3943 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
_ 'l1 "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
Name –�7 4 / ✓� /� `�' .�' Date Z.
A Lo
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _L---""_ Business _— Speculation
No. Bedrooms_ No. Baths No. in Family _
Garbage Disposal YES .E] NO [ Specifications for System:
Auto Dish Washer YES NO p
.Auto Wash Machine YES [ NO
Type Water Supply 4
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
t—
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 ` ��'ff X' ",
r
r-2 I/
X-r
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.
r APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
o6
Davie County Health Department �C�_Nv
Environmental Health Section '�
R O. Box 665
Mocksville, N.C. 27028
4
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BET
E N.ISSUED.
Home Phone
1. Permit Requ ted By
?�-' Business Phone
2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people ;%
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms—S-- Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes
lavatory
urinals
showers
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply systemPeen approved? Yes V No
9. a) Property Dimensions / � acre—5
b) Land area designated to building site
garbage disposal
washing machine
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: ,
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
k Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size �' �� r
PAr`.TnRC ARFA 1 AREA 2 AREA 3 AREA 4
9) Site Classification
1) Topography/ Landscape Position S S S
PS PS PS PS
U U U
') Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) PS PS PS
U U U
1) Soil Structure (12-36 in.) S S S
Clayey Soils PS PS PS
U U U
1) Soil Depth (inches) i.•� - S S S
v( pg PS PS PS
U U U
�) Soil Drainage: Internal S S S S
PS PS PS PS
U U U U
External S S S S
PS PS PS PS
U U U U
1) Restrictive Horizons
Available SpaceS S S
S PS PS PS
U U U U
1) Other (Specify) S S S S
PS PS PS PS
Uc U U U
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS—Provisionally Suitable
Described by� Title
SITE DIAGRAM
DCHD (6-82)
Date
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS—Provisionally Suitable
Described by� Title
SITE DIAGRAM
DCHD (6-82)
Date
V
-46 - )d
Parcel #: D30000006005
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel#: D30000006005
Account #:69938500
Owner Information
Buildin
Tax Codes
BXF:
PILLMAN MICHAEL ARTHUR
nd:
ADVLTAX - COUNTY TA
Market:
943 US HIGHWAY 601 NORTH
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Property Information
Township
FLand (Units/Type): 1.470 AC
CLARKSVILLE
ress: 3943 N US HWY 601
Deed Information
Local Zoning
Date: 11/1986 Book: 00134 Page: 0104
Plat Book: Pa e:
Le al Description
PIN
1.52 AC HWY 601
5822027780
Pro a Values
Buildin
62,95
BXF:
15,01
nd:
21,00
Market:
98 96
ssessed:
98,96
Deferred:
Sales Information
No. Book Page Month Year Instrument Quai/UnQual Improved Price
1 00134 0104 11 1986 WD Unqualified Vacant 1
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
« Return to Basic Search
Page 1 of 1
0�o�e
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.daviecountyne.gov/itsnet/View.aspx?prid=1465158 8/23/2016