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7116 Hwy 801S.t t) �-. �_._ ,+• p;'t• r;'; ya,..•vp,y."d'"i.•�.,.f�,a. a,�,t..er..'>�: •t ��$ "�.r Y:. .r u4,t+s .:♦vm9'°.t�. �. , ,. - — e.. o. .�., i�., F J. DAVIE COUNTY HEALTH DEPARTMENT -' IMPROVEMENTS PERMIT AND CERTIFICATE OF;COMPLETION -;i *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a 1 ...Spnitary Seage Syr' ste�r Permit pa er �' Name - >% N0 76 D e 2 Location _ Subdivision Name Lot No. Sec. or Block No. Lot Size_ House— Mobile Home _�_T___ Business Speculation No. Bedrooms. No. Baths _T— No. in Family _ Garbage Disposal YES ❑ NO �,. Spe i S f•ons .for System: Auto Dish Washer YES s•NO Auto Wash Ma shine Y7S NO ❑v�� �� - if fr 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. f R., `` i .�..,._. Improvements permit by -- Ila // -- I'll' '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 _ Aw/ 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. 1. Application/Permit APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT / Davie County Health Department Environmental Health Section �e P. O. Box 665 Mocksville, NC 27028 By Mailing AddressJ � � � q—A L" � a Home Phone a�L - -/ % Business Phone 2. Name on Permit if Different than Above %40 e- 3. Application/Permit for: ❑ General Evaluation [,eptic Tank Installation 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑l� Basement/No Plumbing No. of Bedrooms IjJ-Waas�shing Machine No. of Bathrooms El Dishwasher / Dwelling Dimensions 9.S7Gr�/ �� ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private ❑ Community 8. Property Dimensions '4 c Y, -E- Sewage Disposal Contractor No 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 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: L �U &0 7-f Yb /3 This is to certify that the information provided is correct to the best of my knowledge, incurred from this application. C� DATE urloerstand I am responsible for all charges SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. Z 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of t eD vie C ty H alth Department to enter upon above described property located in Davie County and owned by /a'qQe ce to conduct all testing procedures as necessary to determines site's suitability for ago absorption sewage treatment and disposal system. (� 16 'A DATE SIGNATURE DCHD (12.90) 4 DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation NAME _ AGI -le e !/ ADDRESS PROPOSED FACIILTY Xo w.Se DATE EVALUATED PROPERTY SIZE 1�ic LOCATION OF SITE Water Supply: On -Site Well Community Public .L_ - Evaluation By: Auger Boring I/ Pit Cut FACTORS 1 2 3 4 Landscape position L I— Sloe % — HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH f �� Texture group Consistence 4,11i Structure J -41 - 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 .1,X SITE CLASSIFICATION: i� EVALUATED BY: 1-/ 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 ■■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■�■NOON■■.■..Ne..■■■..■....■ti■©.■ ■■■■■■.■■■■..■■■■■■■■■■■■■■■.■■■■.■NOON.■.■s■■■.a■.■.■...■.■■■.■■■ ■...■...■.■■■■.■■.■■■■■■.■..■■.■ ■■■.■...■■■.■..■■.■.■...■tit■■.■ ■■■■■...■■■.■■■■■■■■.■.s■..■.■■■■._NOON■■■■■■■...■■.e■■.■e■■■s■■.■ ■■.......■....■..■■■■...■ON..■■■■■■.■■■■.■■■■■.■...■■.■■■■■■■■ N■■ ...................■.............................................. iiiiiiiiiiiiiiiiiii MENNEN MEMENMENNENMENNEN iiiiiisiiiiiiiiiiiiiiiiiiiiiiiii�iiuii�iiiiiiiiii.iieiiii■i■i iii■ ■...■■.........■s..■.....■■.■■■■.■.■�.■■...■■■■■e■■..........■�■■■■ MENNEN0 ...................■..............NOON...■H■■■■■�.■...■■■■■■■.■■■ ........................................................ ........ ■■■■■■■ .■. ....■.....■..■.■■.....■t■■.■■■■■Nee.■.■...■■.....■..■ ................................�.......�................... NOON ................................ ....... ........................ .........■........................................................ ■■■■■■■■■■■■■■■■■■■eeee■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Parcel #: M503OA000801 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search 0 View Prooerty Record for this Parcel View Mau for this Parcel View Tax Bill Information Parcel #: M5030A000801 Account #:82514392 Owner Information BXF' Tax Codes Land: FARRELL TERRY LANE & FARRELL CONNIE JEAN Market' ADVLTAX - COUNTY T ssessed' 132 NC HIGHWAY 801 SOUTH Deferred' IREADVLTAX - FIRE TAX OCKSVILLE NC 27028 Property Information Township Land (Units/Type): 0.920 AC JERUSALEM ddress: 7116 S NC HWY 801 Deed Information Local tonin Date: 01/1999 Book: 00209 Page: 0094 Plat Book: Page: Legal Description PIN 92 AC WHET STONE DR 5746513606 Property Values Building: 23,990 BXF' 01 Land: 50,00 Market' 74,0801 ssessed' 74,08 Deferred' Sales Information No. Book Page Month Year Instrument Qual/UnQuai Improved Price 1 00209 0094 01 1999 WD Qualified Vacant 30 000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 o��r� (cl O'. tZ� 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 otherpublic 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 websiteplease contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnettView.aspx?prid=1474518 8/25/2016