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3175 Hwy 601NDavie County Health Department Environmental Health Section . PAID Date: Aece ved ti : Phone: (336) - 753 - 6780 P.D. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement . Remodeling Reconnection MGM Fax: (336) - 751- 8786 Name: Phone Number IV -,32-6 (Home) Mailing Address: -3l%f-✓ // G' o (Work) I ' �ck6V! e— %Dag Email 14.,Wve r,3 010 &D Detailed Directions To Site: < Please Fill In The Following Information.About The XISTING Facility: �o� None System Installed Under: 1 i�/1 l CI Tyre Of Facility: Date System Installed (Month/Date/Year): 3 Number Of Bedrooms: L-3 Number Of People:. Is The Facility Currently Vacant? No If Yes, For How Long? Any.Known Problems? Yes ' 6 If Yes, Explain: Please Fill In The Following Information About The NE WFacility: Type OfFacility:'4/ Number Of Bedrooms: © Number of People Requested By: Date Requested: cV (Signature) For Environmental Health Office Use Only Disapproved Environmental Health 2- a *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Paid By:_ Account #: 7 Order # ln6— Amount:$ Received By:_ Date: DAVIE COUNTY HEALTH DEPARTMENT J, . e IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a - Sanitary Sewage Systems Permit Number Name Date: No Location \' ''• C ; i u t j. Subdivision Name 317` GAS' #yv V &01' `Lot No. Seca or Block No. - Lot Size House L"" Mobile Home_ Business Speculation No. Bedrooms .No. BathvZ�2- No. in Family F F3' 6-V ✓3 -01 /S1 Garbage Disposal YES 1 N0'❑ S ecification for Svstem: Auto Dish Washer YES NO ❑D d (�,--6 Auto Wash Mw hine YES t� NO ❑ , Type Water Supply _ 'This permit Vold 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-�59�85�. Final Installation Diagram: System Installed by Certificate of Completion .�-!�'= Data L_ '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 ����K����� ����k���� DEPARTMENT ' ' '-'~'- ' IMPROVEMENTS PERMIT-AND���U�OF���� � COMPLETION ' ' - .��. - ^;JOTE:'/omuedin Compliance With Article UofKS.B.CMapter13Oa Sanitary Sewage Systems Permit -Number qz Name Date NO RIG rl; Location ubdivision Name as &014ot No. Sec. or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms --=�----'No. ~~^''a~x�----No. ^'Family ' Garbage Disposal Auto Dish Washer 'Auto Wash K4anhine it 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 *Contact e representative of the Davie County Health Department for final inspection 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: - Installed by� `~- . .� Certificate ofCompletion 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 oftimo. \ APPLIC ION FOR SITE EVALUATION/IMPROVEMENTS PERMIT C1�l E1 ` j Vim- eoo Davie County Health Department—�- �� Environmental Health Section P. O. Box 665 b . Mocksville, NC 27028 �� SAN 2 2 1992 1. Application/Permit Requested By. A _ Mailing Address / Aa7e�� d v�,,�i C -� AIC- �L 2,2" i Home Phone 9Z 9 ^ 419 - % L Business Phone 2. Name on Permit if Different than Above __/ 3. Application/Permit for: ❑ General Evaluation ,b Septic Tank Installation 4. System to Serve: )House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry 1, 1 El Other ❑ Unknown 5. If house, mobile home: Subdivision 1� l4 � s L %/e. �Qil/�S % Section Lot # No. of People No. of Bedrooms 3 No. of Bathrooms 9- y 4 i i Dwelling Dimensions S 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: Public ❑ Private 8. Property Dimensions�-"2Sewage Disposal Contractor C'-Basement/Plumbing ❑ Basement/No Plumbing LrV6shing Machine Erl5shwasher E?1 arbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 21No If yes, what type? ❑ 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: /nl� o7- Caen at 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 in urred from th�is% application. / DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. e2. I DO NOT OWN the property.,/ If you checked Boz #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 County Health Department to enter upon above described property located in Davie County and owned by J D. Zy f f ,i . •% to conduct all testing procedures as necessary to deterrfiine said site's sluitablility for a ground absorption sewage treatment and disposal system. DATE SIGNAT E DCHD (12.90) DAVIE COUNTY -RE. L'1'�-' DEPARTMENT Environmental Heal#h Section 'Soil/Site, Evaluation ,� NAME C`?� t DATE EVALUATED - q ' 1 Z ADDRESS S A `m _ _ _ PROPERTY SIZE PROPOSED FACIILTY a %3 s LOCATION OF SITE C - Water Supply: On -Site Well Community Public Evaluation By: CEt Auger Boring 1/ Pit Cut FACTORS 2- 3 4 Landscape position Sloe M6- U-fs` O - GG -&_Q HORIZON I DEPTHTexture rou S Consistence FZ Structure G C iZ Mineralogy;J HORIZON II DEPTH LP Ll? 421, 4 a%' Texture groupC Consistence y Structure K A 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: - S EVALUATED BY: C S �, LONG-TERM ACCEPTANCE RATES y OTHER(S) P SENTP\ f! ' REMARKS: ��� `�9 �9.o•ti tir.�6 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 -Finn 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 Mineralmy 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 watef 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 DCHD(01-901 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■NEEM ■■■■■■■ ■■■■■■■ ■■ Parcel #: F30000005301 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bili Information Parcel #:F30000005301 Account #:1300000 Owner Information uiidin : Tax Codes BXF• LLGOOD ALLAN CRAIG& ALLGOOD PHYLLIS I Land: ADVLTAX - COUNTY TAX Market: 175 US HIGHWAY 601 NORTH ssessed: FIREADVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 2.020 CLARKSVILLE ddress: 3175 N US HWY 601 Deed Information Local Zoning Pate: 01/1900 Book: Page: Plat Book: Page: Le al Description PIN 2.02 AC HWY 601 5811928439 Property Values uiidin : 212,87 CCCC BXF• 15,68 Land: 27,60 Market: 256 15 ssessed: 256 15 Deferred: 91 Sales Information No Sales Data found. View Property Record for this Parcel Vow Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 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=1459709 8/24/2016