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144 Whetstone Dr � /► -' �- DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary"Sewage Systems l .",-�y� :�' ' pL0 Permit Number Name -.,. jJ -. ,/ . Daae--�.-_S"��/-�?�1� N2 60 i i ' Location / ,, / '�'`c r!J r;✓ .r �r �'r!J j mfr f: ( f%/OJ f'; l Subdivision Name Lot No. Sec. or Block No. Lot SizeHouse Mobile Home — Business ✓f Speculation No. Bedrooms No. Baths No. in Family Z49— Garbage Disposal YES ❑ NO Specifications for System- Auto stem:Auto Dish Washer YES ❑ NO Auto Wash Machine YES ❑ NO 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. Improvements permit by *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 �G h pI?<y� 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. _ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. '�;� Home Phone 1. Permit Requested By `V gG rf7 1� (�. MCP A ►.?I��' Business Phone 2. Address j �C POT S T , m 0 CK'S v(GC{; 10C 3. Property Owner if Different than Above 14 "a go C_t) ov Address 1,4 0 WM (acib— 4. Permit To: a) Install Alter Repair b) Privy Conventional ✓ Other Type Ground Absorption c) Sub-Division Sec. Lot No.- 5. o.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 Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. A 1~ h'1 e N-r hl Estimate amount of waste daily (24 hours) - 7. Number and type of water-using fixtures: commodes Iurinals garbage disposal Sx v+ lavatory showers "' washing machine dishwasher sinks 8. 'a) Type water supply: Public 4 "r Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions b) Land area designated to building site c) Sewage Disposal Contractor tj� 10. Do you anticipate any additions or expansions of the facility thi sewage s stem is intended to serve? What type? l) '?V 'fes, . !� This is to certify that the information is correct o the best of my nowledge. 2 - � Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to propertO XII !" �de -1 0/ v DCHD(6-82) r ; , 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 L CATI O P OPERTy. DATE RECEIVED D r. (office use only) 1 yes 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of thq abov scribed 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. t 7 DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: — Owner only — Owners designated representative anyone requesting results fK Only i4ose listed below A> C40 DATE SIGNATURE DCHD(11/84) DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 / SOIL/SITE EVALUATION Name Date X Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S P PS PS U U U 2) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) & PS PS U U U 3) Soil Structure (12-36 in.) S S Clayey Soils p P PS PS U U U U 4) Soil Depth (inches) S S S S C 3P PS PS U U U 5) Soil Drainage: Internal S S S PS PS PS U U U External S S S S PS PS U U 6) Restrictive Horizons 7) Available Space (12fS S S PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS �U U U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by �� Title Date SITE DIAGRAM DCHD(6-82) Dame County Xealtl 7yae�'17CY rtment do and me Xealtli 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE:(704)634-5985 November 9, 1987 Delmar McDaniel 115 Depot St. Mocksville, NC 27028 Re: Site Evaluation Off 601 S./Near 801 Dear Mr. McDaniel: On November 5, 1987, this office evaluated a 5 1/2 acre tract of land on 601 south of Mocksville near the intersection of 601 S./801. A manufacturing facility is proposed for said site. The soil on the site is provisionally suitable for the proposed project. The system will be designed to a daily flow of 300 gallons per day. If you have any questions, feel free to call this office. Sincerely, . Robert B. Hall, Jr., R.S. Environmental Health RH/wd Enclosure Parcel#: L514OA0018 Page 1 of 1 Davie County, NC - Basic Estate Search 1-oU��, Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Man for this Parcel View Tax Bill Information Parcel#: L5140A0018 Account#:49293000 Owner Information Tax Codes CDANIEL DELMAR N ADVLTAX-COUNTY T 144 WHETSTONE DRIVE FIREADVLTAX-FIRE TAX MOCKSVILLE NC 27028 Property Information Township nd(Units/Type): 5.540 AC JERUSALEM ddress: L514OA0018 Deed Information Local tonin ate: 06/1995 Book: 00181 Page: 0433 Plat Book: 0003 Page: 015 Legal Description PIN OTS 33-45+50-73 SAM FOSTER 5746512903 Propertv Values uildin : 446,93 BXF: 11,33 Land• 101,55 CCCE Market: 559 81 ssessed: 559 81 Deferred: cl Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00181 0433 06 1995 WD Unqualified Improved 0 00141 0715 01 1988 WD Qualified Vacant 11,000 View Property Record for this,Parcel View Man for this Parcel View Tax Bill Information «Return to Basic Search 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/itsneWiew.aspx?prid=1469335 8/3/2016