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4054 Hwy 158 y'.,;y Permitfee's. .SDANE COUNTY HEALTH DEPARTMENT ' Name: AAA-- 4(A Environmental Health Section, PROPERTY INFORMATION P.O.Box 848 ` Directions toroe P rtY� �� (.;, Mocksville,NC 27028 Subdivision Name: P ci7 Phone#:336-751-8760 -1'�l�z.�1 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION 22NO: 34 A Road Nam . do ?•%ct, **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance`of"an`y'$uildi P is Form/Authorization Number should be presented to the Davie County Building Inspections Office wheoapp Ibg or Building Pe =its. ,(In compliance,,w h Article S.Chapter 130' ,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) 1 r � ***NOTICE***.THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION -` IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMEE TA .HE LTH SPECIALIST DATE I U RESIDENTIAL SPECIFICATION:BUILDING TYPEIADQ!�_#BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE —W TYPE WATER SUPPLY( ULV � ��'"� / DESIGN WASTEWATER FLOW(GPD)i!l.L�`--' NEW SITE REPAIR SITE !/ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ` ,ROCK DEPTH LINEAR FT. C)0 r OTHER.. REQUIRED SITE MODIFICATIONS/CONDITIONS: /?� �I/gip�I� �/4-✓ �� I� S t'Y%I J r 1 / IMPROVEMENT PERMIT LAYOUT 0�1 1-1 �T Al� �� **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 SYSTEM INSTALLED BY: "LL F¢ r hlt,ta LIn1V s r 400 �2 714A4 C-kisrato ZZ3�}4 �j AUTHORIZATIO N NO. OPERATION PERMIT BY: DATE: )ID3 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY ESCRIBED ABOV H EEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT A D DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ncan 02102(Revised IDAVIE COUNTY HEALTH DEPARTMENT i IMPROVEMENTS PERMIT..ANDr( CERTIFIC+ ,A1V6�r•'ATE}ygqOF ,COMPLETION S - *Note: Issued in Compliance with G.S. of North Carolina-Chapter 130==Article 13c. 'Permit Num _ ber Name Date `` , � ,` , ° 2982 Location - .. T:G4. Subdivision Name Lot No. Sec. or Bloc No _,.. .. _,.. . Block Lot Size 1 ^° ..r House Mobile Home _ Business Speculation No. Bedrooms No. Baths ' No.'-in Family ..�. �. ....::. ... ...: . . ,.w_�. . ,.... .__ Garbage Disposal, YES C❑ NO ❑ 0"71 r- ...w. ...._ Specifications forR System: Auto Dish Washer YES ❑ NO ❑ 2- ,.� 'X,,�� 'Auto Wash Machine YES ❑ NO ❑ I Type Water:Supply ( ! *This permit Void,if sewage system described below is not installed within 36 months from date of issue. l t x- f Improvements permit by _i *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. � 1 t 30C S. FFI,) FeA,,,C (:q t�� F111fd� Final Installation Diagram: System Installed by i ! � l j Certificate of Completion • Date he 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 tHif the system will function satisfactorily for any given period of time. ' �I DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) G NAME 0.r b aR A P.CN SR PHONE NUMBER �O .� 4 ADDRESS b S S; ��1/S'X� SUBDIVISION NAME ' LOT # DIRECTIONS TO SITE 1 -t� �. 1// _1 r/ Cl-/e-C/f, Q -4 wr'Y-, oS DATE SYSTEM INSTALLED �d S NAME SYSTEM INSTALLED UNDER R'Lrlo,.,.a �./•-moo TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED 3 TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY) 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 7 o a- - N d ef-7—�- DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name - Date Location ` 1 `- Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ r,, Specifications for System: i Auto Dish Washer YES ❑ NO ❑ :• ; ;;_ Auto Wash Machine YES ❑ NO ❑ r� Type Water Supply _— *This permit Void if sewage system described below is not installed within 36 months from date of issue. 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. i Final Installation Diagram: System Installed by �oC s- cr,5i--k7tl,C cqz„ -,r,11, t- a` I r v 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. DAVIE COMM HEALTH DEPARTIENT EITVIROPTi-iEBTAL HEALTH SECTION SOIL/SITE EVALUATION VAME �2uGK� EG � �! ��/J ��"'S� DATE ADDRESS P.034 LOCATION /SP— �o',G•vE.� of LOT SIZE TOPOGRAPHY: S SOIL TEZTURE:/s s . SOIL STRUCTURE:,,of DEPTH: f RESTRICTIVE HORIZOFS:v�`.."•-- PERCOLATION PATE: Presoak Hark & time Dro Time Pate iin. Inch z. 3. **CLASSIFICATIOI!: Suitable rovisionally Suitable nsuitable COin.,R;YITS: SANITARIAFI 416' SITE DIAGEAM Parcel#: E60000007501 Page 1 of 1 qA�f� Davie County, NC - Basic Estate Search 0OUti�a Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#: E60000007501 Account#:24598000 Owner Information Tax Codes EVANS BARBARA ANN ADVLTAX-COUNTY TA 054 US HIGHWAY 158 �FIREADVLTAX-FIRE TAX MOCKSVILLE NC 27028 Property InformationTownshi nd(Units/Type): 0.650 AC FARMINGTON ddress:4054 US HWY 158 Deed Information Local tonin ate: 01/1982 Book: 00115 Page: 0534 lat Book: Page: 9 Legal Description PIN 1.74 AC HWY 158 5861053741 Property Values uildin : 65,8 BXF• 88 nd• 1838 0011 arket: 8514 ssessed• 8514 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00115 0534 01 1982 WD Unqualified Improved 0 View Property Record for this Parcel View Mao 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/itsnet/View.aspx?prid=1465019 6/15/2016