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7348 Hwy 801S50� Account #: Billed To: Reference Name: 989900024 Roger Spillman Proposed Facility: Residence ATC Number: 2850 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mockw lle, NC 27028 (336)751-8760 Tax PIN/EH #: 5745-39-1600.02 Subdivision Info: .1 Location/Address: Hwy 801 S.-27028 Property Size: 5.103 acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, S ion .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE N TJTI N IS VALID FO A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ' Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 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. Septic System Installed By: 4 Environmental Health Specialist's Signature : / is DCHD 05/99 (Revised) Date: ev DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900024 Tax PIN/EH M 5745-39-1600.02 Billed To: Roger Spillman Subdivision Info: Stacee Heights (Tracts) Lot # 2 Reference Name: Location/Address: Hwy 801 S.-27028 Proposed Facility: Residence Property Size: 5.103 acres ATC N%nb?r: 2850 **NOTE** This mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type! #People #Bedrooms #Baths Dishwasher: V/ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 3y0e Type Water Supply �D Design Wastewater Flow (GPD) SZo�) Site: Newgr Repair ❑ System Specifications: Tank Size`&P GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Widthr-/," Rock Depth Linear Ft—?,O p / IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date:. APPUCAZION FOR SIZE EVNIMA110N/IMPROVEMENT PERMIT & ATC rill �nDavie County Healih Department la Environments/Hea/th Suction P.O. Bou 848/210 Hospital Street Mocksville, NC 27028 QY 7200 (336) 7S1-8760 *RWw *TH HIS PLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INi'O IS Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Lilled 0LAt �Contact Person �C,Q,/G! Wt,., r � / Nailing Address AQ 6 o 7 38 How Phone 2 P� "( 41 70 / Zity/State/ZIP l,(5�61�-�Z4-), �-4 Q.. IVC o2 7C%Z-E Business Phone '7/ 2- 2. 2. Name on Permit/ATC if Different than Above Hailing Address 3. Application For: :. Site Evaluation 4. system to service: 0 House ®'Mobile Home s. If Residence: # People _ City/State/Zip Jxmrcvemen Permit = 0 Both ❑ Business 0 Industry 0 Other # Bedrooms_ # Bathrooms 2 ,Dishwasher 0 Garbage Disposal Washing Machine 6. If Business/Industry/Other: Specify type # Commodes # showers 0 Basement/Plumbing 0 Basement/No Plumbing # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water. Usage (gallons per day) 7. Type of water supply: County/City 0 Well 0 Community L,1- Dc ow anticipate additions or expansions of the facility this system is Intended to serve? y y what type? 0 Yes ❑ No '1**114 P9RTANT'** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BULOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: ' /63 c, -C. 1"Al Off ice PIN: # sJl - r 3q- I SCO , Ot Property Address: Road Name 00/5 City/Zip /Y ockst/1 Ap-- If in a Subdivision provide information,, as follows: Name: ��Ie 2 Section: Block: Lot: WRITE DIRECTIONS (from Mocluville) to PROPERTY: l�f S io Jgo/S %urW f2l- �'d/S & m u 164- N) � .1 Irv. e Date Proper ly Flagged: This is to certify that the information provided ;s correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension ®u- Pevocation, if the site plans or intended use change, or if the information submitted in this, application is falsified ore 6iaaged. I, elso, underamd Meat I am responsible for all charges incurred from this appEzadon. I, hereby, give consent W the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and ed by to conduci all testing procedures as necessary to determine the site i ility. .-- I �— { DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWENG YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). may- �+ t� /�.:...✓ �s Account No. '2 Revised DCHD (07/98) Invoice No. ao i Parcel #: M507OA0038 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#: M5070A0038 Account #:8305574 Owner Information I Tax Codes ADVLTAX - COUNTY T READVLTAX - FIRE TAX ORRISON LAWRENCE C& MORRISON MARY C 348 NC HWY 801 S OCKSVILLE NC 27028 BXF: 9501 Property Information Township nd (Units/Type): 0.690 AC ddress: 7348 S NC HWY 801 JERUSALEM ssessed: 68,17 Deed Information Local Zoning Pate: 10/2015 Book: 01001 Page: 0792 Plat Book: Page: 04 2013 TD Unqualified Legal Description PIN 10.691 AC NC HWY 801 5745392464 Property Values Building: 47,22 BXF: 9501 Land: 20,0001 Market: 68,1701 ssessed: 68,17 Deferred: 2 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00372 0882 06 2001 WD Unqualified Vacant 1,000 2 00922 0679 04 2013 TD Unqualified Improved 0 3 00931 0835 07 2013 WD Unqualified Improved 0 4 00423 0181 05 2002 WD Qualified Improved 95,500 5 01001 0792 10 2015 WD Qualified Improved 63,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Page 1 of 1 5- eta` 0001JVI-111i� 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=1482086 18/31/2016