4222 Hwy 601Nt j% S 4 �: ,. - 4<. , ,r"r:..Nl •' 4'„ f a ... i C . r n .. . 5` . .. r . i ..
DAVIE' COUNTY HEALTH DEPARTMENT J ate: l
F :F IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION /i; 3 ; oO
*NOTE:'Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
' Name l •, ' `` � �rn Date J 3 I NO 6549:
' S C�
_ -
Location \� • 1, '; c4 T< C) c VIC; +,) ,��
Subdivision Name Lot No. Sec. or Block No.
Lot Size Y ' �`�- =� House �� Mobile Home _ Business Speculation
No. Bedrooms y .No. Baths No in Family _.—
Garbage Disposal YES ❑ NO ❑r'" Specifications for System::'
Auto Dish Washer YES .NO ❑
'Auto Wash Ma ,hin`e YES [p-' NO ❑
H j' i
Type Water Supply_ --
t.
*.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 by
-*Contact a representative of the Davie County Health Department for final inspection of this system between 8:307
9:30 A.M. or 1:001:30 P.M. on day of completion. Telephone NumbPr 704-634-5985.
E
Final Installation diig m: System Installed by o
ao.
k'„�N lea r
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h:
Certificate of Completion � • �2��-�--X. Date
( - 2-4 93
'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.
Q0( APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665 n-
Home
Mocksville, NC 27028 R ®ci -1. Application/Permit Requested ByMailing Address L� Nox 12-7v C �'� Phone C aR H - 7 g -% Business Phone co 361".91WO
2. Name on Permit if Different than Above_:36-yn -Q-
3. Application/Permit for: ❑ General Evaluation 0 Septic Tank Installation
4. System to Serve: J House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
No. of Bathrooms of
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes
No. of Lavatories
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures _
7. Type of water supply: ❑ Public (�f Private
8. Property Dimensions L nlY)Dw r\ � Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
Section Lot #
X Basementmumbing
❑ Basement/No Plumbing
f$j Washing Machine
Dishwasher
❑ Garbage Disposal
❑ Yes K No
❑ 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: /_ J � .�Z j 1� /f r � �� C y j1 v A
y� J�
r
\ �/L t �►� O, A -A it7 C t.c9 r !` a
-�A
O—L4—+
�� r✓ Kn r e
1�-� N 1 e- G1 r / !f`
This is to certify that the information provided is correct
incurred from this application.
DATE
of my knowledge, and I understand I am responsible for all charges
SIGNA
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property.An
2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a perauthorized by the owner:
I hereby give consent to the authorized represent ti ef t e vie Count Health Department to enter upon above described
property located in Davie County and owned by,
to conduct all testing procedures as necessaryto determine ad site's suita i ity for a ground absorption sewage treatment
and disposal system./
vim/ r 6
DATE
DCHD (12-90)
�r DAYIE COUNTY HEALTH DEPARTMENT
�...., _: Environmental Health Section
Soil/Site Evaluation
NAME ��n �rlsys(� DATE EVALUATED ' 3' 91
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY \X1 o v s LOCATION OF SITE In O 1 N o�aCi\
Water Supply: On -Site Well Community Public
Evaluation By:Auger Boring ►/ Pit Cut
FACTORS
1
2
3
4
Landscape position
S
—5
Sloe %
S - °
S -- o
o
v
HORIZON I DEPTH
%-I+
T 11
Texture group
2
C J
e -i,
'Q L
Consistence
VT
FT
F_
Structure
C
G
Mineralogy
/:!
HORIZON II DEPTH
b
q0
110
Texture group
Consistence
'"
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
.S
S
3 S
RESTRICTIVE HORIZON
_.
SAPROLITE—
CLASSIFICATION
S
S
S
LONG-TERM ACCEPTANCE RATE
C'.. .14b
1 ,
, S - o
-
SITE CLASSIFICATION: ]?-S EVALUATED BY:
LANG -TERM ACCEPTANCE RATE: -3j�'' U OTHER(S) PRESENT:
REMARKS: V11_'F1_
LEGEND
Landscave 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 -Firm 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
Mineralogy
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 water' 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
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Parcel #: D30000003201
Davie County, NC - Basic Estate Search
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Parcel #: D30000003201
Account #:10555250
Owner Information
Buildin
Tax Codes
BXF•
WN CHARLES S& BROWN NANNETTE
[2Z2
Land:
ADVLTAX - COUNTY T
arket:
US HWY 601 N
essed:
READVLTAX - FIRE TAXCKSVILLE
Deferred:
NC 27028
Property Information
Township
nd (Units/Type): 8.730
CLARKSVILLE
ddress: 4222 N US HWY 601
Deed Information
Local Zoning
Pate: 03/1992 Book: 00162 Page: 0847
Plat Book: Page:
Le al Description
PIN
HWY 601
10555250
Propertv Values
Buildin
128,58
BXF•
37
Land:
79,55
arket:
208,50
essed:
208,50
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00162 0847 03 1992 WD Unqualified Vacant 0
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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/itsnet/View.aspx?prid=1460023 8/9/2016