840 Jack Booe RdDav
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I,v All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
r'pU Nei NC or arising out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
Parcel Number:
C20000003801
Township:
Clarksville
NCPIN Number:
5812275986
Municipality:
Account Number:
82525278
Census Tract:
37059-801
Listed Owner 1:
GREEN JAMES DOUGLAS
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
840 JACK BOOE ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE
COUNTY R-A,R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
33.629 AC JACK BOOE
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
31.12 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
4/2007
Middle School Zone:
NORTH DAVIE
Deed Book/ Page:
007110200
Soil Types: MnC2,MnB2,MdB,MdE
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
207280.00
Outbuilding & Extra
Freatures Value:
7980.00
Land Value:
209180.00
Total Market Value:
424440.00
Total Assessed Value:
236350.00
I,v All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
r'pU Nei NC or arising out of the use or Inability to use the GIS data provided by this website.
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AUTHORIZATION No. 'j , �, DAVIE COUNTY HEALTH DEPARTMENT:.
Environmental Health Section PROPERTY INFORMATION
Permittee s `' �' r P.O. Box 848i��
Name'.. ”/Jot r ,-'� Wit" /' Mocksville, NC 27028 Subdivision Name:
Phone # 336-751-8760
Directions to property:�� )�tCsE�"+'cl, Section: Lot:
AUTHORIZATION FOR
fC r� / f ,✓`� j�%Q WASTEWATER Tax Office PIN:#1149%
r . SYSTEM CONSTRUCTION _
/,
t Road NaMV-11 i� 'OC Zip:
t **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any BuildingPermits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits:
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH ffECIALIST DATE ISSUED
C�.Y�.�* � p t"'i-�rrsw'iA.rx .^'`=.ati w� �,.�:xi.+��tC?-+;: itilrti �-�+-•i j-3,�,:;ay„•'�'�'- ,'d�"F �{'"".�i'Ti ''w�.:�ya k. s s''"�''` .� ., , . ,. �' < � �� y
7A,DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Perinittee's
Subdivision Name:
Directions to property: j •� .! <' fr~ r Section: Lot:
� a
IMPROVEMENT,
PERMIT Tax Office PIN:# _ ►, _
Road Name '� L... r Zip: J .", b'
**NOTE** this Improvement Permit DOES NOT authorize the construction or installation 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)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ #BATHS # OCCUPANTS 1 GARBAGE DISPOSAL: Yes or No
_ a
# SEATS INDUSTRIAL WASTE: Yes or No
# PEOPLE/SHIFT
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE f,I
LOT SIZE TYPE WATER SUPPLY (� DESIGN WASTEWATER FLOW (GPD)�%� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE /W. -GAL. PUMP TANK GAL. TRENCH WIDTH ., 'j ROCK DEPTH ./,�x LINEAR FT.�.w' —r
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PE`RMITLA�&T *APPRGVE-D EFFLUEM ' FILTER* *RISER(S{)' I.+F 6" Bt--LCV1 FINISHED GRADE*
M1y
I
"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 THE DAY OF INSTALLATION. TELEPHONE # IS (W)16yd-6U. x
(335)751—a764
OPERATION PERMIT
SYSTEM INSTALLED BY:
If
AUTHORIZATION NO. -/-6-91—ftOPERATION PERMITBY: d'v v a/�ATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 05/96 (Revised)
fr DAVIE COUNTY HEALTH DEPARTMENT
- - - IMPROVEMENTS PERMIT AND CERTIFICATE OF OMPLE
TION
'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 =— - --� ��� rl Date t� r " /� �' t'" r'
Location
/
-01
Subdivision Name �" T Lot No. - Sec. or Block No.
Lot Size t
House Mobile Home _ Business _— Speculation
No. Bedrooms ` No -Baths - No. in Family
Garbage Disposal YES ❑ NO' Specifications for System:
Auto Dish Washer _ YES ❑ NO
Auto Wash MachineYES NO ❑ `! �"
Type Water Supply Q�
i
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
C ()
GU
Improvements permit by
"Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:3Q A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final I' stallation Diagram:
-
System Installed by9=-= _:;-� T--�----
Certificate of Completion Dated r - y
'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.
r
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT 9
101
Davie County Health Department a
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit F
2. Address
3. Property Owner if Different than
Address J 010, 62Y3A
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
Home Phone 9CI14— 93%0
Business Phone /`&-0'&'3' 9Z6
_
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home state size of home and number of rooms.
House Dimensions %�x l,si2
Bed Rooms SL 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 9 urinals garbage disposal
lavatory showers 3 washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community��
b) Has the water supply system been approved? Yes_kZNo
9. a) Property Dimensions a6ms
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipa a any additions or,expagsions of the facility this sjpwage system is intended to serve?
What type? Wl
/1.7 CY
This is to certify that the information is correct to the best of my knowledge.
�]
19—e5k2 01 &e�'
Date O ner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
C4.tc4,
f, 1, g � lell M 1---p -
red �r a /1-)
i .S -lo- k e. 6dhe re- ile-
bfe qZL
Id s12,e
?770 eql
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
RNI /SITF FVAI IIATION
Name—
Address
ame Address b
FACTORS
Date 5 "a 6
Lot Size
ARF4 9 1 ARFA R APPA A
1) Topography/ Landscape PositionS
U
PS
PS
U
S
PS
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
PS
PS
U
S
PS
U
S -
PS
U
3) Soil Structure (12-36 in.)
Clayey SoilsPSPSj
l�
S
!,j
S
PS
U
S
PS
U
1) Soil Depth (inches)
S
P$PSD
U
S
PS
U
S
PS
U
i) Soil Drainage: Internal
VS
S
PS
U
S
PS
U
External
PS
S
PS
S
PS
U
U
U
i) Restrictive Horizons
Available Space
PS�PS
<DS
tus
S
U
S
PS
U
1) Other (Specify)
S
PS
\S
PS
S
PS
U
S
PS
U
1) Site Classification
U—UNSUITABLE
Recommendations/Comments:
Described by
SITE DIAGRAM
DCHD (6.82)
S—SUITA LB EPSS rovisionaliy Suitable
Title Date
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT n/
NAME 04t &ree17 PHONE NUMBER
ADDRESS UBDIVISION NAME L�Y� i(��J
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED/1-
NAME SYSTEM INSTALLED UNDER ��
SPECIFY PROBLEMS OCCURRING/'/JJ ',
DATE REQUESTED
NFORMATION TAKEN BY
�� �� ,�,'c-/. �� :a se, _r/7 v 'At �%