4680 Hwy 601Ny.."-4 r r;,t {"' frv{N...3. t.,: +. t `.,.P '.P -'! s. ..`,.: F";:� f„ :r;;. iL [+,✓{•,::1":'rr .¢. r , ,C 4. .. ,,i. D-` :y.: '• 5. 'i"; i.y 'r''}i E ,, ' q
-•~ DAVIE COUNTY HEALTH DEPARTMENT �...�
- .IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issu,
a
Name
Locatl
in Compliance With Article I I of G.S. Chapter 130a V,
ry Sewage Syste sf. I I
/I �`Y�p�'
PermitrNuTber
N° bb ��.
t�
Subdivision Name Lot No. Sec. or Block No.
Lot Size— House Mobile Home —T Business __ Speculation
No. Bedrooms .No. Baths / No. in Family _
Garbage Disposal YES ❑ NO ❑ S cifications- for System: <i - Ly
Auto Dish Washer YES NO ❑CGU, car
Auto Wash Ma thine YES NO 1j
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 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
r()- tl6V "
F - 99
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�� J APPLICATION FOR SITE EVALUATIONIIMPROVEENTS PERMIT
Davie County Health Department
Environmental Health Section to
P. O. Box 665 SEP 2 3 IM (�
F� Mocksville, NC 27028
C(�I r DAVIE COUNTY HEALTH [;r T11
' .L Gc _..
1. Application/Permit Requested By
Mailing Address NED mss- P /yC_
Home Phone Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for:
V44. System to Serve: ❑ House
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions 141 X ?D
❑ General Evaluation
U3/'Mobile Home
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures _
7. Type of water supply: ❑ Public WPrivate
8. Property Dimensions --5- �L ae-"Y_'-4 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown
Section Lot #
❑ Yes
❑ Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ 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:
4,1��/�jG r����
�b
0
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
incurred from this application.
�— DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: [Y1. I OWN the property. ❑ 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 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
to conduct all testing procedures as necessary to deterfnine said site's suitgbility for a ground absorption sewage treatment
and disposal system.
.o o?X /49 L & 'e.- o� �' 1
DATE I SIGNATURE
DCHD (12-90)
- r DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY 4e ZZ
DATE EVALUATED ! � 5��
PROPERTY SIZE 110�4_..
LOCATION OF SITE
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring / Pit Cut
FACTORS I
1 2
3 4
Landscape position Z..L
.!
Sloe Z f2_
2
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group_
Consistence
r
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
77
LONG-TERM ACCEPTANCE RATE j
-"
SITE CLASSIFICATION:yff EVALUATED BY: ,,11,411 /
LONG-TERM ACCEPTANCE RATE: .0 IV OTHER(S) PRESENT:
REMARKS:
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
Moist
VFR-Very friable
Wet
NS -Non sticky
NP -Non plastic
FR -Friable FI -Finn VFI-Very firm EFI-Extremely firm
SS -Slightly sticky S -Sticky VS -Very Sticky
SP -Slightly elastic P -Plastic VP -Very elastic
Structure
SC -Single grain M -Massive CR -Crumb
SBK-Subangular blocky PL -Platy PR-PrL
Mineralogy
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land st
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water'
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable),
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD(01-901
■■
MESO■
■MME■
■■■M■
■■■M■
■MEM■
■
■
Parcel #: C300000043
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:0300000043
Account #:82527518
Owner Information
Building:
Tax Codes
BXF•
LLIS EUGENE
Land:
ADVLTAX - COUNTY T
Market:
680 US HIGHWAY 601 NORTH
Assessed:
READVLTAX -FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 1.660 AC
Vddress:
CLARKSVILLE
4680 N US HWY 601
Deed Information
Local tonin
Pate: 07/2006 Book: 2006E Page: 0286
Plat Book: Page:
Legal Description
PIN
1.66 AC HWY 601
5823127165
Property Values
Building:
131 22
BXF•
Land:
25,84(
Market:
157,06(
Assessed:
157,06(
Deferred:
Sales Information
No. Book Pape Month Year Instrument Qual/UnQual Improved Price
1 00064 0518 02 1962 WD Unqualified Improved 0
2 2006E 0286 07 2006 WL Unqualified Improved 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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0I-0rj1;-111:
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=1486246 9/21/2016