943 Fork Bixby Rdf
navie cnimty Nr , Tax ParrM Rannrt 161 Warinaeriav Cantamhar 9R 9r11R
Parcel Number:
170000005101
Township:
Fulton
NCPIN Number:
5778185992
Municipality:
Account Number:
41136000
Census Tract:
37059-804
Listed Owner 1:
JONES JERRY D
Voting Precinct:
FULTON
Mailing Address 1:
943 FORK BIXBY ROAD
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
2.033 AC FORK BIXBY RD
Fire Response District:
FORK
Assessed Acreage:
1.98
Elementary School Zone:
CORNATZER
Deed Date:
4/1996
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
001860761
Soil Types:
WeC,WeB,PcB2
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
- ,WS -IV -P
Building Value:
57070.00
Outbuilding & Extra
1820.00
Freatures Value:
Land Value:
30150.00
Total Market Value:
89040.00
Total Assessed Value:
89040.00
141
Davie County, NC
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49
AUi)QRJZAT16N NO: 15 J 8 5 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's� P.O. Box 848
Name: 7�1/ q -•/!J Mocksville, NC 27028 Subdivision Name:
Phone # 336-751-8760
Directions to property: f icy %u .� .lei,%,/ Section: Lot:
AUTHORIZATION FOR
fl WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
Road Name: 0/'Ic ! �� , �B (�
Zip:
.ter System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
Form/Authorization Number should be presented to the Davie County Building Inspections
•eater Systems, Section .1900 Sewage Treatment and Disposal Systems)
^TTCF*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
iS VALID FOR A PERIOD OF FIVE YEARS.
' DAVIE OUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's •
-"Name:-'�r'rl,� �4C� Subdivision Name:
Directions to property: /`� f :y, t j ; Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# t
Road Name: 6 Zip: �0 D
**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
t ,'.; , ,r" -;�1� y�' ;✓ `� 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 /fl # BEDROOMS L # BATHS_# OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE y / TYPE WATER SUPPLY 4f DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZ rli'
GAL. PUMPTANK GAL. TRENCHWIDTHS�� ROCK DEPTH LINEAR �OIJ
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
II "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 (336)751-8760.
OPERATION PERMIT
ALLED BY:
D � /
AUTHORIZATION NO. JS OPERATION PERMIT BY: J 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)
'w. — w ♦ ...�P /fig c
DAVIE OUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS
Permittee's .,....-
PROPERTY INFORMATION
'Name: - -,I tj Subdivision Name:
Directions to property:
Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name: n'% 1
7 7!l Zip:, -,2,1e0(0
**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
constructionlinstallation 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 I " # BATHS --ZL # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE_ TYPE WATER SUPPLY / % DESIGN WASTEWATER FLOW (GPD) r' r' c NEW SITE REPAIR SITE
ill,ij
-
SYSTEM SPECIFICATIONS: TANK SIZF/L'G GAL. PUMP TANK GAL. TRENCH WIDTH c'" ROCK DEPTH,_ LINEAR IT.J`�C?I• ' .
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
y "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 (336)751-8760.
OPERATION PERMIT
ALLED BY:
AUTHORIZATION NO. OPERATION PERMIT BY: G( ' �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)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION '
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT ��r
NAME c�J C�i�� '�'�",-y PHONE NUMBER ��e—d� WV ��
ADDRESSlDiLY�U4N SUBDIVISION NAME
ea s
SUBDIVISION LOT #.
DIRECTIONS TO SITE
_r 0MO q)/
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED__' y 0 INFORMATION TAKEN BY
�� /0
DAVIE COUNTY HEALTji DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
L- (Ground Absor tion Sewage Dis osal S steCm_-.G.S. Chapto
OWNER OR ;,CQNTRACTOR 31' f. "c R DATE I_ PERMIT
., NT ry
LOCATION C,<,;
_ �.t:.. -{;:'�tl,y t�a.r,-�. °�,, 1:.� � . %7g ��� /JCD�/ 1�? 5 1 7
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME CM BUSINESS
NO. BEDROOMS - NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
?; AUTO. DISHWASHER- YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE &!TANK gal.
NITRIFICATIONJIELD sq. ft.
DEPTH OF STONE IN -LINES:
WATER SUPPLY: Individual ® Public ❑
's IMPROVEMENTS PERMIT BY*if.� i�^�Cs�...r�+
House Trailer 8,0.0- 40 Ft.
Two Bedroom House qlffD-Gal.
00 Gal. 600 S Ft.
Three Bedroom House Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft. Af
INSTALLED BY
CERTIFICATE OF COMPLETION =f I -
By Date
(8/16/73) *Construction must comply with all othA app icable State and local regulations
LOT AREA 15'0 [�-C re s
3ftm-
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