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, ,wuTHORizaTlorr,No � ( +� � �,�DAVIE COUNTY HEALTH DEPARTMENT
:':: �" " ' � Environmental Health Section PROPERTY �INFORMATION
'�'ermit?ee s �^ ✓��"�, � P.O.`Box 848 � : ,
: Name: ' �� �� �.,�. Mocksville, NC 27028 � Subdivision Name:
h�,w ''" ,.......�� "Phone # 336-751-8760
Directions to property: .��� �, � � Section: Lot:
rr__ � >
.
,,
AU'�'HORIZATION FOR
�, F� . ��;� i , ; � i . ; • ' WASTEWATER � Tax Office PIN:# - - _
�' `''� ,. �� ` � ! � SYSTF.M CONSTRUCTTON ' _ + �
�ry�� --�-�' ���-� .�y�-C-�..-r''�`f Road Namc;:;� r:.�t ip:�_ f� `
.,; � , y � , . .. - y ry ;
**NOTE** Tlvs Auth�rization %r Wastewater S stem Constn►ction MUST BE ISSUED b the Davie Coun Environmenta] Health Section prior '�
':to issuance of ariy Building-Pemvts' This Fotm/Authorization Number should be presented ro the Davie County Building Inspections'
� " Office when applying forBuilding Permits:'� ' `' • ' ' '
(In�compl�ance with Article 11. of G S.:Chapter',130A, Wastewafer Systems � Secfion .1900 Sewage Treatment and Disposal Systems)
�, ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
'���;� , �� .;?,` , IS,VALID FOR A PERIOD OF FIVE YEARS..`
' E 1R EN., • HEALTH SPECIALIST DATE ISSUED
w.'_"`""„" �" !� ''►�`: __ . . /1 � _ . _ .
't•:�..k� �. rq w, -.caw..- v wt �� 'bhr..,.-...pt.,S-vim-- �.,�-.F r' . • :ei�.::.v:_v. s• �- fis.•t .,�= "_ y. r" 'r. , 1 i ,,� "t, . ,.,.::� _
+ ,�. F a 1 r ♦•' i -. 1 a ; t•Y'� a',."- .� tS.l %i";tt Yy,• t .,` .v ( i v'yrsi �:
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
1 i
Subdivision Name:
Directions to property,e'r 0 Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# - -
�' Road Name --9 /" r ip:'A
t
**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.
(Incompliance with Article 11 of G.S. Chapter 13OA, 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
ENVIR NIvIENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICA;hON: BUILDING TYPE # BEDROOMS #BATHS _ # OCCUPANTS _� GARBAGE DISPOSAL: Yes or No
COMERCIAL SPE ATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
MCIFI C
�.
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
'
01
SYSTEM SPECIFICATIONS: TANK SIZ SAL. PUMP TANK GAL:, TRENCH WIDTH �
(� ROCK DEPTH � LINEAR FT/0a s
1. OTHER c , i
REQ± IRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
*APPROVED EFFLUENT FILTER*:*RISERtS) IF 6" BELOInI FINISHED .GRADE*
`4901
"Lin I
IX A -
**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 (70A)Q4tWMj2X X ,
C10751-8760
AUTHORIZATI' N NO�=C� OPERATION PERMIT BY: i :, 7 DATE: j
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICA ATI �STEMRIBED 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)
k"""i:`'w.�' �t,S�,sd+r'�„�f:�9ta''"ssi'��yt•.4 "q 1''��,...`^aai%�.tti'+z^".� f,,. �., ,.r.�,,��a e, :r r � '� t �cnr� �j.;�tay � �,,- <,'.r: 651t DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name."'� Subdivision Name:
Directions to property Section: Lot:
r ; IMPROVEMENT
PERMIT Tax Office PIN:# -
' Road Name L +° , , r Zip: 9
**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
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 # BATHS ` '' # OCCUPANTS s"�_ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
VA
LOT SIZE/f TYPE WATER SUPI;'� DESIGN WASTEWATER FLOW (GPD) i " NEW SITE REPAIR SITE
ddam'
SYSTEM SPECIFICATIONS: TANK SIZFjr_�.GAL. PUMP TANK GAL. TRENCH WIDTH.=- 2 ROCK DEPTH LINEAR FT/'/00
OTHER--rdC-'S.••f�. i//:: �i c'i-i �r.I.�� ' ` ^ //✓C 12' {...
REQUIRED SITE
IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BEL13W FINISHED GRADE*
q
**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 (7014)43399MIKX X
(336)751-8760
OPERATION PERMIT
�J
SYSTEM INSTALLED BY:
F,.
AUTHORIZATION NO���„- s1 �l OPERATION PERMIT BY: �/ _----:!'"�- DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICA4Ef THAT Ti E SYSTEM DESdRIBED 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 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,
NameDate
3803
�.-,a...
� r
Location /.• al l �,i . I i r ./�i .��,�' �� ,/ �% ��i' �j�%^' l ///� /'r/r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths _T No. in Family_
Garbage Disposal YES ❑ NO ❑ Specifications for System; , i
Auto Dish Washer YES r NO
`Auto Wash Machine YES. j] N0 ❑
Type Water Supply , j jr __ �G� ';✓=-
'This permit Void if sewage system described below is not installed within .36 months from date of issue.
i
t
1
r
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
c -
NZ
� L
if at �1<U^�Q° Date 7 -
*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.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
- APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME
ov &
PHONE NUMBER %$ ' 73&gADDRESS
745y
'
SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE %S�S G PAS
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER X 1^3C� H4
TYPE FACILITY �"�k NUMBER BEDROOMS NUMBER PEOPLE SERVED J
TYPE WATER SUPPLY C e 1 SPECIFY PROBLEM OCCURRING 4SOIR-F�AO `J�
DATE REQUESTED ?,�ci INFORMATION TAKE
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
Parcel #: G50000012401
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: G50000012401
Account #:52213000
Owner Information
Tax Codes
OXLEY PENNY WHITAKER& MOXLEY STEPHEN DANNY IR
ADVLTAX - COUNTY T
158 US HIGHWAY 158
FIREADVLTAX - FIRE TAX
MOCKSVILLE NC 27028
66 67
Property Information
Township
Land (Units/Type): 0.500 AC
MOCKSVILLE
ddress: 2158 US HWY 158
Deed Information
Local Zonin
ate: 02/1998 Book: 00200 Page: 0663
lat Book: age:
Le al Description
PIN
50 AC OFF HWY 158
5749391490
Property Values
uldin :
43,02
BXF:
14,42
Land:
9,23
Market:
66 67
ssessed•
66 67
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00200 0663 02 1998 WD Unqualified Vacant 0
2 00183 0220 10 1995 WD Qualified Improved 35,000
View Property Record for this Parcel View Map for this Parcel View Tax Bili 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,
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/itsnet/View.aspx?prid=754236 6/8/2016