4155 Hwy 158 �ih ► i ---' e w ayK tr v y: ...y -`,
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AUTH6RIZATION.N6: U DAVIE COUNTY HEALTH DEPARTMENT "O 3
Environmental Health Section PROPERTY INFORMATION
.Permittee�:'` f --- P.O.Box'848
Name"`✓/�.i" ldW� �` �P/� „., Mocksville;NC 27028 Subdivision Name:
;Phone# 336-751-8760 . "
Directions to property: JS'� JeJ� iV .>� Section: Lot:
1V AUTHORIZATION FOR
�P� WASTEWATER Tax Office PIN:# -
SYSTEM CONSTRUCTION; _
Road Name Zip:
**NOTE**This Authorization for-Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Secdor prior
to issuance of any Building-Permits.This Form/Authorization Number should be presented to the Davie County BuildingInspections
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S.Chapter 130A.Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) "
. J
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION,,
D / — IS VALID FOR A PERIOD OF,FIVE YEARS.
ENVIRONMENTAL H ALTH SPECIALIST, DATE ISSUED ,
Ut
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
a .e:- +/?)i�l 1/'.3i�' �lr/� "" Subdivision Name:
Directions to property: , / "S` lr�.� +Y Section: Lot:
. .'' IMPROVEMENT
PERMIT Tax Office PIN:# -
Road Name: Zip:
**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
r,I7 PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTALLFWALTH SPECIALIST DATE ISSUE67 SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE'
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No '
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLFISHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE ' TYPE WATER SUPPLY O DESIGN WASTEWATER FLOW(GPD) NEW SITE 'REPAIR SITEy
t / q Y •
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK L GAL. TRENCH WIDTH� ROCK DEPTH LINEAR F�+�(��
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT *APPROVED EF DENT FILTERS *RISER(S)' IF 6" BELOW FINISH€D GRADE*
**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(71 -y8M .
(336)751-8760
OPERATION PERMITel lef
SYSTEM INSTALLED BY:
AUTHORIZATION NO. PERATION PERMIT BY: 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
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) O
NAME T� (,2r�3Uo •gee_ �P/ PHONE NUMBER M
ADDRESS � SUBDIVISION NAME M
M
LOT#
7
DIRECTIONS TO SITE /:C g` Z
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
0
TYPE FACILITY I' NUMBER BEDROOMS k2ANUMBER PEOPLE SERVED -
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED jv� INFORMATION TAKEN BY
_zzzz
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.1193
J.D DAVIE COUNTY HEALTH DEPARTMENT T '
(Septic Tank) ImprovementsPermit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Arvicle 13C)
OWNER OR CONTRACTOR may,, r Fn �'LiC:`CVL a�• t J>-, �
T DATE = 6' 7'�11 PERMIT
19CATION 6y NO 431
S.R. NO.
Sx;BDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES [3e NO ❑ Three Bedroom Hous900 Gal: 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal.. 1200 Sq. Ft.
AUTO. WASH. MACHINE - YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ t`
SIZE OF TANK r i -r=- gal. : �.. x r z �•i+• ,- e, t • '
NITRIFICATION FIELD sq. ft.
. DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT'-BY C�,6e- 4,r\ b INSTALLED BY ��/S Sr/� �•
CERTIFICATE OF COMPLETION By . O Date
(8/16/73) *Construction must &mply with all other applicable State and local regulations
LOT AREA
, /_fie,. S-r8�;
Parcel#: E600000090 Page 1 of 1
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Parcel#: E600000090 Account#:67271940
Owner Information Tax Codes
MITH GROVE VOLUNTEER FIRE ADVLTAX-COUNTY T
155 US HIGHWAY 158 FIREADVLTAX-FIRE TAX
DVANCE NC 27006
Property Information Township
Land(Units/Type): 0.620 AC FARMINGTON
[Address: 4155 US HWY 158
Deed Information Local Zoning
Pate: 01/1900 Book: 00095 Page: 0604
Plat Book: Page:
Le al Description PIN
1 LOT HWY 158 5861163674
Property Values
Buiidin 502,81
BXF• 3,13
Land: 18,79
Market: 524 73
ssessed: 524.,7301
Deferred: al
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00095 0604 01 1900 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnetiView.aspx?prid=1461124 6/16/2016