELD SURVEY MADE UNDER MY
L 2030 1 THAT THIS MAP WAS PREPARED IN AOCO? :.NCE
�9 WITH G.S. 47.30 ASA ENDED. WITNESS MY lIAND
. StfR� AND SEAL THIS �s DAY OF 4u6.0 s r
J/ 19-86 HALL'S Lw^D SURMIBO 00.
P.O.
BOE'294
1JJl�L.37S. 0. 27028 PSi 706-482—ti43?
Ri01STERfA LAND SISRVCYOR .�
=N
'J
u"rked
X point
axle
OFFICE OF THE DIRECTOR
,Vabie Tonntg 'Fealty Pepurtment
unb Dome Wealth �genrg
P. O. BOX 665
90cksbille, North Carolina 27828
September 15, 1986
TELEPHONE
17041 634-5985
Mr. Fred O. Ellis
P.O. Box 312
Mocksville, NC 27028
Mr. Ellis:
As per your request a representative from this office visited your
site on September 15, 1986 in order to determine the soil/site suitabil-
ity for the installation of a ground absorption sewage system. Unfortu-
nately, due to the following reason we were unable to conduct the eval-
uation. Please notify this office as soon as the item or items below
have been completed. Upon notification, this office will place your
application back in the active file and again be placed on our work
schedule. Nothing was staked on the site.
Sincerely,
Robert B. Hall, Jr. R. S.
Environmental Health
RBHJR
Enclosure
Address
FACTORS
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
ARFA 1 AREA 9
Date
Lot Sized'
ARFA A AREA A
1) Topography/ Landscape Position
'4)
8)
9)
S
S
S
(:w
P
PS
PS
U
U
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
yy����
(PS�J
S
PS
S
PS
T��
U
U
3) Soil Structure (12-36 in.)
Clayey Soils
S
S
S
PS
S
PS
4J/
U
U
1) Soil Depth (inches)
S
S
S
J�)
(,w
PS
PS
U
U
U
i) Soil Drainage: Internal
yS.�
S
S
S
PS �)
PS
PS
U
U
External
S
S
P
PS
PS
U
U
U
Restrictive Horizons
Available Space
lPS
S
S
PS
S
PS
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
Site Classification
,
U—UNSUITABLE S—SUITABLE PS—P , visionally Suitable
Recommendations/ Comments:
Described by _
SITE DIAGRAM
DCHD (6-82)
Title ,�'�a J Date
Parcel #: L500000048
Davie County, NC - Basic Estate Search
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Parcel #: L500000048
Account #: 24076000
Owner Information
Tax Codes
ECUS FRED O& ECUS MARIE C
ADVLTAX - COUNTY T
O BOX 1018
FIREADVLTAX - FIRE TAX
OOLEEMEE NC 27014
Market:
ProperLV Information
Townshi
Land (Units/Type): 2.160 AC
JERUSALEM
Address: 6908 S NC HWY 801
Deed Information
Local tonin
ate: 01/1982 Book: 1982E Page: 0071
Plat Book: age:
Legal Description
PIN
10 AC HWY 801
5746735293
Property Values
u" I'
29,98
BXF•
9,73 0011
nd:
23,74
Market:
63 45
ssessed•
63,4501
Deferred:
Cl
Sales Information
No. Book Page Month Year Instrument Qua[/UnQual Improved Price
1 1982E 0071 01 1982 WL Unqualified— Improved 0
View Property Record for this Parcel View Mao for this Parcel hew Tax Bili Information
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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/itsnet/View.aspx?prid=764690 8/25/2016