131 Gloucester LnDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND . CERTIFICATE ' OF COMPLETI N
*NOTE: _Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name • r�f��;i ' �/, cj �%`'� tJ �, ; %, Date%' . �� N2
Location.!'.%C _. �; s i' J ;c r';-=:✓" /=�=: • "t. _.. .�1,
�13%�r,, � .. J � ; , fi' ,r � ..✓ - r- I� ,� ,!J�,��a. SCJ 1 ,ir'--^
Ile
Subdivision Name Lot No: Sec. or Block No.
Lot Size 4 House Mobile Home� �
.�:� Business Speculation
No. Bedrooms No. Baths —_ No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma.hine 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
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.
r. DAVIE COUNTY, HFA-L'T IMPARTMENT
Environmental, ealth Section
Soil/Sites, }►aXuation
NAME _ _ 2za2 DATE EVALUATED
ADDRESS
PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE 901
s'
`Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2
3 4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH r r
Texture group
Consistence
<
Structure
Mineralogy
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:
LONG-TERM ACCEPTANCE RATE: J
REMARKS:
DCHD (01-901
.EVALUATED BY:
OTHER(S) PRESENT:
LEGEND.
Landscape 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
CONSISTENCE
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
Mineralogy
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
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
A' Environmental Health Section )�P. O. Box 665
�Mocksville, NC 27028
1. Application/Permit Requested By iC/TQ
Mailing Address 9 % 0o Y /r -.7 I'll c rr!' , �:2 7 o asc
Home Phone99 Z-60 q-3 Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation peptic Tank Installation
4. System to Serve: ❑ House mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
❑ Basement/Plumbing
No. of People Q
No. of Bedrooms a
No. of Bathrooms /
Dwelling Dimensions �a 8 Q-
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: 92"Public ❑ Private
8. Property Dimensions 1,17 O -r Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Basement/No Plumbing
93/Washing Machine
❑ Dishwasher
❑ Garbage Disposal
Erl*Y,es ❑ No
❑ Community
*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.
Directions to Property:
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
L r 9�
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. I OWN the property. & I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie pu ty Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to deirermine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (12-90)
Davie County, NC - Basic Estate Search
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Parcel #: L600000021 Account #:45678430
Owner Information
Building:
I Tax Codes
OBXF:
LINK BRADY WAYNE & LINK ANGELA ANN
Land:
C ADVLTAX - COUNTY TA
Market:
131 GLOUCESTER LANE
Assessed:
FIREADVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 5.560
JERUSALEM
[Address: 131 GLOUCESTER LN
Deed Information
Local Zoning
Date: 01/1900 Book: Page:
Plat Book: Page:
Legal Description
PIPJ _
5.561 AC OFF HWY 801
5756442541
Property Values
Building:
50,850
OBXF:
7,410
Land:
31,27
Market:
89,530
Assessed:
89,530
Deferred:
0
Sales Information
No Sales Data found.
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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,
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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