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214 Jerusalem Aver ..'•y .... ..r- .... .*re Y ✓'.--:Y'^ f - Y:. ilk Var Y r ;f� Com.. � Yw ¢-.. .♦ • .J. L y,�,„/f '.{/ ,r0. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AWCERTIFICATE CERTIFICATE OF COMPLETION Na C_+ !� *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 13oa Sanitary Sewage e /-n') Nam/f=/n r f�� ci"I r') Al .6�` le- Date . 45 `"1 Location <- Permit Number N° 5439 Subdivision Name Lot No. Sec. or Block No. Lot SizeHouse Mobile Home k:::!:� Business Speculation No. Bedrooms - No. Baths — Z No. in Family Garbage Disposal YES ❑ NO per' Specifications for System: Auto Dish Washer. YES ❑ NO Auto Wash Ma .hine YES ❑ NO Type Water Supply 140 --- �G'l.',�s 1�I *Thispermit 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 —_Z/2 %/ J *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 byT-Cl— 061 Certificate of CompletionDate *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. • AP KATION FOR SITE EVALUATION/IMPROVEMENTS PERM r5a�( Davie County Health Department ental Health Section " 1 Environmental 11i - P. 0. Box 665 Ct, Mock+aville, NC 27024 1. App lication/Permit Requested By Mailing Address 7. If business, industry, other: Specify 'type No. of People Served No. of Commodes No. of Lavatories No. of Showers 8. Type of water supply:Public 9. Property Dimensions 10. Sewage Disposal Contractor No. of Sinks No. of Urinals No. of Water Coolers 0 Private 0 Community 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes N0 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. This is to certify that the information provided is correct to trice best of my knowledge, and I understand I am responsible for all charges incurred from this application. I 5�- �J 21&1, '-� -" - / /. L�/� Date Signature Directions to Property: di 6 C?6 // 3 ff f r� g e J- a (S o "wn I k e JA- r` o Lk S e- 61- Q d peh �ss� ,Bo�c f}S /9 Ila -91196 -tel tea/ �n�� / i h, , DCHD (10-89) Home Phone Business Phone �l/,y ?�U-55 0 _ 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: '0 General Evaluation Tank Installation S. System to Serve: 0 House Mobile Home 0 Business 0 Industry u Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions / �'2 k X'2h Ita"44�- No. of Bedrooms Basement/Plumbing No. of Bathrooms / L Basement/No Plumbing 0 Washing Machine Cj Dishwasher 0 Garbage D:isposai 7. If business, industry, other: Specify 'type No. of People Served No. of Commodes No. of Lavatories No. of Showers 8. Type of water supply:Public 9. Property Dimensions 10. Sewage Disposal Contractor No. of Sinks No. of Urinals No. of Water Coolers 0 Private 0 Community 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes N0 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. This is to certify that the information provided is correct to trice best of my knowledge, and I understand I am responsible for all charges incurred from this application. I 5�- �J 21&1, '-� -" - / /. L�/� Date Signature Directions to Property: di 6 C?6 // 3 ff f r� g e J- a (S o "wn I k e JA- r` o Lk S e- 61- Q d peh �ss� ,Bo�c f}S /9 Ila -91196 -tel tea/ �n�� / i h, , DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to,the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DCHD (11 /84) DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: -!:n'-Owner only — Owners designated representative - Anyone requesting results — Only those listed below -Z-a DATE SIGNATURE f DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ��i'(��57'�' DATE EVALUATED (/ 17/ ADDRESS PROPERTY SIZE PROPOSED FACIILTY �� �_ LOCATION OF SITE %/?/ A00/P Water Supply: On -Site Well Community Public Evaluation By: / Auger Boring Pit Cut -FACTORS 1 2 3 4 Landscape position L Sloe %. i L HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 19ro 94/ Texture group G Consistence Structure /L- Mineralogy (Al / '/ /.• 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: a S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: A OTHER(S) PRESENT: REMARKS: LEGEND Landscave 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 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 Mineraloiiy 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 ■■■■■......■■■........ewes....■....■...■..■.■....e■..■■..■.....■■■ ■.......■■.■■..■M..■■...e.....■■■.■■.Mee...■.■■...■■■■■.sMw■M.■■■■ ■■......■■M■..■■...■...■ewes.....■E■■...e..■.........M.■.■...■■..■� ■................■■.■..■.■.■■■■■�■■......■..■■............... 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O.E.■■■E.eM■M.M■■.■■■■ ■■...■■.■.■■.■■...■■■■■■■■.■.■w■ ■.■wry...■■■■.......■■■.■....M..■ ■■■■■■■■MM■MMM■EM■..■■■■■■M■■■`wM.■...■e.ee.....eee.e...e..■..■..■ ■■■■ecce■■e■■eM.■■■■■MM■eMe■■M■■eeea■■■■■■■■■■■■■■■.■■EM.■■....■.■ ■■■MMM■■■ecce■Mee■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■ ■■..■...■■■s■.M.s■M■■■■■Mee�M■■e■■■■■Mee■■■■■■■■■■■■■■■■■■■.■■.■■■ ■■■EMME.■■■■■■MM.■■■MMM■■■■■M■MMMMMMw.■■■■■■■■■■■■■MMM■MeOM.MOO..■ ■........Mee.......■■■...■...■.u.■.■■■■■■■■■■..■..■■■s....■.....w Parcel #: M5090B0028 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Informatign Parcel #: M509080028 Account #: 20101500 Owner Information Building: I Tax Codes BXF• DAVIDSON THELMA VIOLA Land: I IC ADVLTAX - COUNTY TA Market: PO BOX 998 ssessed: JFIREADVLTAX - FIRE TAX Deferred: OOLEEMEE NC 27014 00914 0516 01 2013 WD Unqualified Property Information Township nd (Units/Type): 1.000 LT JERUSALEM ddress: 214 JERUSALEM AV Deed Information Local Zoning Pate: 01/2013 Book: 00914 Page: 0516 Plat Book: Page: Le al Description SPIN LOTS 38-40 O C WALL 5745075066 Property Values Building: 40 99 BXF• 8,95C Land: 15,63C Market: 65,57C ssessed: 65,57C Deferred: 3 Sates Information No. Book Page Month Year Instrument Qua[/UnQual Improved Price 1 00114 0175 07 1981 WD Unqualified Improved 0 2 00535 0956 02 2004 WD Unqualified Improved 16,000 3 00914 0516 01 2013 WD Unqualified Improved 14,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oZvt� CIO ®rlo 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=964191 8/25/2016