305 Pudding Ridge Rdt HEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Lary Wayne Sykes
Address: 305 Pudding Ridge Rd
City: Mocksville
State[Zip: NC 27028
Phone #: (336) 998-7197
Address Larry Wayne Sykes
Road # Mocksville NC 27028
'Structure:
SINGLE FAMILY
# of Bedrooms: 3 # of People:
`Water Supply: WA
Basement: F] Yes ❑ No
'_Proposed Improvement:
Work Shop
For Office Use Only l
*CDP File Number 121312 -1
E500000009
County ID Number:
valuated For: EXISTING
PERMIT VAUD 5/ 0 3/ 2 0 1 6
UNTIL:
Property Owner: Larry Wayne Sykes
Address: 305 Pudding Ridge Rd
City: Mocksville
StatefLip: NC 27028
Phone #: (336) 998-7197
Property Location & Site Information
Subdivision: Phase: Lot
Township:
Directions
1-40 West, Exit Farmington Rd. Exit #174 turn left go 2 miles, tum left
on Puffing Ridge Rd. House 1/2 mile on left. 305 on mail box.
Type of Business:
Total sq. Footage: No. Of Employees:
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? Oyes ONo
Applicant/Legal Reps. Signature: *Date:
*Issued By: 2244 - Daywalt, Andrew *Date of Issue:_ 0 5 0 3 / a 0 1 3
Authorized State Agent: k "k-)
**Site Plan/Drawing attached.** Total �r+UM
0 1 flours 0 tours
a Hand Drawing OlmportDrawing :`'
Davie County Health Department a,
9 N8 f tp Environmental Health Section
• EFP NfF P.O. Box 84.8nlltblil
ai 210 Hospital Strcct'
p'C
APR 2 Q Courier # : 09-40-06u
Mocksvillc, NC 27028 `I i'`VP
' I N12
BY: y ��,�
Plione: (336) - 753 - 6780 Y= Fax: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: 1 1, // e e Phone Number S 3G- Home)
Mailing Address: (Work)
Detailed Directions To Site:�f� , r
urn �e� l 6-o •Z "'Ief, &C,-#% ((' t OA- a c�r /� r e X
u e Yz 'W'e- ® 0 oK Q�' A0
Property Address: Q / e
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: -HU1' Type Of Facility:
Date System Installed (Month/Date/Year): 00 0 Number Of Bedrooms:--3_Number Of People: o<
Is The Facility Currently Vacant? Yes <9 If Yes, For How Long?
Any Known Problems; Yes If Yes, Explain:
Please Fill In The Following Infof mation About The NEW Facility:
4
Type Of Facility: K ��/e Number Of Bedrooms: Number of People
Pool Size: oGarage Size: Other:
Requested By: Date Requested: t /3
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Check Money Order # Amount:$_
Paid By: l Va cc/—ate SC/ l j Received By:_
Account #: Invoice #:
Date: A/ - �)- -3 — / 3
J-7
Aort-el;o D 4 BO d �l S v 1'113
I Z 13/Z
Davie County, NC - GoMaps Advanced
AW Q 1411i�UI®I JU
Select Map: Parcels
Active Layer: Parcels
Parcels Map Tips
Map Layers SeaRh Tools l Map Tools
Quick Report Results Legend
Davie County Home Bookmarks
http://maps2.roktech.net/davie_gomaps/index.html
Page 1 of 1
Report Search Tools
Property Card Find Adjoiners
up wue;
a uco-uuuw
Legal Description:
2.74 AC PUDDING RIDGE •
Acreage:
2.70
Plat Book:
Plat Page:
Building Value:
109690.00
Outbuilding and Extra
1540.00
Features Value:
Land Value:
47690.00
Total Market Value:
158920.00 -
Total Assessed Value:
158920.00
Deed Book and Page:
001670626
Deed Date:
3/1993
Latitude: 350 59' 23.82" Longitude: -800 32' 38.37'
4/23/2013
Davie County, NC - GoMaps Advanced Page 1 of 1
http://maps2.roktech.net/davie_gomaps/index.hftffl 4/23/2013
AU;HORIZATION NO: 1399 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's ', P.O. Box 848
Name:%�'�'' t7� Mocksville, NC 27028 Subdivision Name:
-" ..- Phone #: 704-634-8760
Directions to property: i� '�(,.' Section: Lot:
i) AUTHORIZATION FOR
WASTEWATER
Tax DOfftce PIN:#
SYSTEM CONSTRUCTION 55 1 L
Road Name: d p: 7o'A'w
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
►<l y / f` i ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
C{� Y /� '.;+ J j •f : �;'` ',„�%` IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
0
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS
--Per iatee's
Name:_.
Directions to property: I a
IMPROVEMENT
! t PERMITo
PROPERTY INFORMATION
Subdivision Name:
Section: Lot:
Tax Office PIN:# 11 - -
Road N e: Lf ddi n a-
**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
' • /' , �" r °` 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 S's' # BEDROOMS -.S # BATHS —sem'` # OCCUPANTS 3 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
��J % —=r"` l
LOT SIZE TYPE WATER SUPPLY y—�/ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
i
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH /' ROCK DEPTH - LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT ^ d v/9
ea
F
"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 (704) 634-8760.
OPERATION PERMIT
SYS INSTALLE Y:
q�
pld
AUTHORIZATION NO. /� OPERATION PERMIT BY:� DATE:
"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)
AL
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER
ADDRESS SUBDIVISION NAME
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER 'Q
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED
SUBDIVISION LOT #,
NFORMATION TAKEN BY