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490 Brier Creek Road Lot 81 41 �''`� • DAVIE 'COUNTY .HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '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 / r /l�ir/ /-i�� ,`7�fllrr� Date �` f?„C:,' 4 1 23.. JI Location ' .r�, �cir 'f . f°j? � Subdivision Name I Lot No. Sec: or Block No. Lot, Size- House Mobile;,Home _ Business Speculation No. Bedrooms 'No. Baths` No. in Family _ Garbage'Disposal.. YES NO p/ 'Auto Dish Washer. YES -NO Q Specification for System: ; 1r Auto.Wash Machine YES j NO Type Water,Supply f✓ ., :.w " ' "This permit Void-'if sewage system described below is not installed within 36 months from date of issue. tmprove.rients.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 71:0011:30 P.M. on day, of completion. Telephone Number: 704-634-5985. Final Installation`Diagram ;' System Installed by e Le /Gad # 2 — ltueL" . .; z. _ 'f. •, Vit. i _ Certificate ofCompletion �" Date a' ' 'The.signing ,. � • g g of this certrficate shall indicate that the-system described above has been installeds.in compliance with. the standards set forth i,n the above.regulation,,but'shall in'NO way tie taken as a guarantee that the system,will fuhction 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 9 / ?- -233 Z 1. Permit Requested By &T".1K 6,e - A }Business Phone 9220 :7.3 2. Address 3. Property Owner if Different than Above S/9 r. Address 11 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub -Division gzjp4�_ Sec. Lot No. 5. System used to serve what type facility: House Mobile Homes 3 Industry Other b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. �� House Dimensions ,uccX .34`�, Bed Rooms— 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 lavatory dishwasher urinal showers sinks Q 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? YeS�NO 9. a) Property Dimensions b) Land area designated to building site _ garbage disposal washing machine c) Sewage Disposal Contractor 49-OLr r Tc f stn � t, a / .NnsNrno, 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? n c7 What type? This is to certify that the information is correct to the best of my knowledge. 42g-1 Date wner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) Name— Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date �/�/� Lot Size A6 FAr.Tr1RR ARFA 1 AREA 9 ARFA 3 APPA A Topography/ Landscape Position e 9) S S I A Name— Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date �/�/� Lot Size A6 FAr.Tr1RR ARFA 1 AREA 9 ARFA 3 APPA A Topography/ Landscape Position e 9) S S S VS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U I) Soil Structure (12-36 in.) S S S Clayey Soils LOPSl PS PS PS U U U Soil Depth (inches) S S S S PS PS PS (f U U U Soil Drainage: Internal S S S pS PS PS PS U U U External S S S �Ps PS PS PS U U U U �) Restrictive Horizons Available SpaceS S S S g PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U Site Classification U—UNSUITABLE Recommendations/ Comments: Described by SITE DIAGRAM DCHD (6-82) S—SUITABLE PS—Provisionally Suitable Title Date Davie County, NC Tax Parcel Report Tuesday, January 3, 2017 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: H7020A0028 Township: 5769957798 Municipality: 77094000 Census Tract: WATSON GERALD Voting Precinct: 490 BRIAR CREEK ROAD Planning Jurisdiction: ADVANCE Zoning Class: NC Zoning Overlay: 27006-0000 Voluntary Ag. District: LOT 81 GREEN BRIER ACRES Fire Response District: 0.72 Elementary School Zone: Land Value: Total Assessed Value: / Middle School Zone: Soil Types: 0005 Flood Zone: 099 Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: Shady Grove 37059-804 WEST SHADY GROVE Davie County DAVIE COUNTY R -A No ADVANCE SHADY GROVE,CORNATZER WILLIAM ELLIS Gn132 DAME COUNTY 9 hIF All data Is provided as Is without warranty or guarantee of any Idnd either expressed or implied Including but not limited to the p Davie County, € Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the J _ - County of Davie, North Carolina, its agents, consultants, contractors or employees from any and aft claims or causes of action due to i n0 DNS J!! NC or arlsing out of the use or Inability to use the GIS data provided by this website. f` fir, �-l� r, �� i .. �i - , • li DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND, CERTIFICATE OF COMPLETION .. F , *Note: Issued in ComplianceII wife G.S. of North Carolina ;Chapter 130—Article 13c. Permit Number ?'Name �,�lY�� f►.��5�. i) Date 2657 i{ n Location' Subdivision Name Lot Size No. Bedrooms Garbage Disposal 1r Auto Dish Washer Y Auto Wash:Machine Y Type Water Supply `This permit Void if sewal Lot No. Sec. "or Block No House Mobile Home Business Speculation Baths c No. in Family ;E]NO f Specifications-, for SystemNO :, ©� N u J�3,'/ ystem described below is n t installed within 36 months from date of issue. ii Il iy - V �I ;i ii I 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: o System Installed by 2i FA z LL Z 1�AU- 1 I� � { 01 Certificate of Completion Date I. 'The signingofthis 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';givien period of time. . DAVIE COUPITY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH•SECTION P. 0. BOX 57 MOCXSVILLE, N.C. 27028 (704) 634-5985 Statement for Septic Tank Improvements Permits and/or Site Evaluations /���,, /// // _�.e NAME 6 �a 1�i1!i� %%%� DATE � �/ 4 ADDRESS �f � !�/ %�% ,� PER11IT 140. EXPLANATION OF CHARGE I A14OUAT DUE SIU4ITARIAN �1 f PLEASE REMIT THE ABOVE MOUNT ON RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s) can not be completed until payment is receivea., Improvements Permits) can not be issued until payment is received.