3228 Hwy 601NPermittee's'f' A I�COUNTY HEALTH DEPARTMENTName._11 '-- di 1 1 11h, -t-Y 51'$/' Environmental Health Section PROPERTY INFORMATION
f fi60' P.O. Box 848
Directions toproperty: 0 'G, i t (1�� Jt Mocksville NC 27028 Subdivision Name:
;�., ! w (. 1 t t :1 . �< j' Phone #: 336-751-8760
Section:_
,+
q AUTHORIZATION FOR
WASTEWATER
Lot:
Tax Office PIN:#
- _
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 003006A Road Name.
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
"1 r***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
I �} IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DAT ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _- # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE fr TYPE WATER SUPPLY �t DESIGN WASTEWATER FLOW (GPD) A�2 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZEXIhAL. PUMP TANK GAL. TRENCH WIDTH —62 ROCK DEPTH -"—� LINEAR FT. 160
OTHER_ ��1y /� F' ✓•CI'l S(a &-
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT 11 __
:SYSTEM INSTALLED BY:A�6►�I�,Lbj;1-0)
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AUTHORIZATION NO. 00.310 ` OPERATION PERMIT BY: DATE: `Z d •ZG� d
"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 02102 (Revised) 14 31731 -9 71-75-
FOR
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Permittees M I COUNTY HEALTH DEPARTMENT
Q�Environmental Health Section PROPERTY INFORMATION
"'. P.O. Box 848 fy.
Directions'to pfopertytMocksville, NC 27028 Subdivision Name:
I (� Phone #: 336-751-8760
Section: Lot:
r ; AUTHORIZATION FOR
�> �• _ - WASTEWATER' -
--j 3 SYSTEM CONSTRUCTION Tae PIN:# -
AUTHORIZATION NO: + t� Road Name: J f /,'i.-- zip:—..,
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying far -Building Permits=
• (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
( ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
(_ti{•a { �� iYl' ;` t <r / %� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE 1SSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE ! # BEDROOMS 7. # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT` # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE GC TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ��/ NEW SITE REPAIR SITE----,--
SYSTEM
ITE.maySYSTEM SPECIFICATIONS: TANK SIZE ( K hAL. PUMP TANK _,X GAL. TRENCH WIDTH �'� ROCK DEPTH LINEAR FT. ICU
OTHER 1G' I2clud ict-� ={� s z nL f
REQUIRED SITE MODIFICATIONS/CONDITIONS:
OPERATION PERMIT
h0
SYSTEM INSTALLED BY: a 6Mj),_ Du t 10
6
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AUTHORIZATION NO. 0 0-3 �' OPERATION PERMIT BY: DATE: I' Z ZU/ D
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED.�.BOVE 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 07102 (Revised) .7i % r ` 7/ 75'
r -
NAME
Nllm. "Ra
Z -WL
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
ADDRESS US d I/ L & O I A SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
ri•
DATE SYSTEM INSTALLED 1q00 NAME SYSTEM I STALLED UNDER QUS-4-' �2
TYPE FACILITY �� NUMBER BEDROOMS 2 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING bJqel&•-Up•
0�u ii"rmil j5SUO ZlYD t 3006
DATE REQUESTED"��'� INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and t I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
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Pe 'rnt, DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property: Mocksville. NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION <97-4'
Z4' US H i�C0IV—
AUTHORIZATION -
NO: 002636 A RoadName: V V W ZI
P: z� I
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
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)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
j° 7,' r tf� t l ' IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
i
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPDy"' C? NEW SITE REPAIR SITE S �✓
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL..,TRENCH WIDTH L° ROCK DEPTH 00 LINEAR FT/ -:S'- 2
OTHER
f'
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
11
S
8
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON E DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLE Y:
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Er �
AUTHORIZATION NO. $4&PERATION PERMIT BY: DATE: s
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T E Ili DES IBED AB HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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.
Parcel #: E300000102
Davie County, NC - Basic Estate Search
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Parcel #: E300000102 Account #:82524017
Owner Information
Buildin :
Tax Codes
BXF:
[FOSTER RANDALL MATTHEW
Land:
ADVLTAX - COUNTY T240
Market:
US HIGHWAY 601 NORTH
ssessed:
FIREADVLTAX - FIRE TAXOCKSVILLE
eferred•
NC 27028
P operty Information
Township
Land (Units/Type): 0.960 AC
CLARKSVILLE
ddress: 3228 N US HWY 601
Deed Information
Local tonin
Date: 12/2014 Book: 00974 Page: 0739
Plat Book: Page:
Legal Description
PIN
1.000 AC HWY 601
5821032146
Property Values
Buildin :
7178 0011
BXF:
1,79
Land:
19,49
Market:
93 06
ssessed:
93,06
eferred•
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00595 0197 02 2005 WD Unqualified Improved 20,000
00974 0739 12 2014 WD Unqualified Improved 75,000
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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/itsneWiew.aspx?prid=1175120 8/17/2016